Endocrine Flashcards
(228 cards)
1
Q
Complications of adrenalectomy
A
IVC injury
devascularized kidney -> HTN
Nerve injury can mimic a hernia
2
Q
Clinical finding in ectopic ACTH secretion
A
Bronze skin
3
Q
Top 5 ectopic ACTH secreting tumors
A
SSC of Lung PNET Thymic neuroendocrine tumor Pheo MTC
4
Q
What is size cutoff to safely do a MIS adrenalectomy?
A
< 6cm
5
Q
What are perioperative medications for a bilateral adrenalectomy?
A
preop steroids
post-op steroids with mineralicosteroids (hydrocortisone + Florinef)
6
Q
4 benefits of Radioactive iodine
A
Destroy microscopic foci of disease (adjuvant therapy)
Minimize the risk of development of de-novo papillary thyroid cancers in at-risk patients
Improve the specificity of thyroglobulin (Tg) as a tumor marker
Increase the specificity of 131-I scanning for detection of recurrent or metastatic disease
7
Q
Who should not get radioactive iodine?
A
No high risk features (LVI, histology)
●Unifocal cancer <1 cm even with less than five lymph nodes measuring less than 2 mm)
●Multifocal cancer when all foci are <1 cm
●Intrathyroidal cancer <4 cm
8
Q
Who should definitely get radioactive iodine
A
any gross extrathyroidal extension (T4)
any distant metastatic disease.
9
Q
Who is intermediate risk who should consider getting RAI?
A
Tumors > 4cm
microscopic extrathyroidal extension
central and lateral LN involvement
10
Q
contraindication to RAI
A
pregnancy and breastfeeding
11
Q
preparations for RAI
A
total thyroidectomy
stop synthroid 3-4 weeks before
Must wait 1-3 months from last contrasted CT scan
low iodine diet for 1 week
12
Q
alternative to stopping sythroid before RAI?
A
give patient recombinant TSH during therapy
13
Q
RAI dose for genetic risk
A
(remnant ablation), 30 mCi
14
Q
RAI dose for adjuvant therapy
A
~100 mCi are used
15
Q
RAI dose for metastatic disease
A
100 to 200 mCi
16
Q
Can you do RAI on dialysis?
A
yes
standard radioiodine dose followed by more frequent dialysis
17
Q
how to follow patient after RAI?
A
Tg levels
I131 scan at 6-12 months if not decreasing
18
Q
toxicities of RAI?
A
sialoadenitis
secondary cancers
infertility
19
Q
Advice for radioactive patient after RAI:
A
The treated patient should remain 6 feet away from other people for about 24 hours after treatment.
especially avoid pregnant women and children
20
Q
How long to delay pregnancy after RAI?
A
6 months
21
Q
Staging for advanced thyroid cancer?
A
Contrast CT will delay RAI, but RAI is never an emergency…
22
Q
Adjuvant therapies for parathyroid cancer?
A
Radiation is effective
[Munson Cancer 2003]
23
Q
what is the rate of an intrathyroid parathyroid gland?
A
1-3%
24
Q
What is the rate of an intrathyroid parathyroid cancer?
A
<1%
25
Parathyroid looks white/gray and is invading the RLN? what do you do?
Do en-bloc resection of parathyroid and ipsilateral thyroid lobe with RLN.
Leave the nodes alone if clinically benign.
26
What syndromes are associated with parathyroid cancer?
MEN
| Jaw tumor syndrome
27
Mechanism of cinacalcet
Calciummemetic, blocks calcium receptor
28
Is a frozen section helpful for parathyroid cancer?
No need architecture showing invasion or a distant met to make the diagnosis
29
5 year survival in parathyroid cancer?
40-80%; only retrospective series
30
Causes of death in parathyroid cancer?
pulmonary mets
| renal failure from hypercalcemia.
31
Absent thyroid lobe
check for ectopic thyroid tissue (tongue)
32
False negative rate of thyroid nodule < 4 cm
1-4%
33
False negative rate of a thyroid nodule > 4 cm
10%
34
Superior margin of a sistrunk procedure?
circumvali papillae in base of tongue
35
major complication of a sistrunk procedure?
airway injury
36
Can pyramidal lobe bifurcate?
yes
37
Chemo for ACC
Mitotane
38
Pheo lab work-up
plasma metanephrines first, then 24 hour urine for specificity
39
Aldosteronoma work-up
Lytes, Renin:Angiotensin ratio
IVC sampling is confirmatory and lateralizing test.
