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Flashcards in NMS Endocrine Deck (25):

What is a dangerous cause of hypercalcemia

metastatic carcinoma to bone (esp breast, prostate)


what is vicious cycle of hypercalcemia? how do you break it

hypercalcemia --> osmotic diuresis --> dehydration --> hypercalcemia; break it by first rehydrating aggressively, followed by loop diuretic (calcium wasting), and bisphosphonates


rule of 10s with pheochromocytomas

10% malignant, 10% bilateral, 10% extraadrenal, 10% epinephrine producing


tx of pheo

immediate tx of crisis is alpha + beta blockade (MUST HAVE BOTH) --> octreotide scan to localize tumor --> adrenalectomy


what is de quervain's thyroiditis? how to dx and tx

acutely enlarged/inflamed thyroid with initial hyperthyroidism; DIAGNOSE by elevated ESR, histology showing granulomas and degenerating follicles; TREAT with aspirin and analgesics, NOT SURGERY


when to operate in acute thyroiditis

if suppurative/bacterial, need surgical drainage


3 big risk factors for thyroid cancer

1) hx of radiation 2) fam hx thyroid cancer 3) voice/airway symptoms


how to work up patient with neck mass+ history of radiation

SURGERY --> further eval unnecessary


what syndrome is a/w medullary thyroid cancer

MEN 2 (RET gene mutation): pheochromocytoma, parathyroid cancer, thyroid cancer


w/u of thyroid nodule

FNA, U/S (NOT radioactive iodine study; FNA is quite accurate)


how to tx thyroid cyst

aspiration: if >4 cm or recurrent, increased risk of malignancy --> excision


which type of thyroid cancer is BAD

anaplastic/undifferentiated --> needs chemo, rads, NOT surgery (usually already too advanced)


4 types of potential surgical complications a/w thyroidectomy

1) unilateral recurrent laryngeal nerve injury (hoarseness) 2) bilateral recurrent laryngeal nerve injury (vocal cord paralysis) 3) external laryngeal nerve injury (distorted high pitched singing voice) 4) parathyroid injury (hypoparathyroidism)


most common cause of primary hyperparathyroidism

pituitary adenoma (carcinoma in need to explore neck +/- preop sestamibi imaging Sestamibi: parathyroid scintography; technetium 99


procedure for exploring primary hyperparathyroidism

if preop sestamibi, can just take out adenomatous parathyroid glands ("minimally invasive"); if no preop sestamibi, need to explore all 4 parathyroid glands


for which thyroid cancers do you use I131 or thyroid hormone suppression postop?

follicular and papillary; doesnt help for medullary since thats parafollicular (C-cell) hyperplasia


What if only find 3 parathyroid glands under exploration

have to find the 4th; often intrathyroid


what does elevated Ca and PTH suggest? how to tx

primary hyperparathyroidism; if adenoma explore/resect; if carcinoma radical resection


what does decreased Ca and elevated PTH suggest? how to tx

secondary hyperparathyroidism (eg, CKD) ; tx medically unless symptomatic (pain, fractures, ectopic calcifications, intractible pruritus) --> surgical mgmt (remove 3.5 PTH glands +/- relocation of remaining 0.5 to arm for easy accessibility)


tx of hashimotos

thyroid hormone replacement, bx surveillance to ensure no cancer (hashimotos a/w increased risk)


how to tx gastrinoma (Zollinger Ellison syndrome)

can be sporadic or metastatic; if SPORADIC, RESECT; if METASTATIC to liver and LN, consider GASTRIC RESECTION vs. HSV to prevent ulcerative complications


(highly selective vagotomy??)


with which syndrome is gastrinoma associated

MEN-1 (MENIN gene mutation); pancreatic, parathyroid, pituitary cancers


what classic triad a/w insulinoma

Whipple triad: 1) fasting hypoglycemia; 2) symptomatic hypoglycemia; 3) relief with glucose administration


tx of insulinoma

if sporadic, RESECT; if not, can use diazoxide (inhibitor of insulin release)


mgmt of incidentally disocered adrenal mass


depends on size; if <5 cm, check labs for indication of malignancy (Vanillylmandelic acid, potassium, cortisol), then remove vs. observe depending on outcome; if >5 cm , high risk of cancer --> wide resection + look for mets