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Endocrine Flashcards

1
Q

Dermatitis associated with glucagonomas?

A

Necrolytic migratory erythema

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2
Q

Where do we find glucagonomas >

A

Distal pancreas

Are malignant—> resect

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3
Q

Tx for tertiary hyperparathyroidism?

A

Removal of 3 1/2 glands

Often 2/2 longstanding secondary hyperparathyroidism, pts usually get renal transplant, but still get high PTH and parathyroid hyperplasia

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4
Q

Most common cause of primary hyperparathyroidism?

A

Solitary adenoma

**next MC is gland hyperplasia

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5
Q

Major feature to distinguish FHH from primary HPT is?

A

low 24 hr urinary calcium in FHH (<100 mg/day)

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6
Q

MEN IIA?

A

Pheochromocytomas
Medullary thyroid cancer
Four gland parathyroid hyperplasia

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7
Q

VHL syndrome characteristics;

A

RCC
Pheochromocytomas
Retinal hemangioblastomas
CNS tumors

MCC of death is RCC

** annual testing with fractionated metanephrines using plasma metanephrines starting at 5 year old recommended as part of screening (rule out pheochromocytomas)

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8
Q

When is a thyroid lobectomy adequate for follicular carcinoma?

A

Age <45
Lesion <4 cm
No family hx of thyroid Ca
No signs of distant mets

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9
Q

What are the boundaries of a central neck dissection?

A

For medullary thyroid cancer, a central neck dissection has LNs 6-7

Hyoid bone superiorly
Innominate artery inferiorly
Carotid arteries bilaterally

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10
Q

Medullary thyroid cancer arises from?

A

Parafollicular C cells

Makes calcitonin

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11
Q

MC site of ectopic parathyroid glands?

A

Thymus

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12
Q

Sxs of glucagonomas ?

A

Dermatitis (necrolytic migratory erythema)
Diabetes
Stomatitis
Anemia
Weight loss

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13
Q

Surveillance for incidental adrenal lesions:

A

All functioning adrenal lesions need removal

Non-functioning lesions with benign appearance need follow up imaging at 6, 12, 24 months and yearly serum testing for 4 years

If increase in size by 1 cm or start being functioning—-> resect

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14
Q

Imaging characteristics of a benign adrenal lesions?

A

<10 hounsfield units

> 50% rapid washout at 10 mins

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15
Q

Best first test for pheochromocytomas?

A

Plasma metanephrines

Followed by 24 hr urine catecholaines/metanephrines

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16
Q

What test can we use to localize pheochromocytomas?

A

MIBG scan

Iodine-131 methyl iodobenzylguanidine

Preferentially take up by adrenal medulla and chromaffin cells

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17
Q

Medullary thyroid cancer can be hereditary or sporadic; hereditary forms include;

A

Familial MTC syndrome

MEN syndrome

Both 2/2 RET mutation

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18
Q

Incidentally found medullary thyroid ca on FNA., what’s our worm up?

A

US the neck; look at central neck compartment for nodes
CEA and calcitonin levels
Check for hereditary syndrome w/ RET mutation

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19
Q

During thyroidectomy, you try and save the parathyroids; if you see a dusky parathyroid, what do you do?

A

Re-implant it into SCM

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20
Q

Most pts with primary hyerparathyroidism have how many enlarged glands?

A

Single ademonatous gland

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21
Q

Inferior parathyroids are derived from?

A

3rd pharyngeal pouch

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22
Q

Superior parathyroids derived from?

A

Fourth pharyngeal pouch

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23
Q

Missing superior parathyroid glands can be found where?

A

Paraesophageal

24
Q

Missing inferior parathyroid gland can be found where?

A

Thymus

25
Q

HU and adrenal masses:

A

Less than 10 HU with rapid contrast washout; benign lesion’

> 20 HU with less than 50% washout; pheochromocytoma, malignancy, adenoma

26
Q

Aldosterone-to-renin ratio >20?

A

Primary hypoaldosteronism

27
Q

US features highly suspicious of thyroid cancer?