40
Malignancy risk of a 6 cm adrenal mass?
25%
41
When do you FNA an adrenal mass?
When suspicious for metastatic disease
| Path cannot tell an ACC on needle biopsy.
42
Genetic syndrome associated with ACC
Lynch syndrome
43
How long to give mitotane for an ACC?
Can give for 5 years; most patients stop sooner due to side effects
44
Confirmatory test to evaluate for ectopic ACTH?
Ask IR to perform inferior petrossal sampling
45
ACTH work-up
low dose dex
| high dose dex
46
Bilateral adrenalectomy for an unresectable ACTH secreting tumor?
never for MTC, SCC as survival is too poor. Maybe for a well selected PNET or thymic tumor.
47
What is mortality from Cushings refractory to medical management?
50% at 2 years
48
Get a frozen section on a thyroid nodule?
No, not useful
49
Thyroid nodule with decrease TSH, next step?
start propranolol
technicium uptake scan
only do lobectomy for a functional adenoma
50
FNA result shows suspicion for Hurthle cell neoplasm,
chance of cancer?
Management?
30% chance this is a Hurthle Cell cancer
would do lobectomy
51
Pancreatic enucleation is appropriate for?
hormonally functional PNETs
52
MEN I gene and function
mennin - transcription factor
53
Best palliative treatment for liver PNETs
TACE
54
Resect primary tumor in metastatic midgut carcinoid?
yes!
Good retrospective data it improves symptoms in 80% of patients.
55
Is there a survival benefit to removing primary tumor in metastatic midgut carcinoid?
Debatable. Some retrospective series say yes, but cannot account for selection bias.
56
Shave nodes off the SMA in metastatic carcinoid?
no.
Still good survival when leaving nodal disease behind.
57
Median survival after carcinoid resection with bulky nodal disease left behind?
>6 years in some retrospective series.
58
HIPEC for carcinoid?
Has been done and abandoned in Europe
No difference in OS
Small PFS improvement, but high morbidity
59
First citation for 90% debulking of NETs
Sarmiento 2003. Retrospective study with suggesting good OS for these patients with no comparison arm, thus this threshold can be debated
PMID 12735141
60
What percent of patients recur after Liver debulking for carcinoid?
95%
61
Who should not get liver debulking for carcinoid?
comorbids that preclude liver surgery
over 50% replacement of hepatic parenchyma
disseminated mets outside the liver.
62
What percent of thyroid nodules are malignant?
5-10% all comers
63
US findings suggesting malignant thyroid nodule (6)
```
hypoechogenicity
calcifications
vascularity
taller than wide
ill defined margins
absent halo
```
64
FNA cutoff for thyroid nodules?
all > 1.5 cm
| all > 1 cm with suspicious features
65
High risk patients for thyroid cancer
history of radiation
genetics
any PET avid node
66
MEN1 gene
mennin - autosomal dominant
67
MEN2 gene
RET - autosomal dominant
68
What percent of MTC are hereditary?
25%
69
What MTC patients get genetic testing?
all!
70
MTC with RLN involvement
take the RLN
71
Operation for MTC
always to total
do central LND if calcitonin >40
transplant all the paras into the forearm
72
MENIIB gene
RET mutation in codon M918T
73
MENIIA thyroid management
some data to tailor to specific mutation
follow calcitonin from birth
Perform total thyroidectomy when calcitonin level >150 or patient at age 5
74
MENIIB thyroid management
Remove thyroid before age 1
| Start screening for pheo at age 11
75
What do you use to guide lymphadenectomy for MTC?
Some use calcitonin levels; (others rely on US)
<20: no nodal dissection
20-50: central and ipsilateral
>50: bilateral neck dissection
>500: add mediastinal lymph node dissection
76
Who should do thyroidectomies for MENIIB?
should send to quarternary center to manage the incredibly small parathyroids in infants.
77
Is ultrasound useful for neck nodes in MTC?
not sensitive enough, rely on calcitonin, but need to take ultrasound positive nodes.
78
Jaw Tumor Syndrome
High risk of parathyroid cancer
79
Best test to find a parathyroid gland in reoperative scenario?
4DCT
80
three tumors in VHL
Pheos
RCCs
PNETs
81
appearance of VHL pancreatic tumors?
Cystic with solid components
82
Workup for VHL pancreatic tumor?
get a pancreatic MRI look closely for the cystic component.
