Endocrine associated stuff Flashcards

1
Q

According to the article “Comparison of computed tomographic and pathologic findings in 17 dogs with primary adrenal neoplasia” Vet Rad/US Vol. 00, No.0 2014 pp 1-7. - Does the presence of vascular invasion in adrenal tumors affect the morbidity/mortality?

A

No. Currently ruling in/out vascular invasion may change the surgical approach but at this time no significant difference has been seen in morbidity/mortality of those with or with out direct vascular invasion.

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2
Q

Which type of adrenal tumor is more likely to be associated with vascular invasion?

“Comparison of computed tomographic and pathologic findings in 17 dogs with primary adrenal neoplasia” Vet Rad/US Vol. 00, No.0 2014 pp 1-7.

A

Pheochromocytomas.

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3
Q

Adrenal tumors have been shown in multiple studies to have a predilection for left vs right sided, which side is the most commonly affected?

“Comparison of computed tomographic and pathologic findings in 17 dogs with primary adrenal neoplasia” Vet Rad/US Vol. 00, No.0 2014 pp 1-7.

A

Left-sided is more common. In this particular study 65% were left sided.

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4
Q

Which adrenal tumor has been reported to invade the hypaxial and epaxial musculature?

“Comparison of computed tomographic and pathologic findings in 17 dogs with primary adrenal neoplasia” Vet Rad/US Vol. 00, No.0 2014 pp 1-7.

A

Pheochromocytomas.

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5
Q

Is the presence of a peripheral contrast-enhancing rim in late phase CT images associated with a more benign or aggressive process when classifying adrenal tumors?

“Comparison of computed tomographic and pathologic findings in 17 dogs with primary adrenal neoplasia” Vet Rad/US Vol. 00, No.0 2014 pp 1-7.

A

Benign. Presence of a peripheral contrast enhancing rim is associated with a fibrous capsule or pseudo capsule which is recognized more frequently in well-differentiated and low-grade tumors.

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6
Q

Malignant pheochromocytoma are considered the most aggressive in terms of vascular invasion. What percentage have direct invasion into the adjacent vasculature and what percentage have distant metastasis?

“Comparison of computed tomographic and pathologic findings in 17 dogs with primary adrenal neoplasia” Vet Rad/US Vol. 00, No.0 2014 pp 1-7.

A

Pheochromoctyomas are reported to have up to 85% direct invasion and up to 40% have distant metastasis.

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7
Q

Is there a difference in mean attenuation when comparing a pheochromocytoma and adrenal adenocarcinoma? If so which is associated with a higher HU

“Comparison of computed tomographic and pathologic findings in 17 dogs with primary adrenal neoplasia” Vet Rad/US Vol. 00, No.0 2014 pp 1-7.

A

Pheochromocytomas have a higher mean attenuation than adrenal adenocarcinomas. Pheo- 44.5 HU AAC- 28.2 HU

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8
Q

In the article: US measurements of adrenal glands in cats with hyperthyroidism. VRU 53.2 (2012).

What were their findings in control vs treated/untreated hyperthyroid cats?

A

No difference in adrenal gland shape - bean/ovoid/elongated shape with hyperechoic halo between healthy/hyperthyroid cats

Adrenal gland size was larger in dorsoventral and craniocaudal directions for hyperthyroid cats (up to 20% larger). No signficant difference between treated/untreated cats.

Hyperthyroid cats were more likely to have hyperechoic foci

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9
Q

In the article: US measurements of adrenal glands in cats with hyperthyroidism. VRU 53.2 (2012).

What are measurements for healthy cat adrenal glands versus hyperthyroid (treated/untreated) cats?

A

Up to 20% increase in adrenal gland size when hyperthyroid.

healthy cat: CrCa: 10mm DV: 3.5-4mm

Hyperthyroid cat: CrCa: 11.1-12.2 DV: 4.5-4.9
(up to increase in 1.6-1.6mm in length, 0.8-0.9 height)

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10
Q

What were causes of hyperechoic foci in adrenal glands in cats?

In the article: US measurements of adrenal glands in cats with hyperthyroidism. VRU 53.2 (2012).

A

fat deposition, small hemorrhage, microscopic calcifications

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11
Q

What is theory behind increased adrenal gland size in cats with hyperthyroidism?

US measurements of adrenal glands in cats with hyperthyroidism. VRU 53.2 (2012).

A

Increased episodes of cortisol secretion, as well as increased amount of cortisol secreted per secretory episode.

High levels of thyroxine –> increased clearance of cortisol –> increased ACTH –> increased work on adrenal gland.

