Please enable JavaScript.
Coggle requires JavaScript to display documents.
Endocrinology (Adrenal Gland (imaging (US - non specific, detects adrenal…
Endocrinology
Adrenal Gland
Cushing's syndrome
- symptoms due to prolonged exposure to high levels of the cortisol:
rapid weigh gain, irritability, depression, muscle and bone weakness, DM, HTN, hirsutism, hypercholestrolemia
- caused by: adrenal hyperplasia, adrenal cortical-producing adenoma, adrenal cortical carcinoma
conn's syndrome
- primary aldosteronism ( HTN, hypokalaemia).
- caused by: adrenal adenoma, hyperplasia, adrenal cortical carcinoma (uncommon)
Addison's disease
- primary adrenal insufficiency
- muscle weakness, fever, weight loss, diarrhoea, headache, sweating, hyper pigmentation
- caused by: adrenal dysgenesis, impaired steroidogenesis, adrenal destruction
Tumors
- adenoma - most common benign tumors, non-functioning incidentaloma mostly, than hyperfuctioning.
- metastases: most common malignant tumors
- pheochromocytoma: catecholamine-secreating, neuroendocrine tumori fund in adrenal medulla
- cortical carcinoma- rare, aggressive tumor
imaging
- US - non specific, detects adrenal mass ( small tumors cannot be visible , especially on the left side), solid, cystic, mixed, calcifications, controlling of tumor enlargement
- CT:
70% of adenomas contains fat and will be of low attenuation on unenhanced CT
adenomas rapidly washout contrast
using 10HU on native CT result in sensitivity 70 % and specificity 90% for diagnosis of adenoma
30% of adenoma called lipid poor and cannot be differentiated from malignant masses on un unenhanced CT , they can be differentiated on the basis of their fast washout of contrast
absolute enhancement wash out > 660% = adenoma
relative enhancement wash out > 40% = adenoma
- MRI:
chemical shift sequence - the highest sensitivity in differentiation adenomas from non-adenomas
coventional T!, T2W1, transverse and corneal planes
Pituitary gland
- hormones of anterior pituitary gland: TSH, ACTH, GH, Somatostatin, FSH, LH, Prolactin
- hormones of posterior pituitary: oxytocin, vasopressin
dysfunction
- pituitary insufficiency ( congenital or acquired - ex. as a result of seller mass): delayed puberty, GH deficiency, hypocorticosolemia, hypothyroidism, diabetes incipidus
- pituitary secretory tumors: precocious puberty, acromegaly/gigantism, cushing, hyperprolactinemia, hyperthyrodisim
- secrting tumors- microadenoma < 1cm.
- Macroadenoma >1 cm: nonfunctioning, supracellar mass, pituitary insufficiency, headache, vision disturbance.
- Macroadenoma should be differentiated with craniopharyngeoma- nonfunctioning cellar and supracellar mass, heterogenous structure - solid (enhancing) and cystic (enhancing of the cyst's wall)
imaging
- MRI is the first choice: thin slices, T1, T2-weighted pictures, coronal and sagittal sections, post-contrast sequences
- CT- only for large seller/suprasellar masses
Thyroid gland
- Graves' disease: autoimmune disorder in wich anton-dies produced by the immune system stimulate the thyroid to produce too much hormones.
- hyperfunctioning thyroid nodules / toxic multinodular goiter / plummer's disease / toxic hyperfunctioning adenoma: one or more adenomas produce too much hormones
- thyroiditis:
Hashimoto's thyroiditis = active phase of chronic lymphocytic thyroiditis (autoimmune inflammatory disease)
subacute thyroiditis = de Quervain's thyroiditis (swollen diffuse inhomogeneous thyroid US)
infectious thyroiditis
postpartum thyroiditis ( occur after or during pregnancy)
hypothyroidism
- coginital
- result of insufficiency of the parenchyma after thyroiditis
- iodine deficiency
- pregnancy: some can develop hypo. during or after. left untreated, increases the risk of miscarriage, premature delivery and preeclampsia
- treatment:
radioactive iodine or anti-htyroid meddicstions.
surgery, radiation therapy
anti-psychotic ( lithium) can cause hypothyroidism
imaging
- US is the method of choice, often associated with biopsy (linger probe 5-10 MHz)
- finding during US:
big thyroid - Goiter or decrease the diameters
irregularity of outline
change of echogenity (hypo, hyper)
inhomogeneity of parenchyma
solid or multiple foci
lymph node enlargement
hypo/hyper vascularity of the parenchyma or of the lesions - Doppler
-
-
-