Fiser Absite. Ch 20-22. Pituitary. Adrenal. Thyroid.

Front 1

What inhibits prolactin secretions?

Back 1

dopamine

Front 2

What does the posterior pituitary produce?

Back 2

ADH, Oxytocin

Front 3

What nuclei in the hypothalamus produces ADH? and Oxytocin?

Back 3

supraoptic, paraventricular

Front 4

What does the anterior pituitary produce?

Back 4

FSH, LH, ACTH, TSH, prolactin, GH

Front 5

Nonfunctional tumors of the pituitary are almost always what type? what is the tx?

Back 5

macroadenomas, transsphenoid resection

Front 6

What rx might cause a response in TSH and FSH/LH secreting pituitary tumors?

Back 6

bromocriptine (dopamine agonist)

Front 7

What is the most common pituitary adenoma?

Back 7

prolactinoma (mostly microadenomas)

Front 8

Prolactinoma macroadenoma of the pituitary should be resected if hemorrhage, visual loss, CSF leak or if pt wants what?

Back 8

pregnancy

Front 9

Prolactinoma microadenoma of the pituitary should be resected if ____ unsafe or ineffective (is OK in pregnancy)

Back 9

bromocriptine

Front 10

Gigantism is a sx of acromegaly. Name 2 more.

Back 10

HTN, DM

Front 11

Name the acromegaly preoperative rx that inhibits the release of GH.

Back 11

octreotide

Front 12

How can acromegaly be life-threatening?

Back 12

cardiac sx (valve dysfunction, cardiomyopathy)

Front 13

Postpartum trouble lactating is usually the 1st sign of what syndrome?

Back 13

Sheehan's syndrome

Front 14

Craniopharyngioma is a caclified cyst, remnants of what?

Back 14

Rathke's pouch

Front 15

What syndrome occurs after bilateral adrenalectomy; increased CRH causes pituitary enlargement resulting in amenorrhea and visual problems?

Back 15

Nelson's syndrome

Front 16

Why is there hyperpigmentation in Nelson's syndrome?

Back 16

bilateral adrenalectomy causes increased ACTH, beta-MSH (melanocyte-stimulating hormone) is a peptide byproduct of ACTH

Front 17

What is the tx for Nelson's syndrome?

Back 17

steroids

Front 18

What syndrome is caused by adrenal gland hemorrhage that occurs after meningococcal sepsis infection; can lead to adrenal insufficiency.

Back 18

Waterhouse-Friderichsen syndrome

Front 19

What is the arterial supply of the adrenal gland and what is their origin?

Back 19

Superior adrenal - inferior phrenic artery
Middle adrenal - aorta
Inferior adrenal - renal artery

Front 20

What is the venous drainage of the adrenal glands?

Back 20

Left adrenal vein goes to left renal vein
Right adrenal vein goes to inferior vena cava

Front 21

What percentage of abdominal CT scans show adrenal incidentalomas? what percentage are mets or primary adrenal tumors?

Back 21

1-2%, 5%

Front 22

When is surgery indicated for asymptomatic adrenal mass?

Back 22

ominous characteristics (nonhomongenous),
>4-6 cm,
functioning,
enlarging

Front 23

How often to follow up for asymptomatic adrenal mass?

Back 23

every 3 mos for first year and yearly after that

Front 24

What is the most common mets to adrenal?

Back 24

lung CA

Front 25

What is the workup for asymptomatic adrenal mass with a cancer history?

Back 25

bx

Front 26

What are the 3 layers of the adrenal cortex and what do they produce?

Back 26

GFR
Glomerulosa - aldosterone (salt)
Fasciculata - glucocorticoids (sugar)
Reticularis - androgens/estrogens (sex)

Front 27

What is the innervation to the adrenal cortex? and the medulla?

Back 27

none, splanchnic nerves

Front 28

What does 4 things does aldosterone affect in the kidney?

Back 28

sodium resorption, secretion of potassium, hydrogen ions, and ammonia

Front 29

What does excess estrogens and androgens by adrenals almost always indicate?

Back 29

CA

Front 30

What is the most common (90%) congenital adrenal hyperplasia?

Back 30

21 hydroxylase deficiency

Front 31

In 21 hydroxylase deficiency what hormone is produced in excess and what is the effect on BP?