Hyperthyroid cats are more stressed out –> increased activation of hypothalamic pituitary adrenocortical axis

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12
Q

Differentials for adrenomegaly in cats? What imaging characteristics help distinguish between conditions (if any)?

US measurements of adrenal glands in cats with hyperthyroidism. VRU 53.2 (2012).

A

Hyperthyroidism, adrenal hyperplasia, hyperadrenocorticism, hyperaldosternosim, acromegaly, tumors

Bilateral enlargement: hyperadrenocorticism, hyperaldosternism, acromegaly, hyperthyroidism

Unilateral enlargement: tumors - most frequently will be >1cm larger than normal (normal is 10mm - usually will be >2cm)

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13
Q

In this study: Prevalence of incidental thyroid nodules in US studies of dogs with hypercalcemia. VRU 56.1

14/91 dogs had thyroid nodules, which had a variable histologic findings (adenoma, cyst, hyperplasia, carcinoma) What were there main US characteristics?

A

well-defined
Most were hypoechoic (some were mixed)
intact/distorted (50/50) capsular margins

Lots of overlap between the histologic findings

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14
Q

What were results of histopath of some of these incidental thyroid nodules?

Prevalence of incidental thyroid nodules in US studies of dogs with hypercalcemia. VRU 56.1

A

cyst, adenomas, adenocarcinoma, nodular hyperplasia

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15
Q

What are defining US characteristics of thyroid adenoma and adenocarcinomas?

Prevalence of incidental thyroid nodules in US studies of dogs with hypercalcemia. VRU 56.1

A

Lots of overlap between the two in early stages - small, well defined, hypoechoic nodules

Later stages - carcinomas: hypoechoic, inhomogeneous, mvariable margination, invasion or regional tissues, high vascularization and mineralization

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16
Q

In humans, what percentage of patients with hyperparathyroidism have co-existing thyroid disease?

A

40% -not sure if there is a link bewteen hyperparathryoidism and thyroid cancer

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17
Q

What percentages represent each pattern of thyroid uptake in cats?

Unilateral
Bilateral-asymmetric
Bilateral-symmetric
Multifocal

Thyroid scintigraphy findings in 2096 cats with hyperthyroidism. VRU 56.1.

A

Unilateral - 30%
Bilateral asymmetric - 50%
Bilateral symmetric - 10%
Multifocal -

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18
Q

What was prevalence of ectopic thyroid tissue and thyroid carcinoma in Thyroid scintigraphy findings in 2096 cats with hyperthyroidism. VRU 56.1.?

A

Ectopic thyroid - 4%

Carcinoma - 2%

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19
Q

What was considered a normal thyroid:salivary and thyroid:background in Thyroid scintigraphy findings in 2096 cats with hyperthyroidism. VRU 56.1.

A

Thyroid:salivary

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20
Q

What was sensitivity for thyroid:salivary ratio and thyroid:background in

Thyroid scintigraphy findings in 2096 cats with hyperthyroidism. VRU 56.1.

A

Thyroid:salivary >1.5 was 0.987

Thyroid:background >6.4 was 0.961

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21
Q

How does the sensitivity of thyroid:salivary and thyroid:background ratio compare to endocrine testing (T4)?

Thyroid scintigraphy findings in 2096 cats with hyperthyroidism. VRU 56.1.

A

Thyroid:salivary sensitivity: 98%
Thyroid:background: 96%
Total T4: 91%

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22
Q

What does effect of methimazole have on thyroid uptake?

In the different studies - how does TSH levels between normal/hyperthyroid cats and methimazole differ?

Thyroid scintigraphy findings in 2096 cats with hyperthyroidism. VRU 56.1.

A

Nieckarz suggested that methimazole can lead to increased uptake (increased T/S) for up to 3weeks after discontinuation in normal cats. After methimazole is discontinued the cats became hypothyroid - and TSH is secreted in high levels to increase T4 levels.

Fischetti et al - reported that methimazole did not increase T/S ratio in hyperthyroid cats. Cats with hyperthryoidism will have low TSH levels, so even after discontinuation of methimazole - TSH does not increase

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23
Q

Describe embryogenesis of the thyroid and how/where ectopic thyroid tissue can occur?

Thyroid scintigraphy findings in 2096 cats with hyperthyroidism. VRU 56.1.

A

Thyroid develops from the anterior foregut endoderm - will migrate ventrally along midline and form bilobed thyroid gland. (Migrates from the base of the tongue to the pretracheal position in the neck).

Failure of migration - results in thyroid tissue from base of tongue to cervical region.