83
Most common MEN1 pancreatic tumor
non-hormonal PNET
84
Steps of a Thompson Procedure for MENI pancreas?
1. Subtotal Distal Pancreatectomy
2. Enucleate all Head tumors
3. perform longitudinal duodenotomy and explore duodenum if gastrin is up.
85
Outcomes with the Michigan/Thompson Procedure
General Morbidity does not support and 30 of first 40 patients still required reoperation.
86
When to do a pancreas operation for MENI patient?
tumors >3cm
enlarging tumor
all insulinomas
87
Perioperative imaging for a MENI pancreas
octroscan preop
| intraoperative ultrasound
88
When to do a duodenotomy for MENI pancreas?
for all elevated gastrin cases
89
Modern approach to MENI pancreas
Once in the OR do an enucleation for all detectable tumors
| only do a whipple for gastrinoma of for recurrence.
90
rate of adrenal masses in autopsy studies?
7%
91
CT evaluation of adrenal masses
get a non-contrast CT benign if:
<10 Hounsfield units
well circumscribed
< 4cm
92
What else do you look for when looking at an adrenal mass?
check to make sure a contralateral adrenal is present!
93
ACC risk factors for peritoneal recurrence?
numerous risk factors suggesting laparoscopic technique is associated with peritoneal recurrence.
94
Node positivity rate of ACC?
10%
95
Any benefit to lymph node dissection for ACC?
no evidence to prove it.
96
FIRM ACT trial
ACC neoadjuvant trial for mitotane +/- EDT
| Higher response rate with EDT but no OS benefit
97
EDT chemotherapy
Etoposide
Doxorubicin
Cisplatin
98
ACC with caval thrombus?
Give neoadjuvant EDT and mitotane
| intraoperative ultrasound to evaluate extent of thrombus.
99
tumor thrombectomy
Try to get distal control on IVC. Could guide a balloon from IJ to below the hepatic veins.
RCC <2cm from renal vein can be "milked back"
thrombus below hepatic veins, a simple thrombectomy.
thrombus above hepatic veins, cardiopulmonary bypass
100
Advanced imaging for pheochromocytoma
PET/Dotatate - most sensitive test.
Would only do if you are still searching for a primary after a normal CT or MRI.
101
what drugs mess up 24hr urine for metanephrines?
amphetamines, cocaine, MAO and tricyclic antidepressants.
102
genetic testing for pheos?
test all positive patients and then all 1st degree relatives.
103
three genetic conditions associated with pheos
Von Hippel Lindau
MENII
Neurofibromatosis I
104
Observation of PNETs?
can observe low grade <1.5 cm
| resect all >1.5 cm and all intermediate and high grade.
105
Observation of PNETs in MENI patients?
resect all > 1 cm
106
embryologic origin of PNET tumors
neural crest
107
resect the primary in small bowel stage IV PNET?
usually should do given that symptomatic relief is well established and some retrospective studies suggest survival benefit
108
pancreatic PNET management?
consider enucleation.
109
Ultrasound follow-up of non-FNA thyroid nodules?
●6 to 12 months for subcentimeter nodules with suspicious characteristics
●12 to 24 months for nodules with low to intermediate suspicion on ultrasound
●2 to 3 years for very-low-risk nodules
110
Suspicious findings for thyroid nodule?
Irregular margins
Microcalcifications
Taller than wide shape
Rim calcifications
111
check a calcitonin for thyroid nodule?
no, especially if you cannot do a pentagastrin confirmatory test.
112
FNA a PET avid thyroid nodule?
yes if >1cm
113
Bethesda Classification
I Nondiagnostic (unsatisfactory) 5 to 10%
II Benign 0 to 3%
III Atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS) 10 to 30%
IV Follicular neoplasm (or suspicious for follicular neoplasm) 25 to 40%
V Suspicious for malignancy 50 to 75%
VI Malignant 97 to 99%
114
Thyroid FNA - no follicular tissue is obtained
Bethesda I nondiagnostic - need repeat FNA
115
Thyroid FNA - dense lymphocytic infiltration and lymphoid germinal centers.
Plasma cell
Hürthle cell changes
fibrosis
Hashimotos Thyroiditis - correlate clinically do not operate.
116
Thyroid FNA - mild nuclear atypia and lesions with extensive oncocytic (Hürthle cell) change but not enough to be classified as Hürthle cell neoplasm.
