NM By Myself > Endocrine NM > Flashcards

Endocrine NM Flashcards

(39 cards)

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1
Q

Adrenal glands location

A

Retroperitoneum
Below diaphragm
Superior and medially to kidney
Between D12 and L1

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2
Q

Glomerular zone

A

Mineralcorticoid hormones
Aldosterone - - control BP

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3
Q

Fascicular zone

A

75% of cortex
Glucocorticoid
Cortisol - - glycemic control

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4
Q

Reticular zone

A

Androgens

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5
Q

Medulla

A

25% adrenal mass
From entoderm, chromaphine cells
Catecholamines
Adrenalin, noradrenalin
Degrade to metanephrines

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6
Q

Adrenal uptake

A

Analog of cholesterol (precursor of steroid hormones)
50% modulated by ACTH
30% by RAS

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7
Q

NP-59 protocol

A

I131-iodomethylnorcholesterol
1 mCi
II, IV, VII day image
High energy collimator
20-30 min, 500k-1mln counts
Photopeak 364 keV

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8
Q

NP-59 preparation

A

Thyroid block 3 days before

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9
Q

NP-59 uptake

A

Liver
Gallbladder
Colon (require laxative)
Add Tc-colloid - - taken up by liver - - subtraction - - adrenal visualization

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10
Q

NP-59 normal

A

Symmetric uptake of adrenal on II day
Right adrenal closer to liver - - scatter - - more active uptake

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11
Q

Scintadren

A

Se75-selenomethylnorcholesterol
0.16-0.22 mCi
Middle energy collimator

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12
Q

Cushing

A

Hypercortisolism (fascicular zone) - - image of cortex by NP-59
Pituitary ACTH-dependent - - intense symmetric uptake in enlarged glands
Cortisol hypersecreting adenoma - - monolateral uptake, contralateral not visualized, ACTH independent
Cortical nodular hyperplasia - - bilateral asymmetric uptake
Corticoadrenal CA - - lack of adrenal glands

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13
Q

Primary hyperaldosteronism

A

Conn sy - - aldosterone secretion by adenoma/hyperplasia of glomerular zone/carcinoma

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14
Q

Secondary hyperaldosteronism

A

Renin elevated
Arterial hypertension
Hypokalemia
Muscular disorders

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15
Q

ACTH suppression with dexamethasone

A

1-4 mg dexamethasone PO 7 days before and continue
Stop ACE inhibitor, spironolactone, diuretics
Cholesterol uptake in fascicular zone decreased
Good image of glomerular and reticular zone
DD adenoma vs bilateral hyperplasia

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16
Q

Image interpretation Adrenal
Limitation
Indication

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A

Normal - symmetric uptake 4-5 days after
Adrenal visualization before 4th day - - adenoma (unilateral) or hyperplasia (bilateral)
Not identify adenoma in case of hyperplasia
Indication - - Primary hyperaldosteronism + normal CT

17
Q

Adrenal incidentaloma

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A

Benign adenoma - <3 cm, fat, <10 HU
Atypical - hemorrhage, no fat, necrosis, calcification, larger
>4 cm - malignant
>10 HU - - CECT–
relative washout >40% - - indeterminate for adenoma,
abs washout >60% - - adenoma incl lipidic poor

18
Q

Adrenal MTS

Study These Flashcards
A

Lung
Breast
Renal
Ovaries
GIT
Lymphoma
Melanoma

19
Q

Adrenal medulla pathology

Study These Flashcards
A

Pheo
Paraganglioma

20
Q

MIBG

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A

Guanethidine analog
WBS, SPECT 4h and 24h
Optimal for Pheo
Identify extra adrenal Pheo, MTS, post surgery recurrence

21
Q

I131-MIBG

Study These Flashcards
A

Image >24 h
False negative

22
Q

Adrenal Ca genetic

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A

Beckwith - Wiedeman - - elevated insulin like growth factor 2 - - hemihyoerthrophy, DM, adrenocortical tumor in children
Li-Fraumeni - - mutation in p53 gene tumor suppression - - tumor in brain, adrenal
MEN1 25-40%

23
Q

Suspicious adrenal Ca

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A

> 4 cm
Irregular margins
Central necrosis/haemorrhage
Enhancement
Invasion
Calcification

24
Q

Adrenal Ca poor prognosis

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A

> 50 years
Positive resection margins
N, M
Poorly diff

25
Functioning adrenal Ca
<5 cm Female Cushing Female virilization or male feminization Conn sy
26
Non-functioning adrenal Ca
>10 cm Male Abd pain Fullness Palpable mass
27
Adrenal Ca image
CT - study of choice to dd benign vs malignant FDG - limited uptake in adenoma, increased uptake in cancer
28
Most appropriate indication for Corticoadrenal scintigraphy
Cortisol hypersecreting adenoma
29
Suppression with dexamethasone
Stop ACTH stimulation - - reduce uptake in fascicular zone For hyperaldosteronism and hyperandrogenism
30
NP-59 + Tc-colloid subtraction
31
NP-59 Right adenoma
32
NP-59 Bilateral hyperplasia
33
MIBG Pheo
34
Octreoscan Paraganglioma
35
Intense symmetrical uptake in enlarged glands
ACTH dependent Cushing
36
Monolateral uptake, contralateral not visualized
Primary adrenal adenoma ACTH independent
37
Bilateral asymmetric uptake
Cortical nodular hyperplasia
38
Lack of adrenal glands
Corticoadrenal CA
39
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