Endocrine Tumors

Question 1

2 MC endocrine tumors

Answer 1

Pituitary
Adrenal

Question 2

The MC pituitary tumors are ____, which oversecrete _____

Answer 2

Adenomas
Prolactin

Question 3

Vasopressin Deficiency ->
Prolactin excess ->
GH excess ->
ACTH excess ->
Tumor smashes the anterior pituitary ->

Answer 3

Vasopressin Deficiency -> **Diabetes Insipidus **
Prolactin excess -> **amenorrhea, galactorrhea, ED and gynecomastia in men
**
GH excess -> Acromegaly in adults, Gigantism before puberty
ACTH excess -> **Cushing syndrome
**
Tumor smashes the anterior pituitary -> mass effect can cause a reduction of all pituitary hormones -> **panhypopituitarism.
**

Question 4

Order a ____ for anyone with endocrinopathies + H/A or visual changes (half visions)

Answer 4

Brain MRI

Question 5

MCnonfunctioning adrenal masses in adults are _____

Answer 5

Adenomas (50%)

Others: Carcinomas, Metastatic tumors, Cysts, lipomas

Question 6

Adrenal Cysts

Question 7

Are most Adrenal tumors Hyper or Hypo -active?

Answer 7

• Hyperactive MC (need to be bilateral to be hypoactive)

Question 8

Adrenal Tumors WU

Answer 8

• CT, MRI
• r/o cushings -> Dexamethasone Suppression test, serum cortisol
• r/o pheochromacytoma -> 24hr urine or plasma fractionated metanephrines
• r/o primary aldosteronism -> plasma aldosterone and renin
• Fine-needle biopsy (cancer)

Question 9

Adrenal tumors ____ cm require excision

Answer 9

2-4+ cm

> 4cm, or if functioning: usually excised
2-4cm: sometimes monitored with imaging and hormone levels, sometimes excised
<2cm: monitored for growth and function

Question 10

Adrenomedullary tumors or Stromal Malignancies?

Malignant pheochromocytoma
Ganglioneuroblastoma
Neuroblastoma
Neuroendocrine carcinoma

Answer 10

Adrenomedullary tumors

Question 11

Adrenomedullary tumors or Stromal Malignancies?

These include the following:
Neurofibrosarcoma
Angiosarcoma
Liposarcoma
Fibrosarcoma
Leiomyosarcoma
Myxosarcoma
Malignant teratoma

Answer 11

Stromal Malignancies

Question 12

Adrenal Carcinomas MC cause which of the following?

Cushings or Addisons?
Hyperaldosteronism or Hypoaldosteronism?
High or low total hormones?

Answer 12

Cushings
Hyperaldosteronism
High total hormones

These tumors are most likely unilateral & unilateral tumors are MC hyperactive. Need to be bIlateral to be hypoactive (suppress)

Question 13

Adrenal Carcinoma WU

Answer 13

• Refer to Endo
• Serum glucose
• Serum cortisol
• Urine vanillylmandelic acid (VMA)
• Urine homovanillic acid (HVA) levels
• Screen for Cushing, pheochromocytoma, Hyperaldosteronism in appropriate symptom complex
• if not an incidentaloma, CT or MRI of adrenals

Question 14

Adrenal Carcinoma WU

Answer 14

• Refer to Endo
• Serum glucose
• Serum cortisol
• Urine vanillylmandelic acid (VMA)
• Urine homovanillic acid (HVA) levels
• Screen for Cushing, pheochromocytoma, Hyperaldosteronism in appropriate symptom complex
• if not an incidentaloma, CT or MRI of adrenals