Endocrine

Question 1

Suspicious ultrasound Thyroid features

Answer 1

-solid versus cystic nodules
-hypoechogenicity
-microcalcifications
-intranodular vascularity
-irregular or infiltrative margins
-shape taller than wide.

Question 2

when to consider FNA for small Nodule in Thyroid ?

Answer 2

-family history of thyroid cancer
-history of radiation exposure
-isolated uptake on PET scan
-suspicious cervical lymphadenopathy
-hoarseness

Question 3

Pathophysio of Gynecomastia

Answer 3

-enhanced peripheral aromatization of androgen to
-estrogen (obesity)
-increases in available estrogen
-alterations in sex hormone-binding-globulin
-decreases in free androgen

Question 4

Workup for primary hyperparathyroidism

Answer 4

-Part of the history to check for inherited syndrome
-Biochemical evaluation should include

calcium
parathyroid hormone levels
creatinine
25-hydroxyvitamin D levels
24-hour urine for creatinine and calcium

-patients with asymptomatic pHPTH undergo abdominal imaging to detect nephrocalcinosis or nephrolithiasis

Question 5

Adrenal incidentalomas Workup

Answer 5

-24-hour urine collection for fractionated catecholamines and metanephrines
-or plasma-free metanephrines to rule out
pheochromocytoma.

-An overnight 1-mg dexamethasone suppression test to evaluate for Cushing syndrome.

-aldosterone:plasma renin activity ratio

Question 6

Algorithm for the evaluation of incidentalomas

Answer 6

in Pic

Question 7

Papillary Thyroid Ca Lobectomy Vs TT

Answer 7

lobectomy for up to 4-cm unifocal
intrathyroid papillary thyroid cancer tumors
absence of prior head and neck radiation
No familial thyroid cancer or clinically detectable cervical nodal metastasis

Question 8

diagnosis of primary HPTH

Answer 8

elevated calcium and parathyroid hormone levels
Vitamin D level

familial hypocalciuric hypercalcemia :
low urinary excretion of calcium along with elevated parathyroid hormone and calcium levels.

Question 9

Hypercalcemia Tx

Answer 9

-IV Saline
-IV bisphosphonates (the initial treatment of choice) > inhibit osteoclastic bone resorption > max effectiveness 2-4 days
-calcitonin > rapidity of its effect > Renal calcium absorption is blocked > effects are seen as soon as 6 hours after administration.

Question 10

Cinacalcet ?

Answer 10

-corrects hypercalcemia by decreasing the production of PTH > For parathyroid cancer and ectopic production of PTH

Question 11

renal compromised patients with High Calcium

Answer 11

Saline diuresis may lead to volume overload.

The most appropriate treatment hemodialysis

Question 12

Bethesda System

Answer 12

1. Nondiagnostic or Unsatisfactory
   II. Benign
   III. Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance
   IV. Follicular Neoplasm or Suspicious for a Follicular Neoplasm
   V. Suspicious for Malignancy
   VI. Malignant

Question 13

Adrenocortical carcinomas features

Answer 13

typically large (6-8 cm) and have characteristic features on imaging such as irregular borders and heterogenous attenuation.

Question 14

what size adrenal tumor suggest resection

Answer 14

Clinical guidelines suggest that any lesion larger than 4 cm undergo resection because of increased cancer risk.

Question 15

Pheochromocytomas initial screening

Answer 15

initial screening test for a pheochromocytoma is plasma-free metanephrines.

If these are elevated THEN 24-hour urine collection for catecholamines and metanephrines should be performed

Question 16

Confirmatory testing for Primary HPTH

Answer 16

-elevated levels of urinary calcium excretion
-normal Vitamin D level
-depressed serum phosphate
-Serum chloride-to-phosphate ratio of greater than 33.

Question 17

for primary HPTH no further imaging is necessary incase of

Answer 17

traditional 4-gland neck exploration is planned

Question 18

If a patient is a candidate for focused parathyroidectomy, or “minimally invasive”

Answer 18

Most experienced surgeons use a 2-imaging test algorithm, and if concordant and confirmatory of solitary adenoma, focused exploration may be appropriate.

neck ultrasonography
Tc-99 sestamibi scanning
contrast-enhanced CT scan of the neck.

Question 19

whenever a diagnosis of medullary thyroid cancer is made you should ?

Answer 19

Exclude pheochromocytomas

because pheochromocytomas should be treated first when any intervention is planned

Question 20

Indications for Parathyroidectomy

Answer 20

-Serum calcium
(>upper limit of normal) 1.0 mg/dL

-Skeletal
BMD T-score < -2.5
Vertebral fracture by x-ray, CT, MRI, or VFA

-Renal
CrCL <60 mL/minute
24-hour urine for calcium >400 mg/day
Presence of nephrolithiasis or nephrocalcinosis

-Age < 50 Years

Question 21

persistent pHPTH Vs Recurrent pHPTH

Answer 21

persistent > failure of cure before 6 months postoperatively

Recurrent > initial normalization of calcium with recurrence after 6 months

Question 22

Patient with Recurrent Primary HPTH after focused parathyroidectomy 1 year ago

Answer 22

sestamibi scintigraphy, should be repeated.

If not localize an adenoma > ultrasound aspiration of potential adenomas with PTH measurement Or parathyroid angiography with selective venous sampling

If Still no localization is found > nonoperative management

Question 23

Initial evaluation of a young patient with apparently localized medullary thyroid cancer

Answer 23

-neck ultrasound examination
-measurement of serum calcium
-calcitonin and carcinoembryonic antigen levels
-urine screening studies for pheochromocytoma
-and genetic counseling for consideration of RET proto-oncogene testing.

Question 24

persistent elevation of calcitonin after thyroidectomy for medullary Cancer

Answer 24

most commonly due to persistent disease in the neck or distant metastatic disease

imaging is indicated