Back 31

increased testosterone causes precocious puberty in males and virilization in females. Is salt wasting so causes hypotension

Front 32

What are the 2 treatments for 21 hydroxylase deficiency and 11 hydroxylase deficiency?

Back 32

cortisol and genitoplasty

Front 33

List the 3 types of congenital adrenal hyperplasia and their sexual development and BP sx.

Back 33

21 hydroxylase deficiency causes precocious puberty in males virilization in females. It is salt wasting so it causes hypotension

17 hydroxylase deficience causes ambiguous genitalia in males at birth and is salt saving

11 Hydroxylase deficiency precocious puberty in males, virilization in females. Salt saving so it causes hypertension

21 hypotensive boy, 17 hypertensive girl, 11 hypertensive boy

Front 34

What is the name of the syndrome with hyperaldosteronism?

Back 34

Conn's syndrome

Front 35

What are the two types of Conn's syndrome and their primary marker?

Back 35

Primary disease has low renin (adenoma),
Secondary disease has high renin (CHF, RAS, liver failure, diuretics, Bartter's syndrome - renin secreting tumor)

Front 36

What is more common primary or secondary Conn's syndrome?

Back 36

secondary

Front 37

What is the #1 and #2 causes of primary hyperaldosteronism?

Back 37

adenoma, hyperplasia

Front 38

Localizing studies in hyperaldosteronesim include Localizing studies – MRI, and ___ (shows hyperfunctioning adrenal tissue; differentiates adenoma from hyperplasia; 90% accurate); ___ if others nondiagnostic

Back 38

NP-59 scintigraphy,
adrenal venous sampling

Front 39

In the tx of hyperaldosteronism, hyperplasia is seldom cured (↑ morbidity with bilateral resection) Try medical therapy first with hyperplasia using ___, calcium channel blockers, and potassium. If bilateral resection is performed (usually done for refractory hypokalemia), patient will need ___ postoperatively

Back 39

spironolactone,
fludrocortisone

Front 40

What is the number one cause of hypocortisolism?

Back 40

withdrawal of exogenous steroids

Front 41

What is the number one cause of hypercortisolism?

Back 41

iatrogenic

Front 42

In the diagnosis of hypercortisolism what is done first (most sensitive test)? What is done 2nd?

Back 42

24 hour urine cortisol, low dose overnight dexamethasone suppression test

Front 43

What is the dx if low-dose overnight dexamethasone suppression test results in low urinary cortisol?

Back 43

Cushing's disease (pituitary adenoma)

Front 44

What is the #1 non-iatrogenic cause of Cushing's syndrome?

Back 44

Cushing's disease (pituitary adenoma)

Front 45

What is the #2 noniatrogenic cause of Cushing's syndrome? what is its most common cause?

Back 45

Ectopic ACTH, small cell lung CA

Front 46

Cortisol is not suppressed with either the low-dose or high-dose dexamethasone suppression test, what is the most likely diagnosis?

Back 46

ectopic ACTH

Front 47

With ectopic ACTH resection of the primary tumor is the tx. What are two alternatives if resection is not possible?

Back 47

medical suppression or bilateral adrenalectomy

Front 48

Name the drug used for adrenocortical cancer with metastatic disease that is an adrenal-lytic

Back 48

Op-DDD (mitotane)

Front 49

What is the origin of the adrenal medulla?

Back 49

ectoderm neural crest cells

Front 50

Catecholamine production starts with tyrosine. What are the next 4?

Back 50

dopa -> dopamine -> norepinephrine -> epinephrine

Front 51

What is the rate limiting step in the production of catecholamines and what is the enzyme?

Back 51

tyrosine to dopa, tyrosine hydroxylase

Front 52

PNMT is the enzyme only found in the adrenal medulla. What does it doe?

Back 52

converts norepinephrine to epinephrine

Front 53

What is the only type of pheochromocytomas that will produce epinephrine?

Back 53

adrenal

Front 54

What is the most notable location for extra-adrenal neural crest tissue?

Back 54

organ of Zuckerkandl

Front 55

What are the 5 things in the 10% rule for pheochromocytoma?

