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Endocrinology > Endocrine Tumors Lecture Powerpoint > Flashcards

Endocrine Tumors Lecture Powerpoint Flashcards

1
Q

The right adrenal gland’s main vein (right suprarenal vein) drains directly into the ___, the left drains ___

A
  • vena cava

- renal vein

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2
Q

Layers of the adrenal gland and hormones secreted in each (4)

A

Zona Glomerulosa - aldosterone
Zona fasciculata - cortisol
Zona reticularis - androgens
Medulla - catecholamines

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3
Q

4 common extramedullary locations of pheochromocytoma (catecholamine secreting paragangliomas that only secrete norepi)

A
  • Organ of Zuckerkandl (near bifurcation of abdominal aorta along spine)
  • neck
  • upper abdomen (most common)
  • bladder
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4
Q

Classic triad of pheochromocytoma and another pathognomonic finding

A
  • palpitations
  • sweating
  • headache

-feeling of impending doom

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5
Q

Other associated conditions with pheochromocytoma (3)

A
  • MEN II a and B
  • neurofibromatosis
  • von hipple-lindau (retinal hemiangioblastomas, CNS hemiangioblastomas, multiple renal cysts)
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6
Q

Pheochromocytoma diagnostic studies (4)

A
  • 24 hour catecholamine (metanephrine, norepi, VMA (most diagnostic))
  • CT to localize
  • MIBG (idonine scan where pheo takes up as well as thyroid so give Lugols solution)
  • PET scan
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7
Q

Pheochromocytoma treatment options (1) and what is the pre op prep?

A
  • surgical resection only (dissection with minimal tumor manipulation to prevent catecholamine surge, venous drainage first*** then arterial)
  • Pre op prep involving preventing hypertension and tachycardia beginning 1 week before (alpha adrenergic antagonist like phenoxybenzamine THEN B receptor antagonist like propranolol
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8
Q

Aldosteronoma pathognomonic findings (2)

A
  • hypertension

- hypokalemia (not on diuretics)

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9
Q

Recall the RAAS system

A
  • at the level of the kidneys hypovolemia causes release of renin from juxtaglomerular aparatus
  • angiotensinogen released from liver is converted by renin to angiotensin I
  • angiotensin I is converted by lungs that release ACE into angiotensin II
  • angiotensin II causes aldosterone secretion at the adrenal gland and has peripheral vasoconstriction effects
  • aldosterone causes retention of sodium and therefore water but loss of potassium
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10
Q

Diagnostic labs of aldosteronoma (4)

A
  • increased plasma aldosterone but decreased plasma renin (inappropriate release of aldosterone)
  • rule out bilateral adrenal hyperplasia (unknown cause) via CT scan
  • oral sodium loading (should suppress aldosterone secretion)
  • captopril administration test (should cause decrease in adlosterone and increased renin but in primary hyperaldosteronism there is no change)
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11
Q

Cushing syndrome vs cushing dz

A

Syndrome is signs and symptoms associated with elevated cortisol level vs in cushing dz see pituitary tumor hypersecreting ACTH resulting in excess cortisol

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12
Q

Glucocorticoid producing tumor diagnostic studies (3)

A
  • increased 24 hr urine free cortisol
  • dexamethasone suppression test
  • CT scan
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13
Q

Cushing syndrome signs and symptoms (8)

A
  • weight gain
  • peripheral muscle wasting
  • hirsutism
  • buffalo hump
  • moon face
  • menstrual irregularity
  • amenorrhea
  • impotence
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14
Q

Cortisol release pathway

A
  • cortosol levels sensed in hypothalamus and releases CRH when low
  • Anterior pituitary receives CRH and this stimulates release of ACTH
  • this acts at the adrenal gland increasing cortisol in the blood stream to be sensed in hypothalamus
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15
Q

Cushings disease has __ ACTH and ___ cortisol, noncushings disease cushings syndrome has ___ ACTH and ___ cortisol

A

Elevated, elevated, low, elevated

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16
Q

Dexamethasone suppression test

A

-24 hr urine for 3 consecutive days, .5 mg of dexamethasone given every 6 hours on day 2 and 3, urinary free cortisol should be <10mcg/day on day 2, if not suppressed then must have adenoma

17
Q

Adrenal cortex incidentaloma

A

Seen in patients often getting CT or screening for something else, if it isn’t presenting symptomatic then don’t need surgical intervention, can do fine needle aspiration after ruling out a pheo*** to determine cause

18
Q

How far is the ampulla of vater from the pylorus

A

7cm

19
Q

Majority of islets of langerhans cell types for the pancreas are located in what part of it?

A

The tail

20
Q

Pancreatic islet cell tumors localization techniques (5)

A
  • CT scan
  • visceral angiography
  • transhepatic portal venous sampling
  • intraoperative exploration
  • intraoperative ultrasound
21
Q

Most common functional pancreatic endocrine tumor

A

Insulinoma

22
Q

Whipples triad and what is it pathognomic of?

A
  • symptoms of hypoglycemia, blood glucose level <50mg/dl, and relief of symptoms following ingestion of glucose
  • pathognomonic of insulinoma
23
Q

Diagnosis of insulinoma (3)

A
  • insulin and glucose determinations during a 72 hr fast
  • insulin to glucose ration >.3 after overnight fast
  • elevated c peptide and proinsulin levels
24
Q

Proinsulin is cleaved to insulin from removal of a free ___, measuring this rules out ___ insulin as a source

A

C peptide, exogenously injected

25
Q

Zollinger Ellison syndrome/gastrinoma suspicious findings (5)

A
  • ulcers in unusual locations (not antrum or prepyloric area)
  • persistent ulcers despite medical management and chronic diarrhea
  • ulcers and manifestations of other endocrine tumors
  • strong family history of ulcer dz
  • recurrent ulcers after antiulcer surgery
26
Q

Gastrinoma diagnostic studies (2)

A
  • fasting gastrin >200 or >1000 highly suspicious

- secretin stimulation increasing gastrin levels >200 is diagnostic***

27
Q

Gastrinoma treatment options (2)

A
  • control gastric hypersecretion (gastrin, Ach from vagus, histamine all contributors) so give PPI
  • surgical localization, assess for mets, and remove
28
Q

Pyramidal lobe of the thyroid

A

Remnant of thyroglossal duct sometimes present extends upward torward cricoid cartilage from isthmus

29
Q

Thyroid arterial supply (2)***

A
  • Inferior thyroid artery from the thyrocervical trunk

- Superior thyroid artery off carotid

30
Q

Thyroid venous supply (3)***

A
  • Inferior thyroid vein draining into subclavian
  • middle thyroid vein (has NO arterial equivalent)
  • superior thyroid vein draining into jugular

Endocrinology (19 decks)

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