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Surgery Rotation > EOR endocrine part 1- pheochromocytoma, thyroid nodule, thyroid carcinoma > Flashcards

EOR endocrine part 1- pheochromocytoma, thyroid nodule, thyroid carcinoma Flashcards

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1
Q

What is pheochromocytoma?

A

Tumor of the adrenal medulla and sympathetic ganglion (from chromaffin cell lines) that produces catecholamines (NE>epi)

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2
Q

Which age group is most likely to be affected by pheochromocytoma?

A 
Any age (children and adults)
Average age is 40-60 yrs
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3
Q

Associated RFs of pheochromocytoma

A

MEN-II
FHx
von Recklinghausen dz
von Hippel-Lindau dz`

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4
Q

S/sx of pheochromocytoma

A 
Classic triad:
Palpitations
HA
Episodic diaphoresis
Also:
HTN
Pallor, leading to:
Flushing
Anxiety
Wt loss
Tachycardia
Hyperglycemia
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5
Q

What is the most common sign of pheochromocytoma?

A

HTN

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6
Q

What diagnostic tests should be performed in a pheochromocytoma?

A

Urine screen: VMA, metanephrine, and normetanephrine

Urine/serum epi/norepi levels

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7
Q

What are the other common lab findings of pheochromocytoma?

A

Hyperglycemia (epi increases glucose, norepi decreases insulin)
Polycythemia (resulting from intravascular volume depletion)

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8
Q

What is the MC site of a pheochromocytoma?

A

Adrenal >90%

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9
Q

What are the other sites of pheochromocytoma?

A

Organ of Zuckerkandl
Thorax (mediastinum)
Bladder
Scrotum

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10
Q

What are the tumor localization tests for pheochromocytoma?

A 
CT scan
MRI
I-MIBG
PET scan
OctreoScan
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11
Q

How does the I-MIBG scan work?

A

I-MIBG is a norepi analog that colelcts in adrenergic vesicles and, thus, in pheochromocytomas

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12
Q

What is the role of PET scan in pheochromocytoma?

A

Positron Emission Tomography is helpful in localizing pheochromocytomas that do no accumulate MIBG

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13
Q

What is the scan for imaging adrenal cortical pheochromocytoma?

A

NP-59 (cholesterol analog)

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14
Q

What is the localizing option for pheochromocytoma if a tumor is not seen on CT, MRI, or I-MIBG?

A

IVC venous sampling for catecholamines (gradient will help localize the tumor)

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15
Q

What is the tumor site for pheochromocytoma if epinephrine is elevated?

A

Must be adrenal or near the adrenal gland because nonadrenal tumors lack the capability to methylate norepinephrine to epinephrine

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16
Q

Can histology be used to determine malignancy in pheochromocytoma?

A

No

Only distant metastasis or invasion can determine malignancy

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17
Q

What is the classic pheochromocytoma rule of 10s?

A 
10% malignant
10% bilat
10% in children
10% multiple tumors
10% extra-adrenal
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18
Q

What is the preop/medical tx of pheochromocytoma?

A

Increase intravascular volume with alpha blockade (e.g., phenoxybenzamine or prazosin) to allow reduction in catecholamine-induced vasoconstriction and resulting volume depletion
Tx should start as soon as dx is made +/- beta blockers

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19
Q

What is the surgical tx of pheochromocytoma?

A

Tumor resection with early ligation of venous drainage and minimal manipulation

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20
Q

What are the possible periop complications of pheochromocytoma?

A

Anesthetic challenge: hypertensive crisis with manipulation (treat with nitroprusside)
Hypotension with total removal of the tumor
Cardiac dysrhythmias

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21
Q

In the pt with pheochromocytoma, what must be ruled out?

A

MEN type II (almost all cases are bilat)

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22
Q

What is the organ of Zuckerlandl?