If thyroid primordium fails to fully disassociate with embryologic aortic sac - will lead to additional caudal descent of the thyroid tissue - cranial mediastinal or heart based thyroid tissue

24
Q

How common was ectopic tissue (%), and where was it most commonly found (%)

Thyroid scintigraphy findings in 2096 cats with hyperthyroidism. VRU 56.1.

A

4% of the cats (79 cats total)
Intra-thoracic (mediastinal) - 80%
Lingual/sublingual - ~10%
Lateral ectopic thyroid tissue in cervical region - 7%

25
Q

What tumors may lead to an increased calcium levels?

High resolution parathyroid sonography VRU 38.6.

A

lymphoma, multiple myeloma, mammary gland adenocarcinoma,

26
Q

Causes of hyperparathyroidism?

High resolution parathyroid sonography VRU 38.6.

A
Adenoma
Carcinoma
Primary hyperplasia
Secondary renal hyperparathyroidism
Hypercalcemia of malignancy
27
Q

What measurements of PT glands helps differentiate between causes of HPT?

High resolution parathyroid sonography VRU 38.6.

A

4mm - adenoma/carcinoma

28
Q

Why do certain tumors cause seconary hyperparathyroidism?

High resolution parathyroid sonography VRU 38.6.

A

Tumors secrete a parathyroid hormone related protein (PTHrP) which are homologous to PTH secreted by PT glands. This results in Ca resorption by the kidneys

29
Q

What is approximate normal length and width measurement of parathyroid glands?

US of histologically normal parathyroid glands and thyroid lobules in normocalcemic dogs VRU 51.4

A

3.3 x 2.3mm

30
Q

What are things on US that can be mistaken for PT glands?

US of histologically normal parathyroid glands and thyroid lobules in normocalcemic dogs VRU 51.4

A

Thyroid lobules, thyroid cyst, parathyroid cyst, follicular cyst, hemorrhagic cyst, follicular adenoma, vasculature, lymph node

31
Q

What was PPV and sensitivity for identification of parathyroid glands on US when compared to histopathology?

US of histologically normal parathyroid glands and thyroid lobules in normocalcemic dogs VRU 51.4

A

74% PPV - 26/35 were correctly identified.

90% sensitivity

32
Q

How do parathyroid glands control calcium?

US of histologically normal parathyroid glands and thyroid lobules in normocalcemic dogs VRU 51.4

A

Increased absorption by the GI tract
Increased retention by the kidneys
Resorption from the bone

33
Q

What is the Arterial phased percentage enhancement washout calculated (AP-PEW?)

Preoperative DDx of canine adrenal tumors using triple phased helical CT Vet Surg 2016

A

(Maximum CT value in art - max CT value in delayed)/ (max CT value in art - max CT value in pre-contrast) X 100

34
Q

How is the AP-PEW calculated?

Preoperative DDx of canine adrenal tumors using triple phased helical CT Vet Surg 2016

A

(Max CT value in venous - max CT value in delay) / (max CT value in venous - max CT pre-contrast)

35
Q

How do you calculate the relative percentage washout?

Preoperative DDx of canine adrenal tumors using triple phased helical CT Vet Surg 2016

A

(Max CT value in art - max CT value in delayed phase ) / max CT value in arterial phase

36
Q

How do you calculate the enhancement washout between different phases?

Preoperative DDx of canine adrenal tumors using triple phased helical CT Vet Surg 2016

A

AP-VP = max CT value in art phase - max CT value in venous phase

Enhancement washout AP-DP = max CT value in art phase - max CT value in delayed phase

37
Q

What was prevalence of tumor calcification between different adrenal gland types? Where was there significance?

Preoperative DDx of canine adrenal tumors using triple phased helical CT Vet Surg 2016

A

Highest in cortical adenocarcinoma (63%)

Significance when compared with pheochromocytoma - 15.4% and adenoma 14.3%

38
Q

What was prevalence of tumor thrombus between the tumor types? where was there significance?

Preoperative DDx of canine adrenal tumors using triple phased helical CT Vet Surg 2016

A

Most common in pheochromocytoma (77%)

Significance when compared to adenomas (0%), and carcinomas (31%)

39
Q

Was lobulation more common with malignant or benign tumors?

Preoperative DDx of canine adrenal tumors using triple phased helical CT Vet Surg 2016

A

Malignant (54% pheo, 3/13 carcinomas)

40
Q

What were phases were pheochromcytomas more likely to have a higher HU?