Atypia of undetermined significance - Bethesda III - repeat FNA v lobectomy
117
Thyroid FNA - mixed macrofollicular and microfollicular pattern
Folicular lesion of undetermined significance - Bethesda III - repeat FNA v lobectomy
118
Thyroid FNA - microfollicles, scant colloid, the absence of follicle formation, cells arranged in clusters and clumps, and varying nuclear atypia and cellular pleomorphism
Follicular neoplasm Bethesda IV - lobectomy
119
Thyroid FNA - large polyclonal cells with abundant oxyphilic cytoplasm.
Hurthle Cells- bethesda IV - need lobectomy, diagnosis of cancer can only be made after excision
120
Thyroid FNA - large cells, where cytoplasm has a "ground glass" appearance, nucleoli are prominent, and the nuclei demonstrate clefts and grooves and intranuclear cytoplasmic inclusions ("Orphan Annie eyes")
Psammoma bodies
dense "sticky" colloid may also be seen
diagnostic for papillary thyroid cancer
121
Thyroid FNA - eccentrically placed nuclei and cytoplasmic tails. The cytoplasm may be slightly granular and is usually configured as a tear drop or cytoplasmic tail
Medullary Thyroid cancer - may not always be picked up.
122
immunostain positive for calcitonin
Medullary Thyroid cancer
123
Thyroid FNA - marked pleomorphism, bizarre giant cells, and spindle cells
AnaplasticThyroid cancer
124
Pathology of thyroid lymphoma
difficult to distinguish from hashimoto's thyroiditis
125
rate of distant mets with anaplastic thyroid cancer?
15-50%
126
most common location for anapastic thyroid cancer to met?
extensive lung and mediastinum
127
labs for an anaplastic thyroid cancer
Thyroid function tests
CBC/CMP
Serum calcium and phosphorus
hypercalcemia of malignancy
hypocalcemia due to compromise of the parathyroids
Serum thyroglobulin
128
image based staging of anaplastic thyroid cancer
PET and brain MRI
129
Metastatic disease seen with anaplastic TC primary
~30 percent of patients with ATC have coexisting differentiated thyroid cancer,
metastases may not originate from anaplastic thyroid cancer.
thyroglobulin level and/or PET scan may help distinguish between the two
130
stage IV anaplastic TC management
There is no curative therapy for metastatic anaplastic thyroid cancer, and the disease is uniformly fatal.
median survival 4.2 months, compared with six months in those without metastases.
131
best case scenario with anaplastic thyroid cancer
with complete R0 resection and post-op radiation, median OS is 2 years.
132
chemo for anaplastic thyroid cancer
strongly consider clinical trials (basket trials)
doxorubicin
check for BRAF status for vemurafenib/trabetenib
133
PTC is found in contralateral lobe in what percent?
80%
134
PTC recurs clinically after what percent of thyroid lobectomies?
3-5%
135
Offer genetic testing for Bethesda II-IV thyroid nodules?
Probably not ready for primetime/board answer.
Safety is generally established at high experience centers but NPV depends on local incidence.
Multiple validation studies have questioned NPV at different institutions.
136
non-invasive follicular thyroid neoplasm with papillary like features. (NIFTP)
usually diagnosed at time of diagnostic lobectomy
No completion lobectomy
does need ultrasound surveilance of contralateral lobe.
137
Ideal candidate for PTC observation?
young patient
small tumor (~<2cm?)
tumor not near capsule, airway or RLN
138
Observe a Papillary TC?
Probably wouldn't offer personally but offer referral to quarternary hospital that was following result prospectively.
Saftey seems established at MSKCC and Japanese studies.
139
Patients who will eventually need PTC resection after o
tumor grows >3mm or >50% from baseline
140
Evidence of stable persistent thyroid cancer after resection?
This is the norm, try to avoid overtreatment. Consider Tg doubling time.
141
previous Papillary TC. Tg> 10 and I131 scan is negative, what next?
PET scan
142
Local recurrence after resection of PTC?
make sure to read old op notes and path notes to gauge quality of previous operation
143
What disease is RAI most effective for?
very effective for pulmonary mets
| minimally effective for bone mets. (consider palliative RT?)
144
TKIs for stage IV Papillary TC?
sorafenib
Lenvatinib (preferred)
(both dirty TKIs)
145
what med screws up aldosteronoma work-up?
need to take patient off spirinolactone
146
AUS/FLUS and benign molecular diagnostics
observation
147
Goal TSH for high risk PTC patient?
< 0.1 mU/L
148
Additional supplements when patient of TSH suppression Synthroid?
Calcium
| Vitamin D
149
First measurement of TSH and Tg after PTC resection?