A

Body of embryonic chromaffin cells around the abdominal aorta
Normally atrophies during childhood, but is the most common site of extra-adrenal pheochromocytoma

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23
Q

DDx of thyroid nodule

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A 
Multinodular goiter
Adenoma
Hyperfunctioning adenoma
Cyst
Thyroiditis
Carcinoma/lymphoma
Parathyroid carcinoma
24
Q

Name three types of nonthryroidal neck masses

Study These Flashcards
A

Inflammatory lesions
Congenital lesions
Malignant lesions: lymphoma, metastases, squamous cell carcinoma

25
What studies can be used to evaluate a thyroid nodule?
U/s- solid or cystic nodule FNA- cytology I scintiscan- hot or cold nodule
26
What is the diagnostic test of choice for thyroid nodule?
FNA
27
What is the percentage of false neg results on FNA for thyroid nodule?
~5%
28
What is meant by a "hot" vs a "cold" nodule?
Nodule uptake of IV I131 or mT99 Hot- increased I123 uptake= functioning/hyperfunctioning nodule Cold- decreased I123 uptake= nonfunctioning nodule
29
What are the indications for a I123 scintiscan for thyroid nodule?
Nodule with multiple nondiagnostic FNAs with low TSH | Nodule with thyrotoxicosis and low TSH
30
What is the role of thyroid suppression of a thyroid nodule?
Diagnostic and therapeutic | Administration of thyroid hormone suppresses TSH secretion, and up to half of the benign thyroid nodules will disappear
31
What hx suggests thyroid carcinoma in a thyroid nodule?
Neck radiation FHx (thyroid CA, MEN-II) Young age M>F
32
What signs suggest thyroid carcinoma in a thyroid nodule?
``` Single nodule Cold nodule Increased calcitonin levels LAD Hard, immobile nodule ```
33
What sx suggest thyroid carcinoma in a thyroid nodule?
Voice change (vocal cord paralysis) Dysphagia Discomfort (in neck) Rapid enlargement
34
What is the MCC of thyroid enlargement?
Multinodular goiter
35
What are indications for surgery with multinodular goiter?
Cosmetic deformity Compressive sx Cannot r/o CA
36
What is Plummer's dz?
Toxic multinodular goiter
37
Name the five main types of thyroid carcinoma and their relative percentages?
``` Papillary carcinoma: 80% Follicular carcinoma: 10% Medullary carcinoma: 5% Hurthle cell carcinoma: 4% Anaplastic/undifferentiated carcinoma: 1-2% ```
38
S/sx of thyroid carcinoma
Mass/nodule LAD Most are euthyroid
39
What comprises the workup of thyroid carcinoma?
``` FNA Thyroid u/s TSH Ca level CXR +/- I123 scentiscan ```
40
What oncogenes are associated with thyroid cancers?
Ras gene family and RET proto-oncogene
41
Environmental risk of papillary adenocarcinoma
Radiation exposure
42
Average age of papillary adenocarcinoma
30-40 yrs
43
Sex distribution of papillary adenocarcinoma
F>M, 2:1
44
Associate histologic findings of papillary adenocarcinoma
Psammoma bodies
45
Route and rate of spread of papillary adenocarcinoma
Most spread via lymphatics (cervical adenopathy) | Spread occurs slowly
46
I131 uptake of papillary adenocarcinoma
Good uptake
47
10-yr survival rate of papillary adenocarcinoma
~95%
48
Tx for papillary adenocarcinoma with <1.5 cm and no hx of neck radiation exposure
Thyroid lobectomy and isthmectomy Near-total thyroidectomy Total thyroidectomy
49
Tx for papillary adenocarcinoma with >1.5 cm, bilat, + cervical node metastasis OR a h/o radiation exposure?
Total thyroidectomy
50
Tx for papillary adenocarcinoma with lateral palpable cervical LNs
Selective neck dissection (ipsilateral)
51
Do pos cervical nodes affect the prognosis of papillary adenocarcinoma?
No
52
Tx for papillary adenocarcinoma with central cervical LNs
Central neck dissection
53
What postop med should be administered with papillary adenocarcinoma?
thyroid hormone replacement, to suppress TSH
54
What is the MC site of distant metastases with papillary adenocarcinoma?
Pulm (lungs)
55
What are the Ps of papillary thyroid CA?
``` Popular (MC) Psammoma bodies Palpable LNs Positive I131 uptake Positive prognosis Postop I131 scan to diagnose/treat metastases Pulmonary mets ```

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