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ABSITE > Endocrine and Breast > Flashcards

Endocrine and Breast Flashcards

1
Q

How do non-functional tumors of the pituitary present?

A

Macroadenomas that present with mass effect and decreased anterior pituitary hormone levels

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2
Q

What are contraindications to the transsphenoidal approach to pituitary tumors?

A

suprasellar extension, massive lateral extension, dumbbell shaped tumor

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3
Q

What drug to most pituitary tumors respond to?

A

Bromocriptine (dopamine agonist)

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4
Q

What are the characteristics of prolactinoma?

A

Most common pituitary adenoma
Microadenoma
Prolactin > 150 for symptoms

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5
Q

What are indications for resection of macro adenomas?

A

Hemorrhage
Visual loss
Desires pregnancy
CSF Leak

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6
Q

What are the characteristics of growth hormone releasing adenomas?

A

Macroadenomas

Elevated IGF-1 and GH >10 in 90%

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7
Q

What is the treatment of acromegaly?

A

Oxtreotide

Transsphenoidal resection

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8
Q

What is a frequent post-op complication following craniopharyngioma resection?

A

Diabetes insipidus

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9
Q

What should you think of with bilateral pituitary masses?

A

Mets if pituitary hormones OK

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10
Q

What is Nelson’s Syndrome?

A

Pituitary enlargement from bilateral adrenalectomy resulting in amenorrhea and visual problems as well as hyperpigmentation

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11
Q

What is the arterial supply of the adrenal gland from superior to inferior?

A

Inferior phrenic artery
Aorta
Renal artery

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12
Q

What is the workup of an adrenal incidentaloma?

A

Check for functioning tumor: Urine metanephrines/VMA/catecholamines, hydroxycorticosteroids, serum K, plasma renin and aldosterone levels
Metastatic workup: CXR< colonoscopy, mammogram

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13
Q

When is surgery indicated for an adrenal mass?

A

Non-homogenious
> 4-6 cm
Functioning
Enlarging

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14
Q

What hormones are present in all zones of the adrenal?

A

21 and 11 beta hydroxylase

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15
Q

What are the symptoms of Conn’s syndrome?

A

HTN without edema
Hypokalemia
Weakness
Polydipsia and polyuria

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16
Q

What is the diagnostic tests for primary hyperaldosteronism?

A

Salt load suppression test (urine aldosterone stays high)

Aldosterone:renin ratio > 20

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17
Q

What is the treatment for adenomas causing Conn’s syndrome?

A

Control HTN and K

Adrenalectomy

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18
Q

What is the treatment for hyperplasia causing Conn’s syndrome?

A

Sprionolactone, CCBs, K replacement

if refractory: bilateral resection with fludrocortisone post-op

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19
Q

What are the most common causes of Addison’s disease?

A

Withdrawal of exogenous steroids

Autoimmune disease

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20
Q

What is the diagnostic test for Addison’s disease?

A

Cosyntropin test (ACTH given, urine cortisol remains low)

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21
Q

What are hte signs of acute adrenal insufficiency?

A

Refractory hypotension, fever, lethargy, n/v, hypoglycemia, hyperkalemia

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22
Q

What is the most common cause of hypercortisolism?

A

Iatrogenic

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23
Q

What is the diagnostic tests for hypercortisolism?

A

24 hour urine cortisol and ACTH
ACTH low -> cortisol secreting lesion
Both High -> pituitary adenoma or ectopic ACTH (e.g. SSLCA)

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24
Q

What is the follow up test if ACTH is high after a 24 hour urine test?

A

High-dose dexamethasone suppression test
If urine cortisol suppressed -> Pituitary adenoma
Not surpressed -> Ectopic ACTH producer

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25
Q

What are medical treatments for adrenal hyperplasia causing hypercortisolism?

A

Metyrapone (blocks cortisol synthesis)
Aminoglutethimide (inhibits steroid production)
If fails: bilateral adrenalectomy

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26
Q

What are the characteristics of adrenocortical carcinoma?

A

bimodal age distribution (<5 > 5th decade), females
50% are functioning
Children have virilization 90% of the time

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27
Q

What are the treatments for adrenocorticol carcinoma?

A

Radical adrenalectomy
Debulking helps sx and prolongs survival
Mitotane for chemo

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28
Q

What is the rate limiting step in epinephrine production?

A

Tyrosine hydroxylase

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29
Q

What converts norepinephrine to epinephrine?

A

PNMT (only in adrenal medulla)

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30
Q

Where is the organ of Zuckerkandl?

A

At the adrenal bifurcation

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31
Q

What is the 10% rule for pheochromocytoma?

A 
Malignant
Bilateral
In Children
Familial
Extra-Adrenal
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32
Q

Which pheochromoctyomas are more likely to be malignant?

A

Extra-adrenal tumors

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33
Q

What is the most sensitive test for dx of pheochromocytoma?

A

Urinary VMA

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34
Q

What are other tests to diagnose and localize pheochromocytoma?

A

Ct/MRI
MIBG Scan
Clonidine suppression test (no response from tumor)
NO VENOGRAPHY

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35
Q

What drugs should be ready for use during adrenalectomy for pheochromocytoma?

A

Nipride
Neo-synephrine
Antiarrythmic agents

36
Q

What causes falsely elevated levels of VMA?

A

Coffee, tea, fruits, vanilla
Iodine contrast
labetalol
alpha and beta blockers

37
Q

What is a ganglioneuroma?

A

Rare benign asymptomatic neural crest tumor in adrenal medulla or sympathetic chain

38
Q

What is an Ima artery?

A

1% of population, directly from innominate or aorta and supplies the isthmus of the thyroid

39
Q

Where do veins of the thyroid drain?

A

Superior and middle - IJ

Inferior - Innominate

40
Q

What is the function of the superior laryngeal nerve?