6 - 12 weeks
150
PTC CNS mets?
gamma knife RT
151
Hoarsness is a presenting symptom for?
supraglottic or glottic cancer
152
Treatment for glottic cancer?
T1-T2 definitive RT + laser surgery
153
Neck node with occult primary?
FNA the node -> SSC
fine cut CT/MRI of the H&N
PET Scan
154
Labs for occult SSC?
HPV/EBV
Thyroglobulin
Calcitonin
Pax 8
155
Procedural work-up for SSC occult primary level IV or V node?
tripple endoscopy
laryngoscopy, consider tonsillectomy
bronchoscopy
esophagoscopy
156
When to get ThyroSeq?
Bethesda 3-4 lesions
| if low then <5% chance of cancer
157
When is it an emergency to give RAI?
never
158
Pre OR work-up for all thyroid cases?
TSH, T3/T4, thyroglobulin, calcium
laryngoscopy
Neck ultrasound
159
What is the mortality in the MSKCC PTC observation series?
zero
160
Risks of thyroidectomy?
3% RLN injury
3% permanent hypothyroid
1% risk of bleeding requiring reoperation
161
hypoparathyroidism refractory to Ca and other supplements
NATPARA
| recombinant PTH injections
162
Black box warning on NATPARA
caused osteosarcomas in animal experiments
163
Non-operative options for chyle leak
TPN/no fat diet
| if fails, can get IR to sclerose the thoracic duct.
164
Lambatinib
1st line in RAI non-responsive PTC
165
Anaplastic Thyroid Cancer
Start with chemoradiation while sending of tumor sequencing
targeted therapy based on sequencing
basket trials
166
What stage is Anaplastic Thyroid Cancer
Stage IV at presentation
167
RAI for anaplastic thyroid cancer?
NO!
168
When to trach anaplastic thyroid cancer?
only when symptomatic
| tumor will often grow out of wound and cause bleeding issues.
169
Gastrinoma management?
are mostly managed with PPIs now.
170
what to do for a RLN injury?
call for backup
repair with 9-0 suture
Consult a laryngeal specialist after to help with tone.
171
Bilateral RLN injury?
Need to do an emergent tracheostomy
172
ACC tumor thrombus
usually small.
See if you can resect and reconstruct that segment
if you can't go on veno-venous bypass, open vessel and tumor will usually "slide right out."
173
ATA 2016 guidelines for RAI?
give for:
extrathyroid extension
R2
distant mets of LN >3cm
```
selective use:
aggressive histologies
microscopic extension
LVI
>5 lymph nodes
```
174
Post-op care for parathyroid cancer patient?
trend calcium levels q6hrs.
give standing calcitriol and tums
IV only if symptomatic
175
dosage for calcitriol
half a microgram daily PO
176
intense workup of functional adrenal tumors?
dexamethasone supression test
plasma metanephrines
renin/aldosterone levels
177
hormonal work-up for an ACC?
yes, and not unusual to secrete more than one hormone
178
Dosing of phenoxybenzamine for pheo?
stat at 10 mg daily
| max 100 mg daily
179
Timing of phenoxybenzamine for a pheo?
at leas two weeks preop
180
Timing of b-blocker for a pheo?
3-5 days preop
181
dosing of b-blocker for a pheo?
propranolol 10mg q 6
| can change to extended release
182
alternatives to a/b-blockade for a pheo?
calcium channel blocker
| metyrosine (inhibits catacholamine synthesis)
183
Side effects of metyrosine?
```
sedation/depression/anxiety
nightmares
diarrhea
urolithiasis
galactorrhea
extrapyramidal signs
```
184
Screening after pheo resection?
Don't forget genetic testing
Imaging if malignant tumor
annual urine metanephrines
185
immaging options for an occult Pheo?
standard PET
| Dotatate scan
186
Unresectable stage IV pheo?
XRT
Tace/RFA for liver
I-131 if MIGB scan positive
187
How do you protect the thyroid if giving I-131 for a pheo?
give patient potassium-iodide
188
Lutathera for Pheo?
not yet FDA approved, but promising;
| could present at tumor board/look for trials
189
Chemical surveillance of carcinoids/NETs?
chromogrannin level
| urinary 5HIAA levels
190
preparation before a procedure for carcinoids?
give preop octrotide 500 mcg IV
191
hypotension during carcinoid case?
"carcinoid crisis"
start an octreotide gtt
generally refractory to volume/pressors
can happen during TACE too!
