Imaging relevant to endocrine disease

Question 1

Where does the pituitary gland sit?

Answer 1

In the base of the skull in the sella turcica of the sphenoid bone
Connected to hypothalamus via pituitary stalk
Found inferior to the optic chiasm
Lateral to the carotid arteries

Question 2

What type of pituitary tumours tend to be hormonally active?

Answer 2

Microadenomas

Question 3

What does the thyroid gland lie deep to?

Answer 3

Strap muscles: stenohyoid, sternothyroid, thyrohyoid, omohyoid

Question 4

What are the anatomical landmarks of the thyroid gland?

Answer 4

Anterior to trachea and esophagus
Deep to strap muscles
Medial to common carotid and internal jugular veins
Lies superior to the sterum
Associated with recurrent laryngeal nerves and parathyroid gland

Question 5

What structures do the left and right recurrent laryngeal nerves pass under respectively?

Answer 5

Right - Right subclavian artery

Left - arch of the aorta

Question 6

What can present as a midline neck mass?

Answer 6

Goitre
Lymph nodes but typically eccentric
Thyroglossal cyst
Cystic hygroma 
Thyroid cancer 
Metastatic cancer

Question 7

When is a thyroid ultrasound used?

Answer 7

In euthyroid patients with a goitre/palpable nodules and hyperthyroid patients with a focal mass/ radioisotope uptake

Question 8

What is used in thyroid scintigraphy?

Answer 8

Tc 99

Question 9

What does a homogenous increased tracer uptake of more than 3% suggest?

Answer 9

Graves disease

Question 10

What conditions will cause reduced uptake by the thyroid gland?

Answer 10

Hashimotos
Amiodarone disease
Post-partum thyroiditis

Question 11

Where do the adrenal glands lie?

Answer 11

Suprarenal position

Question 12

What are the anatomical relations of the right adrenal gland?

Answer 12

Posterior to the IVC

Question 13

What are the anatomical relations of the left adrenal gland?

Answer 13

Lateral to the aorta and left diaphragmatic crus

Question 14

What is the 10% rule of phaeochromocyomas?

Answer 14

10% are extra-adrenal
10% are bilateral 
10% are found in children
10% are familial - MEN syndrome 
10% are not associated with hypertension

Question 15

What cancers should be looked for in the ase of an adrenal metastasis?

Answer 15

Lungs
Liver
Adrenal glands

Question 16

How will long bones grow?

Answer 16

Start as cartilage and undergo enchondral ossification
Osteoblasts will replace the cartilage with osteoid to form bony trabeculae. Trabeculae are loosley packed in the medulla but condense towards the cortex

Question 17

How will cartilagenous bones grow?

Answer 17

First ossify within the diaphysis

Secondarily they ossify within the epiphysis

Question 18

How is increased bone girth achieved?

Answer 18

Cells derived from the periosteum which lay down circumferential new bone on the periphery of the existing cortex

Question 19

How is increased bone length achieved?

Answer 19

Increased by cartilage proliferation at growth plates between the metaphysis and epiphysis
The cartilage will ossify

Question 20

What is a diffuse bone abnormality?

Answer 20

All bones are too brittle

All bones are too soft

Question 21

What can cause a focal bone abnormality?

Answer 21

Traumatic
Neoplastic (lytic or sclerotic)
Inflammatory
Degenrative

Question 22

What can cause a diffuse bone abnormality?

Answer 22

Osteoporosis
RIckets and osteomalacia
Pagets disease
Fibrous dysplasia

Question 23

What causes osteoporosis?

Answer 23

Reduction in trabecular density

Post-menopausal females

Question 24

What are the typical fracture sites for osteoporotic bones?

Answer 24

Proximal femur - NOF
Sacrum and pubic rami
Thoracolumbar vertebral bodies
Distal radius - colles

Question 25

What can cause secondary osteoporosis?

Answer 25

Steroids Early menopause Anorexia Induces via cancer surgery

Question 26

How can you distinguish between an osteoporotic fracture and metastatic disease?

Answer 26

Osteoporotic fractures will only affect the anterior vertebral bodies Metastatic disease will involve posterior elements

Question 27

What is rickets?

Answer 27

``` Vit D deficiency Non-ossification of soft osteoid Bone deformity, pain and growth abnormality Widened growth plates Irregular, flared metaphyses ```

Question 28

What is pagets disease?

Answer 28

Increased bone turnover with unknown cause Single or multiple bones affected Initial lytic phase results in well definced lucency Latter sclerotic phase with enlarged bones, increased density, coarse trabecular pattern

Question 29

What is lytic bone destruction?

Answer 29

Medullary lucency and loss of trabeculae Loss of inner cortex (endosteum( Complete loss of cortex Potential for pathological fracture

Question 30

What is a sclerotic bone lesion?

Answer 30

Sublte medullary density and loss of trabeculae Spreading zone of density which includes cortex Featureless white bone Expansion beyone normal bone limits, with cortical destruction and potential for pathological fracture

Question 31

What can cause sclerotic bone lesions?

Answer 31

Prostate cancer in men | Breast cancer in women