Back 55

malignant, bilateral, in children, familial, extra-adrenal

Front 56

What type(s) of MEN syndrome are associated with pheo?

Back 56

MEN IIA and IIB

Front 57

Which side are most pheos on?

Back 57

right

Front 58

Extra-adrenal pheos are more likely what?

Back 58

malignant

Front 59

What type of scan is useful in finding the location of a pheo?

Back 59

MIBG (noepinephrine analogue)

Front 60

Why don't you use venography with pheo dx?

Back 60

can cause hypertensive crisis

Front 61

How do you control pressure in a pheo pt preoperatively?

Back 61

alpha blocker (phenoxybenzamine) before beta blocker to prevent a hypertensive crisis from unopposed alpha blockade

Front 62

What drug is used in the tx of pheo, inhibits tyrosine hydroxylase causing decreased synthesis of catecholamines?

Back 62

metyrosine

Front 63

What is an important step in the resection of a pheo?

Back 63

ligate veins before manipulating tumor

Front 64

Name 4 extra adrenal sites for pheo.

Back 64

vertebral bodies, opposite adrenal gland, bladder, aortic bifurcation

Front 65

Name the rare benign, asymptomatic tumor of neural crest origin in the adrenal medulla or sympathetic chain.

Back 65

Ganglioneuroma

Front 66

What is the origin of the thyroid?

Back 66

1st and 2nd pharyngeal pouches

Front 67

What is the blood supply of the thyroid with origins?

Back 67

superior thyroid arter is the 1st branch off the external carotid artery,

inferior thyroid artery is off the thyrocervical trunk

Front 68

What is the blood supply to the parathyroids and how should they be ligated in thyroidectomy?

Back 68

inferior thyroid arteries, ligate close to thyroid to avoid injuring parathyroids

Front 69

What is the blood supply to the thyroid isthmus that is occurs in 1% and its origin?

Back 69

Ima artery arises from the innominate or aorta

Front 70

What is the venous drainage of the thyroid and where do they drain?

Back 70

Superior and middle thyroid veins drain into the internal jugular. The inferior vein drains to the innominate vien

Front 71

Nonrecurrent laryngeal nerve arises directly from the vagus and occurs in 2-3%. Which side is more common?

Back 71

right

Front 72

The superior laryngeal nerve tracks close to what other structure?

Back 72

superior thyroid artery but is variable

Front 73

What is the innervation of the cricothyroid muscle and what does injury result in?

Back 73

superior laryngeal nerve, loss of projection and easy voice fatigability

Front 74

Where does the recurrent laryngeal nerve track?

Back 74

runs posterior to thyroid lobes in the tracheosophageal groove. can track with inferior thyroid artery but is variable

Front 75

What structures do the right and left recurrent laryngeal nerves loop around?

Back 75

right loops around right subclavian, left loops around aorta

Front 76

What does the recurrent laryngeal nerve innervate?

Back 76

motor to all larynx except cricothyroid

Front 77

Injury to recurrent laryngeal nerve results in hoarseness. What additional tx is need for bilateral injury and why?

Back 77

needs emergency trach since bilateral injury can obstruct airway

Front 78

What is the posterior medial suspensory ligament of the thyroid that is close to the RLNs and requires careful dissection?

Back 78

Ligament of Berry

Front 79

What is the molecule that stores T3 and T4 in colloid?

Back 79

thyroglobulin

Front 80

What is the most lateral posterior extension of thyroid tissue called? They can be rotated medially to find what structures? (left behind with subtotal thyroidectomy because of proximity).

Back 80

Tubercles of Zuckerkandl

Front 81

What is the name of the cells that produce calcitonin?

Back 81

Parafollicular C cells

Front 82

What is a long-term side effect of thyroxine treatment?

Back 82

osteoporosis

Front 83

Postthyroidectomy pt develops stridor. What do you do?

Back 83

open neck emergently to remove hematoma, can result in airway compromise

Front 84

Thyroid storm is most common after surgery in pt with undiagnosed ____?

Back 84

Grave's disease

Front 85

What are the following sx of?:

increased HR, fever, numbness, irritability, vomiting, diarrhea, high-output cardiac failure (most common cause of death)

Back 85

Thyroid storm

Front 86

Describe the Wolf-Chaikoff effect which is very effective for pts in thyroid storm.