Preoperative DDx of canine adrenal tumors using triple phased helical CT Vet Surg 2016

A

arterial and venous phases

41
Q

Was there significance between tumor types for any of the enhancement washouts?

Preoperative DDx of canine adrenal tumors using triple phased helical CT Vet Surg 2016

A

There was significant differences between pheochromocytomas and adrenal carcinoma in nearly all calculations.

42
Q

Where does thyroid develop embryologically?

CT features of basihyoid ectopic thyroid carcinoma in dogs. VRU 54.6

A

Endoderm - near the base of the tongue, and then migrates caudal to the larynx.

43
Q

Where can ectopic thyroid tissue live?

CT features of basihyoid ectopic thyroid carcinoma in dogs. VRU 54.6

A

Anywhere from the base of the tongue to the base of the heart

44
Q

What is thyroid status of dogs with thyroid neoplasia?

CT features of basihyoid ectopic thyroid carcinoma in dogs. VRU 54.6

A

60% are euthyroid
30% are hypothyroid
10% are hyperthyroid

45
Q

What are imaging characteristics commonly seen with ectopic basihyoid thyroid tumors?

CT features of basihyoid ectopic thyroid carcinoma in dogs. VRU 54.6

A

2 normal thyroid glandsa re seen in their correct anatomic location (8/8)
Ventral to the larynx +/- invasion into ventral larynx (2/8)
Ventral margins distinct, dorsal margins are indistinct
Lysis of the basihyoid bone (partial to complete)
No vasculature invasion - the lingual vein can be associated with the tumor
Heterogeneous pre and post contrast
Symmetrical
Retropharyngeal LN metastasis

46
Q

What are differentials for a tumor ventral to the larynx +/- association with the basihyoid bone?

CT features of basihyoid ectopic thyroid carcinoma in dogs. VRU 54.6

A

Soft tissue sarcomas
Primary bone tumor
Laryngeal carcinoma

47
Q

Most common laryngeal tumors in dogs? Cats?

Laryngeal adenocarcinoma in a dog. VRU 35.3

A

Dogs - carcinoma

Cats - lymphosarcoma

48
Q

What imaging characteristics are USUALLY seen with laryngeal carcinomas in both dog and man?

Laryngeal adenocarcinoma in a dog. VRU 35.3

A

Soft tissue mass
No dystrophic mineralization
No bony destruction

49
Q

What imaging characteristics were seen in THIS report of laryngeal carcinoma?
Laryngeal adenocarcinoma in a dog. VRU 35.3

A

Soft tissue mass with lysis of the basihyoid bone and dystrophic mineralization of the surrounding soft tissue structures

50
Q

What were most common tracheal tumors in dogs? cats?

Tracheal and laryngeal tumors in the dog and cat: literature review and 13 additional tumors. VRU 32.5

A

Dogs - osteochondromas

Cats - epithelial malignancies (carcinoma)

51
Q

What was typical signalment and radiographic changes associated with osteochondromas of the trachea in dogs/

Tracheal and laryngeal tumors in the dog and cat: literature review and 13 additional tumors. VRU 32.5

A

Signalment

52
Q

What is most common laryngeal tumor in dogs? cats?

Tracheal and laryngeal tumors in the dog and cat: literature review and 13 additional tumors. VRU 32.5

A

Dogs - epithelial malignancies (Carcinomas)

Cats - lymphosarcoma (**although in this article there were 12 epithelial malignancies and only 9 lymphosarcoma??)

53
Q

What wre radiographic characteristics of laryngeal masses in dogs?

Tracheal and laryngeal tumors in the dog and cat: literature review and 13 additional tumors. VRU 32.5

A

Distinct masses in the larynx that were lobulated

No mineral associated with these masses.

54
Q

What is the percentage of adrenal tumors that invade vascualture?

US identification of vascular invasion by adrenal tumors in dogs VRU 53.4

A

Pheochromocytomas - 82%
Adrenocorticals - 11-41%
In this study - 36% of the tumors

55
Q

Which tumor time was signifciantly more likely to cause CVC invasion?

US identification of vascular invasion by adrenal tumors in dogs VRU 53.4

A

Pheochromocytomas

56
Q

What was sensitivity/specificity of US for detecting tumor thrombi in the CVC?

US identification of vascular invasion by adrenal tumors in dogs VRU 53.4

A

100% sensitivity

96% specificity

57
Q

What was sensitivity and specificity of US in detecting adrenal tumors that had formed thrombi, but had not been present within the CVC?

US identification of vascular invasion by adrenal tumors in dogs VRU 53.4

A

76% sensitivity

96% specificity