Other Endocrine

Question 0

Patient complains of sudden onset of swollen, tender thyroid gland – likely diagnosis? Effect on thyroid hormone? Associated finding? Histologic finding? Management?

Answer 0

DeQuervain’s thyroiditis

Hyperthyroid from sudden release due to injury

Elevated ESR

Giant cell granulomas around degenerating thyroid follicles

Analgesics and aspirin

Question 1

Test for pheochromocytoma?

If positive, next step?

Answer 1

Elevated urinary catecholamines, metanephrine, vanillylmandelic acid

1. Locate tumor
#T2-weighted MRI. 
#if difficult to locate, octreotide scan
#Last resort, metaiodobenzylguanidine (MIBG scan)

2. Alpha blockade 10 to 14 days before surgery
3. Transabdominal expiration and tumor resection

Question 2

When do you do surgery for acute thyroid inflammation?

Etiologies?

Management?

Answer 2

Acute superlative thyroiditis (bacterial infection)

Streptococcus, Staphylococcus, Pseudomonas, tuberculosis, aspergillosis, actinomycosis, syphilis

Antibiotics and drainage

Question 3

Hashimoto’s – histologic findings?

When surgery?

Answer 3

Lymphocytic and plasma cell invasion into thyroid tissue

Compressive symptoms

Question 4

Patient m with history of parathyroidectomy presents with intractable ulcers – suspected diagnosis? Establish diagnosis with?

Associated with?

Answer 4

Gastrinoma (Zollinger-Ellison syndrome)

Elevated unstimulated serum gastrin level or positive calcium/secretin stimulation test

MEN-1

Question 5

Difference in treatment between sporadic gastrinoma and MEN gastrinoma?

Answer 5

MEN – Multifocal an dcan metastasize. Appropriate therapy is Debated

Sporadic – disease limited. Resect

Question 6

Operative strategy for gastrinoma?

Answer 6

#Endoscopy and ultrasound for location
# surgical enucleation
#If mass involves large pancreatic duct, Whipple

Question 7

Strategy for unoperable metastasized gastrinoma?

Answer 7

Streptozocin as chemotherapeutic agent

Question 8

Whipple Triad?

Answer 8

#Fasting hypoglycemia (under 60)
#Symptomatic hypoglycemia 
#relief with glucose

Question 9

Surgical management of insulinoma? If inoperable?

Answer 9

#Endoscopy an ultrasound for location
#Resection
#if involves large pancreatic duct, Whipple

Diazoxide (inhibitor of insulin release)

Question 10

Patient with medullary carcinoma of the thyroid is found to be MEN-2 positive. Management of thyroid carcinoma?

Answer 10

Total thyroidectomy and removal of lymph nodes in central compartment of neck

Question 11

Patient with incidental adrenal mass – when to remove?

Answer 11

5 cm or more