Endocrine & Salivary Glands

Question 1

MC cause of hyperparathyroidism is……, that of hypoparathyroidism is…..

Answer 1

Parathyroid adenoma
Surgical removal or devascularization diring thyroidectomy

Question 2

CP of hyperparathyroidism

Answer 2

Asymptomatic, bone pain (osteitis fibrosa cystica), recurrent UT stones, abdominal pain due to pancreatitis & peptic ulcer, mentak changes, ectopic calcifications, muscle weakness, thirst polyuria, constipation, wt loss
Part of MEN1, MEN2A

Question 3

DD of hypercalcemia

Answer 3

1. Hyperparathyroidism
2. Malignant hypercalcemia
3. Adrenal crisis
4. Nutritional causes as milk alkali $, excess vit D
5. Prolonged immolbilization
6. Hypocalciuric hypercalcemia

Question 4

Describe ttt of hyperparathyroidism

Answer 4

1. Adenoma/carcinoma remove affected gland
2. Hyperplasia & 3ry hyperparathyroidism: remove 3 & half glands, some surgeons implant remaing half in firearm
3. 2ry treat CRF & administer phosphate binders
4. Ectopic PTH-rP: remove tumor source

Question 5

Mention causes of malignant hypercalcemia

Answer 5

Either secrete PTH-rP, as SCC of lung, RCC, bladder cancer
Osteolytic as BC, leukemias, MMs

Question 6

Mention manifestations of hypoparathyroidism

Answer 6

Circumoral numbness, Chvostek’s sign, Trousseau sign, muscle cramps & tetany in severe cases

Question 7

TTT of hypopara

Answer 7

Early PO hypocalcemia, IV Ca gluconate
Persistent hypocalcemia, oral administration of high dose Ca & vit D

Question 8

Describe etiology of Addison’s disease

Answer 8

1. Autoimmune disorder
2. Infections (TB)
3. Adrenal amyloidosis
4. Metastatic carcinoma
5. Surgical removal of adrenals

Question 9

MC cause of Cushing is….

Answer 9

Iatrogenic

Question 10

List inv for Cushing $

Answer 10

1. Loss of diurnal variation in cortisol in blood, saliva, urine
2. ACTH blood levels & DMST to diff pituitary from adrenal cause
3. Localisation mainly by CT, MRI on pituitary & adrenal

Question 11

MC cause of hyperaldosteronism is….

Answer 11

Adrenal adenoma (Conn $)

Question 12

Describe diagnosis & ttt for hyperaldosteronism

Answer 12

Diagnosed by Na, K, & aldosterone in the blood & imaging tests to detect adrenal tumors
TTT by resection of tumor, correction of renal artery stenosis or by using drugs that block the action of aldosterone (e.g. spironolactone)

Question 13

Mention ttt of non-functioning adrenal gland

Answer 13

Mass more than 4 cm, removed surgically
Less than 4 cm, follow up by repeated imaging & blood tests, monitor any inc in size & any transformation to functioning tumor that starts secreting excess hormones then surgery is indicated

Question 14

Mention inv for virilization

Answer 14

1. Dexamethasone suppression test suppresses androgen caused by adrenal hyperplasia to a lesser extent or not at all in other causes
2. Localization is done by CT, MRI & US
3. Surgical removal of the tumor

Question 15

List inv for pheochromocytoma

Answer 15

1. Measuring levels of CAs or their urine products
2. Determination of plasma-free metanephrine & normetanephrine levels
3. Localization of lesions
4. Radionuclide imaging (MIBG) only abnormal tissues show uptake of MIBG & normal adrenals do not visualize

Question 16

MC neuroendocrine tumors of pancreas are….

Answer 16

Insulinoma & gastrinoma

Question 17

Whipple triad is for diagnosis of…., includes….

Answer 17

Insulinoma
1. Symptoms of fasting hypoglycemia
2. Documented fasting hypoglycemia w/ sG less than 50 mg/dl
3. Relief of hypoglycemic symptoms after glucose administration

Question 18

Mention manifestations of:
1. Gastrinoma
2. VIPoma
3. Glucagonoma

Answer 18

1. Abdominal pain, peptic ulceration of UGIT, GERD, diarrhea (Zollinger-Ellison)
2. Vernor Morrison $: Watery Diarrhea, Hypokalemia,Achlorhydria, Acidosis.
3. Glucose intolerance, diabetes, cachexia, 1/3 pts have 2ry thromboembolic phenomena

Question 19

Mention labs & a special inv for insulinoma

Answer 19

1. Monitored fasting test
2. Insulin-to-glucose ratios
3. Levels of pro-insulin, insulin &c-peptide
   Intraoperative US is study of choice for localization of insulinomas

Question 20

Ideal inv for PanETs is…..

Answer 20

PET CT scan

Question 21

How to detect deep parotid tumors?

Answer 21

Diffuse bulge in the roof of soft palate or tonsillar fossa region, also may be palpable manually

Question 22

Mention inv for salivary glands

Answer 22

1. CT evaulate anatomical details
2. MRI for cranial nerves
3. FNAC of clinically suspected tumors of salivary glands
4. Sialography & plain X-ray: presence of salivary calculi

Question 23

GR: Submandibular stones are more common

Answer 23

1. More viscide secretion with high Ca
2. Elongated duct ascends upwards: inadequate drainage
3. Orifice in floor of mouth easy blockage

Question 24

What is Lugwig’s angina

Answer 24

2ry infection in the obstructed system leads to rapidly worsening symptoms & even spreading cellulitis of the floor of mouth

Question 25

Describe management of salivary stones

Answer 25

1. Superficial conservative parotidectomy 2. Sub mandibulectomy: is indicated for calculi within the gland, incision is well below mandible avoid damaging mandibular branch of the facial & avoiding the hypoglossal n 3. Orifice of parotid gland: meatotomy In anterior 2/3: intraoral approach longitudinal incision If it is impalpable, duct is opened from orifice backwards May be removed endoscopically or w/ lithotripsy

Question 26

Mention comp of acute bacterial sialoadenitis

Answer 26

1. General: chronicity, bacteremia, septicemia, pyemia, toxemia 2. Local: stone, fistula, abscess, VII palsy 3. Comp of drainage: fistula, facialn injury, Frey’s post-op $

Question 27

TTT of recurrent sialadenitis

Answer 27

1. AB according to C&S of parotid duct discharge 2. Oral hygeine 3. Ductoplasty to open duct orifice 4. If sialogrpahy shows remote duct stenoses, these can be dilated using balloons similar to angioplasty devices

Question 28

Mention hallmark of advanced malignant change of pleomorphic adenoma

Answer 28

Rapid growth w/ pain & facial n involvement

Question 29

MC 1ry malignancy of parotid is….that of submandibular is…..

Answer 29

Mucoepidermoid carcinoma Adenoid cystic carcinoma

Question 30

MC metastatic parotid tumor is….., ttt is…..

Answer 30

Squamous cell carcinoma Parotid resection, neck dissection, PO radiotherapy

Question 31

Describe TTT of ranula

Answer 31

Excision it is difficult bec of fragile lining & proximity to vital structures in the floor of mouth Incomplete removal leads to recurrence Marsupialization is an option