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Surgery EORE > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Adrenal carcinoma epidemiology

A

RARE
40-50 YO
POOR prognosis - >50% present w/ mets to liver/lung

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2
Q

Clinical presentation adrenal carcinoma

A

HORMONE hypersecretion!!!

Women = hirsutism, temporal balding, inc muscle mass, amenorrhea

Men = gynecomastia, testicular atrophy, impotence, decreased libido

Boys = precocious puberty

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3
Q

PE adrenal carcinoma

A

Abdominal mass

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4
Q

Dx adrenal carcinoma

A

CXR - may be first indication if aneurysm is large enough - widened mediastinum

Echo: TTE (only able to visualize proximal ascending aorta)

MRI if pt cannot receive IV contrast for CTA

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5
Q

Treatment adrenal carcinoma

A 
Surgical excision (gross tumor removal)
Early disease - adrenalectomy & LN dissection 
Late disease (mets) - ipsilateral nephrectomy

Metastatic/unresectable: Systemic chemotherapy

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6
Q

Post-op adrenal carcinoma

A

Corticosteroid replacement after adrenalectomy!!!

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7
Q

Primary hyperparathyroidism etiology

A

Parathyroid adenoma (85%)

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8
Q

Secondary hyperparathyroidism etiology

A

CKD

Hypocalcemia

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9
Q

Clinical presentation hyperparathyroidism

A

Excess PTH = HYPERCALCEMIA / hypophosphatemia

= stones (kidney), bones (pain), groans (ABD pain), & moans (psych manifestations)

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10
Q

PE hyperparathyroidism

A

Decreased DTR

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11
Q

Dx hyperparathyroidism

A

Hypercalcemia
Increased PTH
Decreased phosphate

24 hour urine - increased calcium, vitamin D

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12
Q

Treatement hyperparthyroidism

A 
Medical - 
Severe hypercalcemia (IVF, loop, bisphos, calcitonin)
CKD patients (vit D/Ca2+ supplement if 2/2 CKD)

Surgical -
Parathyroideectomy ( >50 YO or w/ any sx)
Either 3.5 glands removed or all 4 with autotransplantation of PTH tissue into forearm

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13
Q

Etiology Hyperthyroidism

A

Graves, thyroiditis, toxic adenoma, goiter, TSH-secreting pituitary tumor

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14
Q

CP & PE hyperparathyroidism

A

Restlessness, fast speech, tremor, moist/warm skin, fine hair, menstrual irregularity, increased stools

Tachycardia, hyperreflexia, weight loss, lid lag, proptosis, exophthalmos, diaphoresis

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15
Q

Labs hyperparathyroidism

A

TSH (decreased)
T3/T4 (increased)
Anti-thyroid antibodies (TRAB, TSI)

Decreased cholesterol
Hypercalcemia

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16
Q

Treatment hyperparathyroidism

A

Medical -
Potassium iodide/ lugol solution
Thioamides: PTU, methimazole
Beta-blockers for sx relief

Radio-iodine ablation - PREFERRED over surgery

Surgical resection - for pregnant pts, or pt unable to take medications (levothyroxine)

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17
Q

Thyroid carcinoma epidemiology

A

2:1 FEMALE
Most are EUTHYROID
Incidence has increased two-fold in last decade

18
Q

MC Type of thyroid carcinoma

A

Papillary (80%)
2/2 radiation exposure - YOUNG female - least aggressive thyroid CA, excellent prognosis, mets to cervical LN (distant mets uncommon)

19
Q

Types of thyroid carcinoma

A

Papillary - MC (young female 2/2 rad, treatable w/ excellent prognosis)

Follicular - (40-60 YO 2/2 iodine deficiency - aggressive but slow, mets common, treatable w/ excellent prognosis)

Medullary - RF = hx MEN2 - from pararfollicular cells that secrete calcitonin - LN mets first, distant later - POOR prognosis - doesn’t take up iodine

Anaplastic - RF = years of radiation exposure, MALES > 65, MOST AGGRESSIVE FORM, rarest form - mets (trachea) local & distant - prognosis POOR

20
Q

Papillary thyroid cancer characteristics

A 
Papillary -
MC thyroid cancer 
Young female 2/2 rad
Treatable 
Excellent prognosis
21
Q

Follicular thyroid cancer characteristics

A

Follicular -
40-60 YO 2/2 iodine deficiency
Aggressive but slow
Mets common but treatable w/ excellent prognosis)

22
Q

Medullary thyroid characteristics

A 
Medullary - 
RF = hx MEN2
From pararfollicular cells that secrete calcitonin
LN mets first, distant later
POOR prognosis - doesn't take up iodine
23
Q

Anaplastic thyroid cancer characteristics

A 
Anaplastic - 
RF = years of radiation exposure
MALES > 65
MOST AGGRESSIVE FORM, rarest form 
Mets (trachea) local & distant
Prognosis POOR
24
Q

