OnlineMedEd: Surgery: Subspecialty - "Endocrine Diseases"

Question 1

Discuss the workup of thyroid nodules.

Answer 1

1) Get a TSG to see if the nodule is functioning.
- If the TSH is low then the nodule is hyperfunctioning and it is low risk. Go to #2.
- If the TSH if normal, then the nodule is high risk and go to #3.

2) Get a radioactive iodine uptake scan.
- If the nodule is hot. Treat it medically because it is not cancer.
- If the nodule is not hot, do an FNA because this is high-risk for cancer.

3) Do an US.
- If the nodule is greater than 1 cm, that is high risk and do an FNA.
- If the nodule is less than 1 cm, that is low risk so watch and wait (Q6M US).

Question 2

What do you do if the thyroid nodule FNA shows each of these situations?

• Cancer
• Not cancer
• Unknown

Answer 2

• Cancer: resect the thyroid
• Not cancer: Q6M US
• Unknown: repeat FNA immediately

Question 3

Go through the workup of suspected gastrinoma.

Answer 3

1) In a patient with multiple ulcers on EGD or ulcers refractory to triple therapy, get a gastrin level.
2) If the gastrin level is extremely elevated (above 1600), then this is likely a gastrinoma so do a somatostatin receptor scintigraphy scan (SRS) looking for the gastrinoma.
3) If the gastrin level is only moderately elevated, do a secretin stimulation test. The gastrin should go down. If it rises, then it’s a gastrinoma so do the SRS.

Question 4

Insulinoma presents with ______________.

Answer 4

episodic hypoglycemia

Question 5

If you suspect insulinoma, then get what three labs?

Answer 5

• Insulin levels
• C-peptide levels
• Sulfonylurea levels

Question 6

What is the rash that presents with glucagonoma?

Answer 6

Migratory necrolytic dermatitis

Question 7

How do you diagnose glucagonoma?

Answer 7

• Migratory necrolytic dermatitis
• High glucagon levels
• CT

Question 8

Review the labs that suggest hyperparathyroidism.

Answer 8

• High Ca
• High PTH
• Low Phos

Question 9

Which scan tells you the hyperfunctioning parathyroid gland?

Answer 9

The sestamibi scan

Question 10

Why does hypocalcemia present after resection of only one hyperfunctioning parathyroid gland?

Answer 10

The other, normal parathyroid glands atrophy under the hypercalcemic state. They thus need some time to regrow when calcium levels drop.