Back 86

Patient given high doses of iodine (Lugol’s solution, potassium iodide), which inhibits TSH action on thyroid and inhibits organic coupling of iodide, resulting in less T3 and T4 release

Front 87

What is the first step in dx of asymptomatic thyroid nodule?

Back 87

thyroid function tests

Front 88

Asymptomatic thyroid nodule FNA shows cyst fluid. It is drained and it recurs, what next?

Back 88

thyroidectomy or lobectomy

Front 89

Asymptomatic thyroid nodule with normal TFTs what is the next step in dx?

Back 89

FNA

Front 90

Thyroid FNA shows colloid tissue what is the tx?

Back 90

Low chance of malignancy (<1%), thyroidectomy or lobectomy if it enlarges

Front 91

Thyroid FNA shows follicular cells, what next and what is the malignancy rate?

Back 91

thyroidectomy or lobectomy (5-10% malignancy rate)

Front 92

What percentage of thyroid nodules are benign?

Back 92

85%

Front 93

What next if a thyroid nodule FNA is indeterminate?

Back 93

Radionucleotide study

Front 94

Thyroid nodule FNA is indeterminate, radionucleotide study shows hot nodule, what next?

Back 94

Give thyroxine for 6 months, if size does not decrease perform lobectomy

Front 95

Thyroid nodule FNA is indeterminate, radionucleotide study shows cold nodule, what next?

Back 95

thyroidectomy or lobectomy

Front 96

Diffuse enlargement of thyroid without evidence of functional abnormality = nontoxic colloid goiter. What is the tx?

Back 96

Tx: try to suppress with thyroxine; 131I (may be ineffective), thioamides, subtotal thyroidectomy or lobectomy on side of goiter if medical treatment ineffective

Front 97

What is the name of the thyroid lobe that occurs in 10%, extends from the isthmus toward the thymus?

Back 97

pyramidal lobe

Front 98

What is the cyst that classically moves upward with swallowing?

Back 98

thyroglossal duct cyst

Front 99

What is the tx for thyroglossal duct cyst and why?

Back 99

Resection, susceptible to infection and my be premalignant. (Also need to take midportion or all of hyoid bone along with the cyst)

Front 100

What are the two main side effects of PTU and Methimazole?

Back 100

aplastic anemia or agranulocytosis

Front 101

What is the treatment for hyperthyroidism that is good for young pts, small goiters and mild T3 and T4 elevation?

Back 101

PTU and methimazole

Front 102

What is the treatment for hyperthyroidism that is good for pts who are poor surgical candidates or unresponsive to PTU?

Back 102

radioactive iodine (131I)

Front 103

When is the best time to operate in pregnant women with hyperthyroidism?

Back 103

2 trimester due to decreased risk of teratogenic events and premature labor

Front 104

What is the most common cause of hyperthyroidism and what is the pathophys?

Back 104

Graves' disease, IgG antibodies to TSH receptor

Front 105

What is the recurrence rate for tx of Graves' disease with thioamides, 131I, and subtotal thyroidectomy?

Back 105

70%, 10%, 10%

Front 106

Suspicious nodule in pt with Graves' disease, what is the tx?

Back 106

bilateral subtotal or total thyroidectomy

Front 107

What is the preop preparation for a pt with Graves' disease undergoing a bilateral subtotal or total thyroidectomoy?

Back 107

Preop preparation: PTU or methimazole until euthyroid, β-blocker, 1 week before surgery, Lugol’s solution for 10–15 days to decrease friability and vascularity (start only after euthyroid)

Front 108

What is the most common cause of thyroid enlargement?

Back 108

toxic multinodular goiter

Front 109

Sx of toxic multinodular goiter include:

cardiac symptoms, weight loss, insomnia, airway compromise;

What could precipitate sx?

Back 109

contrast dyes

Front 110

What is the tx for toxic multinodular goiter and single toxic nodule?

Back 110

131I and thioamides; 131I can be less effective in some (inhomogeneous uptake by gland); subtotal thyroidectomy or lobectomy if medical treatment ineffective

Front 111

What is the most common cause of hypothyroidism in adults?

Back 111

hashimoto's disease

Front 112

Why can a goiter develope in Hashimoto's disease?

