NMS Endocrine Flashcards
What is a dangerous cause of hypercalcemia
metastatic carcinoma to bone (esp breast, prostate)
what is vicious cycle of hypercalcemia? how do you break it
hypercalcemia –> osmotic diuresis –> dehydration –> hypercalcemia; break it by first rehydrating aggressively, followed by loop diuretic (calcium wasting), and bisphosphonates
rule of 10s with pheochromocytomas
10% malignant, 10% bilateral, 10% extraadrenal, 10% epinephrine producing
tx of pheo
immediate tx of crisis is alpha + beta blockade (MUST HAVE BOTH) –> octreotide scan to localize tumor –> adrenalectomy
what is de quervain’s thyroiditis? how to dx and tx
acutely enlarged/inflamed thyroid with initial hyperthyroidism; DIAGNOSE by elevated ESR, histology showing granulomas and degenerating follicles; TREAT with aspirin and analgesics, NOT SURGERY
when to operate in acute thyroiditis
if suppurative/bacterial, need surgical drainage
3 big risk factors for thyroid cancer
1) hx of radiation 2) fam hx thyroid cancer 3) voice/airway symptoms
how to work up patient with neck mass+ history of radiation
SURGERY –> further eval unnecessary
what syndrome is a/w medullary thyroid cancer
MEN 2 (RET gene mutation): pheochromocytoma, parathyroid cancer, thyroid cancer
w/u of thyroid nodule
FNA, U/S (NOT radioactive iodine study; FNA is quite accurate)
how to tx thyroid cyst
aspiration: if >4 cm or recurrent, increased risk of malignancy –> excision
which type of thyroid cancer is BAD
anaplastic/undifferentiated –> needs chemo, rads, NOT surgery (usually already too advanced)
4 types of potential surgical complications a/w thyroidectomy
1) unilateral recurrent laryngeal nerve injury (hoarseness) 2) bilateral recurrent laryngeal nerve injury (vocal cord paralysis) 3) external laryngeal nerve injury (distorted high pitched singing voice) 4) parathyroid injury (hypoparathyroidism)
most common cause of primary hyperparathyroidism
pituitary adenoma (carcinoma in need to explore neck +/- preop sestamibi imaging Sestamibi: parathyroid scintography; technetium 99
procedure for exploring primary hyperparathyroidism
if preop sestamibi, can just take out adenomatous parathyroid glands (“minimally invasive”); if no preop sestamibi, need to explore all 4 parathyroid glands
for which thyroid cancers do you use I131 or thyroid hormone suppression postop?
follicular and papillary; doesnt help for medullary since thats parafollicular (C-cell) hyperplasia
What if only find 3 parathyroid glands under exploration
have to find the 4th; often intrathyroid
what does elevated Ca and PTH suggest? how to tx
primary hyperparathyroidism; if adenoma explore/resect; if carcinoma radical resection
what does decreased Ca and elevated PTH suggest? how to tx
secondary hyperparathyroidism (eg, CKD) ; tx medically unless symptomatic (pain, fractures, ectopic calcifications, intractible pruritus) –> surgical mgmt (remove 3.5 PTH glands +/- relocation of remaining 0.5 to arm for easy accessibility)
tx of hashimotos
thyroid hormone replacement, bx surveillance to ensure no cancer (hashimotos a/w increased risk)
how to tx gastrinoma (Zollinger Ellison syndrome)
can be sporadic or metastatic; if SPORADIC, RESECT; if METASTATIC to liver and LN, consider GASTRIC RESECTION vs. HSV to prevent ulcerative complications
(highly selective vagotomy??)
with which syndrome is gastrinoma associated
MEN-1 (MENIN gene mutation); pancreatic, parathyroid, pituitary cancers
what classic triad a/w insulinoma
Whipple triad: 1) fasting hypoglycemia; 2) symptomatic hypoglycemia; 3) relief with glucose administration
tx of insulinoma
if sporadic, RESECT; if not, can use diazoxide (inhibitor of insulin release)
mgmt of incidentally disocered adrenal mass
depends on size; if <5 cm, check labs for indication of malignancy (Vanillylmandelic acid, potassium, cortisol), then remove vs. observe depending on outcome; if >5 cm , high risk of cancer –> wide resection + look for mets
