PANCE Blueprint Endocrinology (7%)

Primary endocrine malignancy (Pearls)

Thyroid neoplastic disease
Patient will present as → a 40-year-old woman who is otherwise healthy presents to your office complaining of a lump in her neck. On examination, she is found to have a firm 2-cm nodule associated with the left lobe of the thyroid gland.

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
Patient will present as → a 43-year-old female with high blood pressure unresponsive to therapy. She complains of headaches, palpitations, and sweating. She has a history of neurofibromatosis type 1, though without any neurological deficits. She has multiple café-au-lait spots on her body. The ECG demonstrates sinus tachycardia. She is found to be hypertensive to 154/121 mmHg. Her 24-hour urine metanephrines and VMA come back elevated. Her abdominal CT demonstrates an adrenal mass.


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


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


  • Resect tumor - complete adrenalectomy
  • Medical treatment preoperative: Alpha blocker (phenoxybenzamine)
Neoplastic syndrome (Lecture) (Prev Lesson)
(Next Lesson) Thyroid neoplastic disease (Lecture)
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