Endocrine Surgery Flashcards
malignant thyroid nodule
70 yr old person comes in with neck mass. hx: irridiation, hx carcinoma, firm and immobile lump. DDX graves/ toxic multinodular goitre, papillary carcinoma of thyroid, folllicular carcnoma of thyroid, anaplastic cancer of thyroid ( worst one). parathyroid issue,met from elsewhere. px: hoarse voice, dysphagia, nontender nodule ix: CBC, Calcium to assess parathyroids, TSH, T3, T4, FNA biopsy. tx: surgical resection. once you cut out their thyroid, replace their TSH for life ( synthroid)
benign neck mass
could be a follicular adeoma, papillary adeoma, hashimoto thyroiditis, graves, thyroglossal duct cyst, abscess. hx: pain tender, soft smooth nodule with fam hx of thyroid dysfxn. may present with dry skin/ hair loss/ wt gain for hypothyroidism or opposit for hyperthyroidism. if benign on U/S you U/S q6-8 mos
primary hyperparathyroidism
hx:recall memory aid: stones, bones, groans, psychiatric overtones ( renal stones, bone pains and osteo, abdominal complaints, confusion/ depression) px:hypertension, bradycardia, no palpable neck mass. ix: Ca, PTH, 24 hr urine calcium. With high PTH, get high Calcium, low P04. ix: U/s neck tx: if due to primary HyperPTHism ( gland hypertrophy), excision of one or all four glands +- reimplantation.
what is the differential for someone with PTh, Ca, and P04 dysregulation?
FHH - familial hypocalciuric hypercalcemia, gland hypertrophy. 2ndary= youre hypocalcemic for some reason like chronic renal failure or vit D Deficiency, which ramps up PTH but theres no ca to mobilize so you keep increasing PTH. 3iary= rare and werd sounding
how do PTH, CA and P04 relate?
PTH is released from parathyroid glands to mobilize calcium , usually from bone, to increase reabsorption at kidney and increase absoprtion at gut. It acts to decrease P04 with increasd extretino. recall that MEN is included here, or adenoma/ carcinoma of the parathyroid glands ( they are englarging for no good reason)
pheo
hx: episodic sweating/palpitations/headaches/visual blurring px: tacy, diaphoretic, HTN. Classic triad is PHE: palpiation, headahce, sweating. R/o carcinoid syndrome ix: urine vanillas and metenphinre byproducts, 5HIAA for carcinoma, CT to stage, Tx: surgerical excisions
cushings
you are being crushed by all your cortisol. Hx moon face, psychiatric changes, weight gane, skin straie, acne, hirsutism, osteoporosis, decreased libido. most commonal from use of corticorticosteroid use ddx: adrenal issues: cushings, adrenal adenoma, adrenal mass, ectopic source of cortisol via ACTH ix: confirm its oddly high cortisol by trying to supress it; dexamethasone supression test - if it stays elevated its cushings. + order a24 hr urine cortisol, serum cortisol, ACTH. Issue is to find where the cortisol-producint lump is: can be in the pituitary ( pituitary adenoma), adrenal, ectopic ( somewhere else, usually lung). Tx: surigcal excision, or medical: metyrapne ( inhibits cortisol production)