Treatment for papillary vs follicular vs medullary vs anaplastic

A

PAPILLARY & FOLLICULAR: * Total thyroidectomy * Subtotal thyroidectomy + radioiodine therapy * Monitor thyroglobulin levels 6mo for residual cells (give recombinant TSH, then check thyroglobulin) *

MEDULLARY * Total thyroidectomy w neck LN dissection * Calcitonin levels used to monitor *

ANAPLASTIC * Most cannot be surgically resected * External beam radiation * Chemotherapy * Palliative tracheostomy to maintain airway

25
Thyroid nodule RF
Extremities of age (very old, very young) Hx head/neck radiation 10% are malignant
26
CP thyroid nodule
Mostly ASX Compressive sx: difficulty swallowing/coughing, ear/jaw pain, hoarseness, (recurrent laryngeal nerve compression)
27
PE Benign thyroid nodule vs malignant
Benign: varied, smooth, sharp outlines, painless Malignant: Rapid growth, fixed, no movement with swallowing
28
Thyroid function test results of most ppl w/ thyroid nodule
Euthyroid
29
Best initial test for person w/ thyroid nodule
FNA w/ Bx - ends up being benign nodule or follicular thyroid cancer 50-60% of the time
30
Most concerning radioactive iodine uptake results
NO uptake = cold nodule = highly suspicious for malignancy
31
Treatment for thyroid nodule
If cancer suspected - surgery Observation w/ US for 6-12 mo if suspicious Suppressive therapy with thyroid hormone to shrink nodule
32
Pheochromocytoma epi
Catecholamine-secreting tumor on adrenal gland - secretes epi/norepi INTERMITTENTLY A/w with MEN II 90% benign, `10% malignant
33
CP pheochromocytoma
Hypertension - temporary or sustained - REFRACTORY TO MEDICATIONS = KEY Palpitations Headaches Excessive sweating
34
Diagnosis of pheochromocytoma
24 hour urine catecholamine - metabolites (metanephrine, vanillymandelic acid) MRI/CT to visualize the tumor Labs will show hyperglycemia & hypokalemia
35
Treatment pheochromocytoma
complete adrenalectomy w/ pre-op nonselective alpha/beta blockade (prevent massive release during surgery) - w/ phenoxybenzamine, phentolamine x 7-14 days followed by beta blockade for HTN
36
Non-selective alpha/beta blockade before adrenalectomy for pheo
pre-op nonselective alpha/beta blockade (prevent massive release during surgery) - w/ phenoxybenzamine, phentolamine x 7-14 days followed by beta blockade for HTN
37
Etiology palpitations
Cardiac - any arrhythmia, cardiac and extracardiac shunts, valvular heart disease (mitral valve prolapse, aortic or mitral insufficiency), pacemaker, cardiomyopathy Psych - panic attack Meds - sympathomimetic agents - anticholinergic drugs, beta blocker withdrawal Habits - cocaine, meth, caffeine, nicotine Metabolic disorders - hypoglycemia, thyrotoxicosis, pheo High-output states - anemia, pregnancy, paget's disease, fever Catecholamine excess - exercise, stress, pheo
38
Four variables that are predictive of palpitations being cardiac
Male sex Description of irregular heart beat ***History of STRUCTURAL HEART DISEASE*** Event duration > 5 min None of patients w/ zero had cardiac etiology compared w/ 26, 48, and 71% of pt with 1, 2, and 3 predictors respectively
39
Cardiac causes of palpitations
Catecholamine excess 2/2 SANS stim 2/2 exercise/stress = nonsustained SVT & PVCs = palpitations Autonomic dysfunction = inc vagal tone = PAF in men 3rd-6th decade of life Idiopathic ventricular tachycardia during exercise or stopping of exercise in 2nd-3rd decade of life = palp, dizziness, syncope
40
Indications for radiofrequency ablation
If non-sustained SVT or ventricular ectopy (PVCs) (aka benign rhythms) --> reassure pt that rhythm is non-life-threatening - but if it's incapacitating then initial tx = beta-blockade - anti-arrhythmic meds NOT recommended Radiofrequency ablation of isolated ventricular ectopy is NOT recommended - unless person has fatigue & syncope on exertion or if ventricular ectopy has morphologic features & occurs incessantly
41
Dx evaluation of palpitations
Detailed history, physical exam, 12-lead EKG. Labs to rule out anemia & hyperthyroidism Ambulatory monitoring if palp are bothersome or sx recurrent - two weeks of transelephonic monitoring - daily sx get 24 hour holter Get electrophysiologic study if palpitations are sustained or poorly tolerated or if pt has high prestes liklihood of ersious arrhythmia (ie pt w/ structural heart disease) Management of most sustained SVT or ventricular arrhythmias should be managed by cardiologist trained in paharmacologic invasive electrophysiologic management of arrhythmias

Surgery EORE (3 decks)

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