192
medical therapy for aldosteronoma?
spirinolactone
193
post-op management after removal of aldosteronoma
check an aldosterone level
| Q6 hr lytes to watch for hyperkalemia
194
Adrenal venous sampling pearls?
can give with cosyntropin infusion to increase sensitivity
need ratio of 1:5 in stimulated test
typically the unaffected side will be even less than the IVC since it is supressed.
195
patient presents with hypokalemia and hypertension?
aldosteronoma
196
young patient with unexplained weight change, facial plethora
cushings syndrome (exctopic corticosteroids)
197
how to rule out Munchausen's with cushings?
check urinary cortisol, if low then likely patient is taking pills.
198
cushing's work-up?
need at least 2 screening tests
low dose dexamethasone supression (1 mg)
urinary cortisol levels
late night salivary levels
199
high dose dexamethasone supression test
4-8 mg dexamethasone
if plasma cortisol/ACTH supressed then pituitary source.
if no supression, then ectopic tumor
200
patient presents with adrenal mass and virulazation?
think ACC
201
what percent of virulizing tumors are cancer?
~50%
202
What percent of ACC secrete hormones?
50% cortisol
| 25% androgens
203
Blood tests for virulizing tumor
adrenal androgens
- ----DHEAS
- ----androstenedione
- ----testosterone
- ----17-hydroxyprogesterone
- ----serum estradiol (men, old women)
204
control of cortisol secreting ACC?
Mitotane 1 g four times a day
if refractory
metyrapone 250 mg four times a day
205
control of androgen secreting ACC?
finasteride
| tamoxifen
206
who gets adjuvant mitotane?
high-grade disease (Ki67 >10 percent or mitotic rate greater than 20 per 50 high-power fields [HPF]), incompletely resected disease
intraoperative tumor spillage or fracture
large tumors
vascular or capsular invasion
207
Any RCTs for ACC?
ADIUVO
RCT for mitotane for low grade resected ACCs
208
How do you dose Mitotane?
Needs pharmacy serum monitoring
levels between 14 and 20 mcg/mL
209
tumor markers for MTC?
calcitonin
| CEA
210
5 year recurrence of MTC if biochemical cure?
<5%
211
follow-up MTC?
complete genetic testing if not done
follow calcitonin/CEA
Get a repeat neck ultrasound at year 1
212
workup for elevated post-op calcitonin?
<150 start with neck ultrasound
| >150 Neck ultrasound and CT c/a/p
213
Mildly elevated post-op calcitonin and no radiologic evidence of disease?
suspect microscopic disease in the neck,
| present at tumor board for consideration of neck irradiation
214
Symptoms of metastatic MTC?
Diarrhea - usually from large calcitonin producing liver mets
Cushings - ectopic ACTH
215
Palliation of MTC diarrhea?
imodium (check a c.diff)
octreotide
TACE
palliative debulking
216
Palliation of MTC cushings?
Vandatanib - dirty TKI hits RET
Mitotane - inhibits synthesis
Bilateral adrenalectomy - select patients carefully
217
Systemic therapies for stage IV MTC?
consider observation for Mets <1cm and asymptomatic
variety of TKIs (vandatanib 1st)
chemo has <10% response rate
LUTATHERA is emerging
218
Resect a primary MTC in the setting of stage IV disease?
only for palliation of airway or esophageal compression.
219
usefulness of postop PTH?
multiple studies show that PTH < 10 predicts symptomatic hypocalcemia and can be used to guide calcium replacement.
220
critical error to avoid on a parathyroid cancer?
rupture caries a high risk of neck carcinomatosis.
221
when to enucleate an insulinoma?
tumors < 2cm away from the main duct
| Test for MEN I first so you don't miss additional lesions
222
malignancy rate of insulinomas?
10%
223
most common non-adrenal location of a pheo?
organ of zuckerkandl at the aortic bifurcation.
224
jaw tumor syndrome
hyperparathyroidism
mandible fibromas
kidney lesions
225
patient presents with high PTH and calcium?
get genetic testing first before going into hyperparathyroid work-up!
226
Lymph node dissection for follicular carcinoma?
NO! spreads hematogenously
| remainder of treatment is as per PTC
227
Initial work-up for an insulinoma?
fasting glucose and insulin level
c-peptide
get genetic testing or Brain MRI Ca++/PTH to rule our MEN I
228
What to do before OR for an insulinoma?
Admit night before for D10 infusion while NPO