A

Talller than wide

Microcalcifications

Hypoechogenicity

Irregular borders

Extrathyroidal extension

28
Q

How does a parathyroid adenoma appear on US/

A

Well circumscribed hypoechogenic mass with a feeding vessel

29
Q

Primary hyperaldosteronism;

A

Can be 2/2 adrenal adenoma or adrenal hyperplasia

HTN refractory to meds and hypokalemia seen

Plasma aldosterone to plasma renin >20 is required for diagnosis

Sx can potentially be curative

30
Q

Adrenocortical carcinoma?

A

Pts usually have a mix of Cushingoid symptoms as well as virilization; usually rapidly progressive

Very aggressive malignancy

Assc/ with tP53 and Li Fraumeni

31
Q

In MEN1 what is treated first?

A

Hyperparathyroidism

2/2 4 gland hyperplasia in MEN1

Tx; four gland resection with auto-transplant

32
Q

What gene assc with papillary thyroid ca?

A

SMAD4

33
Q

MCC of goiter and hypothyroidism in the US?

A

Hashimotos AKA lymphocytic thyroiditis

34
Q

Radioactive iodine and pregnancy?

A

Contraindicated

Can’t give during breastfeeding either

35
Q

Graves dx?

A

Autoimmune condition cause hyperthyroidism

Radioactive iodine usually use

Not helpful from Graves opthalmopathy; infact, it can make it worse

36
Q

Most important predictor of survival of adrenal ca?

A

Adequacy of resection; removing all involved tissue and LNs

37
Q

CT findings of adrenocortical cA?

A

> 6 cm
Irregular margins
Tumor heterogeneity
Presence of hemorrhage

38
Q

MC NET in MEN1?

A

Gastrinoma

39
Q

MC functioning NET overall?

A

Insulinomas

Least malignant

40
Q

Symptoms of gastrinoma?

A

ZES

Epigastric pain, reflux esophagitis, secretory diarrhea, weight loss

41
Q

Incretin effect?

A

Augmentation of insulin secretion after oral vs iv administration of insulin

Medial by GLP-1 and GIP

42
Q

How does gastric stimulate acid secretion?

A

Stimulates enterochromaffin like cells, which release histamine, which stimulate parietal cells to make HCL

43
Q

Inferior thyroid a is a branch off of?

A

Thyrocervical trunk

44
Q

Superior thyroid artery is a branch off of?

A

External carotid

45
Q

Graves dx?

A

Autoantibodes stimulate TSH receptors causing hyperthyroidism

46
Q

Best diagnostic test in a solitary thyroid nodule?

A

FNA

47
Q

Suspicious US features of thyroid nodules;

A

Hypoechogenic
Solid
Taller than wide
Microcalcifications
Irregular margins
Vascularity

48
Q

Sxs of somatostatinomas:

A

Gallstones
Diabetes
Achlorhydria
Steatorrhea

Somatostatin level > 100 is diagnostic

49
Q

In both papillary and follicular thyroid ca, what needs to be done after total thyroidectomy;

A

Radioactive iodine

50
Q

Conn syndrome?

A

Primary hyperaldosteronism
HTN, + hypokalemia

Cause is bilateral adrenal hyperplasia

51
Q

Cut off value for aldosterone/renin screening test for Conn syndrome?

A

30

52
Q

Orphan Annie nuclei, psammoma bodies?

A

Papillary thyroid ca

53
Q

Cushing disease?

A

Pituitary adenoma; MC cause of endogenous Cushing syndrome

Tx is trans-sphenoidal resection

In rare cases where pts are still symptomatic, can do external beam radiation

As a last resort, b/l adrenalectomy done

54
Q

Findings of Microcalcifications of thyroid US/

A

Strongly suggestive of Ca

55
Q

Gastrinoma diagnosis?

A

Usually >1000

If results are equivocal, can do a secretin stimulation test and measure gastrin levels at 2, 5, 10 mins after

After biochemical confirmation, then cross sectional imaging with CT done

56
Q

How does PTH help absorb ca?

A

Stimulates Ca absorption at the distal convoluted tube

57
Q

Medullary thyroid Ca and central neck dissection?

A

Medullary thyroid ca should undergo total thyroidectomy with central neck dissection regardless of LN status

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