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General Surgery EOR > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What is adrenal carcinoma?

A

adrenal cortical cancer (ACC) is a rare disease that can be functional but should be considered on the differential for any adrenal mass, especially tumors larger than 4 cm

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2
Q

What are the characteristics of adrenal carcinoma?

A
  • less common benign masses include myelolipoma/lipoma, ganglioneuroma, epithelial cyst, and pseudocyst
  • nearly 4% of abdominal CT scans obtained for another indication demonstrate an incidental adrenal mass
  • adrenal tumors can also be detected clinically due to manifestations of tumor hormone production
  • of all adrenal masses, 80% are nonfunctional adenomas, while 15% are functional with laboratory evidence of hormonal overproduction
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3
Q

What are the labs for adrenal carcinoma?

A
  • plasms fractionated metanephrines or 24-hours urine metanephrines - must full out pheochromocytoma for any adrenal mass
  • serum potassium and aldosterone and plasma renin activity
  • 24-hour urinary-free cortisol or dexamethasone suppression test
  • DHEA-S - high levels can be associated with ACC; virilization is the clinical manifestations of androgen overproduction
  • CT scan - size > 4 cm
  • MRI
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4
Q

What is the tx for adrenal carcinoma?

A
  • adrenal tumors with evidence of hormone production or suspicion of ACC should be considered for adrenalectomy
  • prognosis for ACC is dependent on treatment at an early stage and complete surgical excision with negative margins
  • laparoscopic adrenalectomy is NOT recommended for ACC given higher local recurrence rates due to positive or close margins
  • complete resection often requires en bloc resection of kidney, spleen, pancreas, liver, or IVC for negative margins
  • overall prognosis remains poor with overall 5-year survival of 25%
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5
Q

What are the ddx of fatigue?

A

endocrine/metabolic causes of fatigue

  • addison’s disease (adrenocorticol insufficiency) - adrenal gland destruction causing lack of cortisol and aldosterone secretion usually autoimmune (decrease cortisol)
  • hypothyroidism: cold and heat intolerance, fatigue, constipation, depression, weight gain, bradycardia
  • diabetes mellitus: fatigue, weight loss, polyuria, polydipsia, polyphagis
  • pituitary insufficiency
  • hypercalcemia
  • chronic renal failure
  • hepatic failure
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6
Q

What are the laboratory testing for fatigue?

A
  • complete blood count - anemia
  • erythrocyte sedimentation rate - inflammatory state
  • chemistry panel - liver disease, renal failure, protein malnutrition
  • thyroid function tests - hypothyroidism
  • human immunodeficiency virus antibodies - if not previously tests
  • pregnancy test, if indicated
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7
Q

What is less commonly indicated for fatigue?

A
  • chest radiography - adenopathy
  • tuberculin skin test
  • electrocardiography - CHF, arrhythmia
  • pulmonary function tests - COPD, arrhythmia
  • toxicology screen - substance abuse
  • lyme titers - chronic Lyme disease
  • rapid plasma reagin - syphilis infection
  • brain magnetic resonance imaging - multiple sclerosis
  • echocardiography - valvular heart disease, CHF
  • specialized blood testing (e.g. ferritin, iron, vitamin B12, and folate levels; iron-binding capacity; direct ant globulin test
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8
Q

What is hypothyroidism?

A

Hashimoto’s (chronic lymphocytic/autoimmune), previous thyroidectomy/iodine ablation, congenital

  • cold and heat intolerance, fatigue, constipation, depression, weight gain, bradycardia
  • Labs: TSH - elevated in primary disease, low T4 (increase TSH and decrease free T4)
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9
Q

What are the sis of hyperthyroidism?

A

heat intolerance, palpitations, sweating, weight loss, tremor, anxiety, tachycardia

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10
Q

What is hyperparathyroidism?

A

PALPABLE neck tumor and hypercalcemia (parathyroid cancer)

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11
Q

What is hyperthyroidism?

A

female with heat intolerance, palpitation, sweating, weight loss, tremor, anxiety, tachycardia

  • graves (autoimmune) - most common cause -diffuse goiter with a bruit, exophthalmos, pretibial myxedema
  • thyroid storm - fever, tachycardia, delirium
  • toxic adenoma, thyroiditis, pregnancy, amiodarone
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12
Q

How is hyperthyroidism dx?

A
  • TSH (best test): decreased in primary disease ( decrease TSH and increase free T4) elevated in secondary disease (increase TSH and increase free T4)
  • thyroid radioactive iodine uptake:
  • graves: diffusely high uptake
  • toxic multionodular: discrete areas of high uptake
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13
Q

What are the antibodies?

A

(Graves): anti-thyrotropin antibodies (anti-TSH receptor antibodies)

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14
Q

What is the tx for hyperthyroidism?

A
  • beta-blockers (symptomatic), methimazole/propylthiouracil, radioactive iodine, thyroidectomy
  • thyroid storm - prompt beta blockers, hydrocortisone, methimazole/propthiouracil, iodine
  • thyroidectomy - most likely complication is recurrent laryngeal nerve (hoarseness)
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15
Q

What is hyperthyroidism?