Back 112

lack of organification of trapped iodide inside gland

Front 113

What usually precipitates DeQuervains's thyroiditis?

Back 113

viral URI

Front 114

What is the tx for De Quervains thyroiditis?

Back 114

steroids, ASA

Front 115

Rare condition of woody, fibrous component to thyroid that can involve adjacent strap muscles and carotid sheath    • Can resemble thyroid CA or lymphoma (need biopsy)    • Disease frequently results in hypothyroidism and compression. Tx is steroids and thyroxine. May need isthmectomy or trach.

Back 115

Riedel's fibrous struma

Front 116

What is the most common endocrine malignancy in the US?

Back 116

thyroid CA

Front 117

What is the most common type of thyroid CA?

Back 117

papillary

Front 118

What type of thyroid CA is the least aggressive, slow growing and has the best prognosis?

Back 118

papillary

Front 119

What is the prognosis in papillary thyroid CA based on?

Back 119

local invasion

Front 120

What type of thyroid cancer's pathology has psammoma bodies and ophan Annie nuclei?

Back 120

papillary

Front 121

Papillary thyroid CA less than what size can have a lobectomy instead of total thyroidectomy?

Back 121

<1 cm

Front 122

Papillary Thyroid CA with clinically positive cervical nodes or extrathyroidal tissue requires what additional tx?

Back 122

ipsilateral MRND

Front 123

Papillary thyroid CA with metastatic disease, residual local disease, positive lymph nodes or capsular invasion requires what addtional tx?

Back 123

131I 6 weeks after surgery

Front 124

When would you give XRT for papillary thyroid CA

Back 124

unresectable or no response to 131I

Front 125

What is the 5 year survival in papillary thyroid CA?

Back 125

95%

Front 126

Enlarged lateral neck lymph node that shows normal appearing tissue. What is it and what is the tx?

Back 126

papillary thyroid CA with lymphatic spread, total thyroidectomy and MRND

Front 127

What percentage of follicular thyroid carcinoma has metastatic disease at the time of presentation?

Back 127

50%

Front 128

What is the route of metastasis and most common site with follicular thyroid carcinoma?

Back 128

hematogenous, bone

Front 129

If thyroid nodule FNA shows just follicular cells, what is the chance of malignancy?

Back 129

10%

Front 130

Lobectomy for follicular cells on thyroid FNA. Pathology shows adenoma or follicular cel hyperplasia. What next?

Back 130

nothing

Front 131

What size thyroid lesions showing follicular CA need total thyroidectomy?

Back 131

>1 cm

Front 132

Follicular thyroid CA with clinically positive cervical nodes or extrathyroidal tissue involvement. What additional tx is needed?

Back 132

ipsilateral MRND

Front 133

Follicular thyroid CA > 1 cm or extrathyroidal disease need what tx in addition to thyroidectomy?

Back 133

131I 6 weeks after surgery

Front 134

What is the 5 year survival rate with follicular thyroid CA?

Back 134

70%

Front 135

What does the pathology show in medullary thyroid carcinoma?

Back 135

amyloid deposition

Front 136

What can be used to test for medullary thyroid CA? Causes increase in calcitonin?

Back 136

Gastrin

Front 137

From what cells does Medullary thyroid carcinoma arise and what do they secrete?

Back 137

parafollicular C cells, calcitonin

Front 138

What two other conditions should be screened for if medullary thyroid carcinoma is diagnosed?

Back 138

hyperparathyroidism and pheochromocytoma

Front 139

What are two sx of elevated calcitonin?

Back 139

flushing and diarrhea

Front 140

Tx for medullary thyroid carcinoma is total thyroidectomy with what other dissection?

Back 140

central neck

Front 141

Prophylactic thyroidectomy and central node dissection in MEN IIa or IIb patients at what age?

Back 141

2 years

Front 142

What can be monitored for disease recurrence in medullary thyroid carcinoma?

Back 142

calcitonin

Front 143

What is the 5 year survival in medullary thyroid carcinoma?

Back 143

50%

Front 144

What is the 5 year survival for anaplastic thyroid cancer?

Back 144

0%

Front 145

What types of thyroid CA is 131I effective?

Back 145

papillary and follicular only