PANCE Blueprint Endocrinology (7%)

Primary endocrine malignancy (Pearls)

Thyroid neoplastic disease Hoarse voice, solitary cold nodule on thyroid uptake scan!

Most often papillary carcinoma (80%)

Diagnostic studies:

  • Ultrasound is the best initial screen followed by a thyroid uptake scan. Usually normal thyroid function.
  • Microcalcifications, hypoechogenicity, a solid cold nodule, irregular nodule margins, chaotic intranodular vasculature, and a nodule that is more tall than wide.
  • Fine needle biopsy for definitive diagnosis (all lesions >1 cm should be biopsied)

Treatment: Surgical resection

  • Surgical resection with chemotherapy and external beam radiation reserved for anaplastic thyroid cancer.
Adrenal tumors/neoplastic disease Pheochromocytoma

  • Adrenal neoplasm - catecholamine secreting adrenal tumor - secretes norepinephrine and epinephrine autonomously and intermittently
  • Presentation: Recurrent headaches, HTN, sweating, palpitations.

Diagnosis:

  • 24-hour catecholamines including metabolites (metanephrine and vanillylmandelic acid)
  • MRI or CT of the abdomen to visualize tumor

Treatment:

  • Resect tumor - complete adrenalectomy
  • Medical treatment preoperative: Alpha blocker (phenoxybenzamine)
Multiple endocrine neoplasia (Prev Lesson)
(Next Lesson) Thyroid neoplastic disease
Back to PANCE Blueprint Endocrinology (7%)

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