A

heat intolerance, palpitations, sweating, weight loss, tremor, anxiety, tachycardia

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16
Q

What is a pheochromocytoma?

A

recurrent headaches, HTN, sweating, palpitations

  • adrenal neoplasm - catecholamine secreting adrenal tumor - secretes norepinephrine and epinephrine autonomously and intermittently
  • recurrent headaches, HTN, sweating, palpitations
17
Q

How is a pheochromocytoma dx?

A
  • 24-hour catecholamines including metabolites (metanephrine and vanillymandelic acid)
  • MRI or CT of the abdomen to visualize tumor
18
Q

What is the tx for a pheochromocytoma?

A
  • resect tumor - complete adrenalectomy

- medical treatment preoperative: alpha blocker (phenoxybenzamine)

19
Q

What is thyroid carcinoma?

A

a 35-year old female with a hoarse voice, solitary cold nodule on thyroid uptake scan, lymphadenopathy, radiation exposure

  • most often papillary carcinoma (80%) - think papillary is “popular”
  • follicular carcinoma: 10%
  • medularry carcinoma: 5%
  • hurthle cell carcinoma: 4%
  • anaplastic/undifferentiated carcinoma: 1 to 2%
20
Q

What are the diagnostic studies for thyroid carcinoma?

A
  • ultrasound is the best initial screen follow by a thyroid uptake scan - usually normal thyroid function
  • microcalcification, hypoechogenicity, a solid cold nodule, irregular nodule margins, chaotic intranodular vasculature, and a nodule that is more tall than wide
  • fine needle biopsy for definitive diagnosis (all lesions > 1 cm should be biopsied)
  • TSH, calcium level, CXR
21
Q

What is the tx for thyroid carcinoma?

A

surgical resection with chemotherapy and external beam radiation reserved for anapestic thyroid cancer

22
Q

What is a thyroid nodule?

A

the diagnostic test of choice for thyroid nodule is fine needle aspiration (FNA)

23
Q

What is the evaluation for a thyroid nodule?

A
  • U/S - solid or cystic nodule
  • fine needle aspirate (FNA) - cytology 123 1 scintiscan (hot or cold nodule)
  • hot - increased 123 1 uptake = functioning/hyperfuntioning nodule (non-cancerous)
  • cold - decreased 123 1 uptake = nonfunctioning nodule (cancerous)
24
Q

What is the history with a thyroid nodule?

A
  • neck radiation
  • family history (thyroid cancer, MEN-II)
  • young age (especially children)
  • male > female
25
Q

What are the signs of thyroid nodule?

A
  • single nodule
  • cold nodule
  • Increased calcitonin levels
  • lymphadenopathy
  • hard, immobile nodule
26
Q

What are the symptoms of a thyroid nodule?

A
  • voice change (vocal cord paralysis)
  • dysphagia
  • discomfort (in the neck)
  • rapid enlargement
27
Q

What are types of rest tremors?

A
  • Parkinson’s disease
  • Wilson’s disease
  • essential tremor - only if severe: rest < postural and action
28
Q

What are the characteristics of postural and action (terminal) tremors?

A
  • physiologic tremor
  • exaggerated physiologic tremor (these factors can also aggravate other forms of tremor)
  • stress, fatigue, anxiety, emotion
  • endocrine: hypoglycemia, thyrotoxicosis, pheochromocytoma, adrenocorticosterioids
  • drugs and toxins: b-agonists, dopamine agonists, amphetamines, lithium, tricyclic antidepressants, neuroleptics, theophylline, caffeine, valproic acid, alcohol withdrawal, mercury (hatter’s shakes), lead, arsenic, others
  • essential tremor (familial or sporadic)
  • primary writing tremor
  • with other CNS disorders
  • Parkinson’s disease
  • other akinetic-rigid syndromes
  • Idopathic dystonia, including focal dystopias
  • with peripheral neuropathy
  • charcot-marie-tooth syndrome (controversial whether to call this the Rossy-levy syndrome)
  • variety of other peripheral neuropathies (especially dysgammaglobulinemia)
  • cerebellar tremor
29
Q

What is a kinetic (intention) tremor?

A

disease of cerebellar outflow (dentate nucleus and superior cerebella peduncle): multiple sclerosis, trauma, tumor, vascular disease, Wilson’s acquired hepatocerebrjl degeneration, drugs, toxins (e.g. mercury), others

30
Q

What are the miscellaneous rhythmical movement disorders?

A
  • psychogenic tremor
  • orthostatic tremor
  • rhythmical movements in dystonia (dystonic tremor)
  • rhythmical myoclonus (segmental myoclonus - e.g palatal or branchial myoclonus, spinal myoclonus, limb myorhythmia
  • osciallatory myoclonus
  • asterixis
  • clonus
  • hereditary chin quivering
  • head bobbing with third ventricular cysts
  • nystagmus

General Surgery EOR (10 decks)

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