A

Motor to cricothyroid

Loss = loss of projection and voice fatigability

41
Q

What percent of population has a non-recurrent largyneal nerve?

A

2%

More common on the right

42
Q

What runs near the ligament of Berry?

A

RLNs

It is the posteromedial suspensory ligament

43
Q

What are the tubercles of Zuckerkandl?

A

Most posterolateral extension of the thyroid

This is left behind during subtotal as it is near RLN

44
Q

What is the most common cause of death in thyroid storm?

A

High-output cardiac failure

45
Q

What is the treatment of thyroid storm?

A 
Beta blocker first!
PTU
Lugol's solution
Cooling blankets
Oxygen
Glucose
46
Q

What effect does Lugol’s solution take advantage of?

A

Wolff-Chaikoff effect

47
Q

If you drain a thyroid cyst and it recurs or fluid is bloody, what is Tx?

A

Thyroid lobectomy

48
Q

What is the difference between primary and secondary substernal goiter?

A

Primary -> Blood vessels from thyroidal arteries

Secondary -> from innominate artery

49
Q

What is the mechanism of PTU and MTH?

A

Inhibits thyroid peroxidases and prevents iodine-tyrosine coupling

50
Q

What is the operative pathway for Grave’s disease?

A

Pre-op: PTU till euthyroid then beta blocker and Lugol’s for 14 days
Operation: Bilateral subtotal or total

51
Q

What are indications for surgery in Grave’s disease?

A 
Noncompliant patient
Recurrence
Children
Pregnant not controlled with PTU
Concomitant suspicious nodule
52
Q

What does pathology of Hashimoto’s disease show?

A

Lymphocytic infiltrate

53
Q

What is treatment of De Quervain’s thyroiditis?

A

Steroids

ASA

54
Q

What is Riedel’s fibrous trauma often associated with?

A

PSC, fibrotic diseases, methysergide Tx, RP fibrosis

55
Q

What are worrisome features for thyroid CA?

A

Solid, solitory, cold, slow growing, hard
Male, age > 50, prior XRT
MEN IIa or IIb

56
Q

What could sudden growth of a thyroid nodule represent?

A

Hemorrhage into previously undetected nodule or malignancy

57
Q

Are follicular adenomas associated with an increased cancer risk?

A

NO

58
Q

What is the most common tumor following neck XRT?

A

Papillary thyroid cancer

59
Q

What is prognosis of papillary thyroid cancer based on?

A

Local invasion

60
Q

What is seen on pathology for PTC?

A

Psammoma bodies

Orphan annie nuclei

61
Q

What are indications for total thyroidectomy with PTC?

A 
Bilateral lesions
Multicentricity
History of XRT
Positive margins
Tumors > 1 cm
62
Q

What are indications for I131 in PTC?

A

Metastatic disease
Residual local disease
Positive LNs
Capsular invasion

63
Q

What is an enlarged lateral neck LN with normal appearing thyroid tissue?

A

This is PTC with lymphatic spread

64
Q

What is the most common metastatic site for follicular thyroid cancer?

A

Bone

65
Q

What are indications for total thyroidectomy for FTC?

A

> 1 cm or extra thyroidal disease

66
Q

What is one of the first symptoms of MTC?

A

Diarrhea, flushing

67
Q

What is seen on pathology for MTC?

A

Amyloid deposition

68
Q

Where do mets from MTC go?

A

Early mets to lung, liver, bone

69
Q

What are indications for MRND with MTC?

A

Clinically positive nodes, bilateral if disease in both lobes,
Or if extra thyroidal disease present

70
Q

What is prophylactic thyroidectomy indicated in MEN II syndromes?

A

IIa - 6 years

IIb - 2 years

71
Q

Which thyroid cancers is I-131 effective for?

A

Papillary and Follicular

72
Q

What pharyngeal pouches do the parathyroids come from?

A

Superior 4th

Inferior 3rd

73
Q

Where are the superior parathyroids found?

A

Lateral to RLN, superior to inferior thyroid artery

74
Q

Where are the inferior parathyroids found?

A

Medial to RLN, inferior to the inferior thyroid artery

75
Q

How does Vitamin D act?

A

Increases levels of calcium binding protein

76
Q

What is a normal PTH level?

A

5-40

77
Q

What are the laboratory abnormalities in primary hyperparathyroidism?

A

Increased calcium, Decreased phosphate
CL to PO4 ratio > 33
Increased renal cAMP
Increased bicarb in urine

78
Q

What are the criteria for intra-op PTH monitoring?

A

Should decrease by 1/2 in 10 minutes

79
Q

Where is the most common location to find a gland at re-operation for missing gland?

A

Normal anatomic location

80
Q

What are indications for surgery in secondary hyperparathyroidism?

A

Bone pain, fractures, pruritus

81
Q

What is the surgical treatment for tertiary hyperparathyroidism?

A

Subtotal parathyroid resection

82
Q

What are the findings in MEN I?

A

Parathyroid hyperplasia
Pancreatic islet cell tumors (Gastrinoma #1)
Pituitary adenoma (Prolactinoma #1)

83
Q

What are the findings in MEN IIa?

A

Parathyroid hyperplasia
Medullary thyroid cancer
Pheochromocytoma (bilateral, benign)

84
Q

What are the findings in MEN IIb?

A

Medullary thyroid CA
Pheochromocytoma
Mucosal neuromas
Marfan’s habitus

85
Q

What are the genes for MEN I and MEN IIa/IIb?

A

I - MENIN

IIa/IIb - RET proto-oncogene

86
Q

What is the treatment for hypercalcemic crisis?

A

Fluids

Lasix

87
Q

How do breast cancer bone mets cause hypercalcemia?

A

They release PTHrP

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