Endocrine problems and the Breast Flashcards
Cushing disease vs cushing syndrome
cortisol excess caused by an ACTH-hypersecreting pituitary adenoma.
ACTH normal or elevated
Cortisol suppressed with administration of HIGH-DOSE DEXAMETHASONE
syndrome - prolonged exposure of body to elevated levels of cortisol, independent of source. M/c cause is pharmacologic glucocorticoid use for treatment of inflammatory disorders.
Contraindications for BCT?
- diffuse microcalcifications
- persistant positive margins in face of multiple reexcisions
- pregnancy
- multicentric disease (multiple tumors in separate quadrants)
- previous h/o radiation to breast
- expected poor cosmetic results
How does age relate to the prognosis of papillary and follicular thyroid cancer?
Age greater than 45 years old is associated with a bad prognosis
Type of breast mass that occur in adolescent black girls? Appearance is very firm, lobulated surface with a whorl like pattern.
Juvenile fibroadenomas
First step in management of hyperparathyroidism?
Vigorous hydration to restore intravascular volume. This will establish renal perfusion and promote urinary calcium excretion. LASIx may be used
What is the single most important determinant of malignancy in an adrenal tumor?
Size
What is the best approach to managing pheochromocytoma preoperatively?
Initiate an alpha blocker 1–3 weeks prior to surgery. Phenoxybenzamine
Should always be considered in patients with intractable peptic ulcers. How would you diagnosis?
Zollinger Ellison syndrome, ZES
Secretin stimulation test– Fasting gastrin levels obtained before and after the administration of secretin
Diagnostic if there is an increase in gastrin level greater than 200 pg/mL
The presence of hypercalcemia any patient with the ZES should prompt a work up for this condition?
MEN1 most common organ is parathyroid. Next most common is a Zollinger Ellison syndrome, followed by insulinoma
In a pregnant female with grave disease, how can you reduce the risk of developing a thyroid storm in the operating room?
Lugol
Osteitis fibrosis cystica
A condition associated with hyperparathyroidism that is characterized by severe demineralization with subperiosteal bone resorption, bone cysts, testing of distal phalanges on hand films
Treatment for hurthle cell carcinoma?
Radioiodine ablation
A type of follicular carcinoma, more often multifocal and bilateral, more likely to spread to local nodes and distant sites
Management of fine needle aspiration showing follicular cells?
– For lesions less than 4 cm in size, thyroid lobectomy is adequate because at least 80% of follicular lesions are adenomas.
– Four confirm carcinomas or lesions greater than 4 cm in size, total thyroidectomy
– No role for prophylactic neck dissection for follicular carcinoma
Can follicular carcinoma be diagnosed by FNA? What confirms a diagnosis of malignancy?
No, capsular or vascular invasion on histology confirms a diagnosis
T4
Tumors with extension into the chest wall or skin or inflammatory carcinomas
