Glandular Adenomas. Objectives 3/12/2012. Christopher Sonnier MD, FACE, ECNU. Review incidence rates. Review functionality concerns.
|
|
- Harvey Franklin
- 7 years ago
- Views:
Transcription
1 Glandular Adenomas Christopher Sonnier MD, FACE, ECNU No Disclosures Related To This Discussion Objectives Review incidence rates. Review functionality concerns. Review determination of nonsurgical vs. surgical cases. 1
2 Why Be Concerned? Imaging volumes with Ultrasound, CT, MRI, PET, and other modalities have all increased finding more incidental glandular adenomas. e.g. the term Incidentalomas was coined. Prevalence of all glandular adenomas increases with age. The largest population group in the country is >60 years of age with continued growth predicted for at least another two decades. Pituitary 2
3 3
4 Pituitary Adenomas Incidence by autopsy series 14% Incidence by imaging series 23% Microadenoma (< 10 mm) Common accounts for 99% of cases 30% with no clinical history Macroadenoma (> 10 mm) Rare accounts for 1% of cases Usually symptomatic JCEM 2006:91; Clev Clin J of Med 2008:75: Pituitary Adenomas Microadenoma (< 10 mm) 10% grow over time Macroadenoma (> 10 mm) 20% grow over time Main concern with growth is always related to optic chiasm impingement. JCEM 2011:96; Pituitary Hormone Producing Adenomas Medical >90% of cases Non-Functioning (most produce low levels of Gonadotropins) Prolactinoma Surgical <10% of cases Acromegaly (Growth Hormone) Cushing s Disease (ACTH) TSH related (rare) Endocrine Society 2011 Guideline: Pituitary Incidentaloma Medicine 1999:78; JCEM 2011:96;
5 Other Pituitary Findings Of Note Empty Sella Syndrome 10% have hormone deficiency. Meningioma Typically does not effect function but can cause mass effect. Craniopharyngiomas Typically requires surgery and leads to panhypopituitarism. Pituitary cysts Benign process. Medicine 1999:78; Thyroid 5
6 6
7 Thyroid Adenoma Incidence ranges from 25-50% in general population. Occurs more frequently in persons > 60 years of age. Well studied that physical exam findings are incorrect 50% of the time considering this high incidence rate. JCEM 2002:87; NEJM 2004:351; Recommended Screening A TSH level is the only recommended screening test to assess thyroid status when a nodule is found. Normal range for TSH by 3 rd generation testing is uiu/ml. If the result is outside of the normal range, all that can be said at that point is that the TSH is abnormal pending further evaluation. FNA biopsy should not be attempted without TSH data or in setting of abnormally low TSH until determination of possible toxic nodule is made. Thyroid 2006:16;1-33 Revised, Thyroid 2009:19; Thyroid Disease Spectrum Subclinical Hyperthyroidism TSH IU/mL Overt Hyperthyroidism TSH <0.007 IU/mL Mild Thyroid Failure TSH IU/mL Euthyroid TSH IU/mL Overt Hypothyroidism TSH >30.0 IU/mL 7
8 Functional Thyroid Nodule More common in regions with low iodine intake. Accounts for less than 5% of thyrotoxicosis cases in iodine-sufficient areas. Cancer incidence < 2%. Evolution from sporadic diffuse goiter to toxic nodular goiter is gradual. Thyrotropin receptor mutations and TSH mutations have been found in some patients with toxic nodular goiter. Braverman LE, et al. Werner & Ingbar s The Thyroid. A Fundamental and Clinical Text. 8th ed Treatment of Toxic Nodule Beta-Blockers symptomatic treatment to counteract effect of elevated thyroid hormone levels on target organs. Anti-thyroid medications reduce thyroid hormone synthesis and peripheral conversion. Radioactive Iodine (I 131) definitive ablative therapy. Potassium Iodide blocks release of hormones from the thyroid. Surgery depends on many factors usually size of the lesion. Thyroid 2011:21; Non-Functional Thyroid Nodules Account for more than 95% of cases in iodine-sufficient areas. Cancer incidence ranges from 5-20% depending on data source. General incidence rate felt to be 10-15% of all patients with nodules. 80% Papillary, 14% Follicular, 3% Medullary, and 2% Anaplastic Papillary and Follicular cancer rates are on the rise. JCEM 2006:91; NEJM 2005:352;
9 Updated Thyroid Nodule Guidelines 2006 Key Concepts Cold nodules are no longer a concern, so nuclear medicine uptakes and scans no longer indicated just for finding of thyroid nodule. Use of Synthroid to suppress growth of nodules or goiter is no longer considered valid and this practice should be discontinued. Thyroid 2006:16;1-33 Revised, Thyroid 2009:19; Updated Thyroid Nodule Guidelines 2006 Key Concepts High resolution real-time ultrasound (US) has become the cornerstone imaging modality for management of thyroid nodules. US features and size determine need for fine needle aspiration (FNA). Patients need consistent long term follow up preferably by thyroidologist in same location for accurate comparison purposes. Thyroid 2006:16;1-33 Revised, Thyroid 2009:19; Parathyroid 9
10 10
11 Parathyroid Hormone Producing Adenoma Primary hyperparathyroidism Declining incidence estimated to be 4 cases per 100,000 patient-years in Recent unpublished data from 2010 estimated to be 2 cases per 100,000 patient-years. Compared to incidence estimated to be 15 cases per 100,000 patient-years prior to Ann Intern Med 1997:126; Parathyroid Hormone Producing Adenoma Common Causes Sporadic Inherited primary hyperparathyroidism Uncommon Causes MEN 1 MEN 2 a Very rarely cancerous Nat Rev Cancer 2005:5; Asymptomatic Primary Hyperparathyroidism Most patients are now in this category. Commonly exacerbated by HCTZ use or Vitamin D deficient state. Most patients are just followed long term after full lab evaluation has confirmed diagnosis. Revised NIH guidelines from 2008 used as definitive source to determine if surgery indicated. Age being the key factor. Endo Practice 2009:15;
12 Adrenal 12
13 Adrenal Adenomas Incidence by autopsy series 2-10% Incidence by imaging series 5% 15% are bilateral <5% are cancer Endo Practice 2008:14; NEJM 2007:356:
14 Adrenal Hormone Producing Adenomas Cushing s Syndrome Incidence 5-45% (Likely 10-25%) Pheochromocytoma Incidence 2-20% (Rule of 10 s) Hyperaldosteronism (Conn s Syndrome) Incidence 1-20% (Likely 1-5%) Subclinical Cushing s Incidence 5-10% Endo Practice 2008:14; NEJM 2007:356: Endocrine News Sept 2009 Adrenal Adenomas Well defined algorithm for the evaluation and management of patients. Outlines approach to long term follow up of the subclinical and non-functioning lesions. Key point is to at least rule out pheochromocytoma for all cases especially before intervention is attempted. Developed by Dr. Young, Division of Endocrinology, Diabetes, Metabolism, Nutrition, and Internal Medicine, Mayo Clinic, Rochester, MN. NEJM 2007:356: Pancreas 14
15 15
16 Pancreatic Hormone Producing Adenomas Rare incidence 4 cases per 1 million patient-years. Pancreatic cancer accounts for 6% of all cancer deaths per year about 40,000 patients per year. JCEM 2005:90; NCI 2010 Data Set 16
17 Pancreatic Hormone Producing Adenomas Insulinoma Gastrinoma (Zollinger-Ellison Syndrome) Glucagonoma VIPoma Insulinomas Most common type and presents with symptoms of hypoglycemia. Mostly sporadic but is associated with MEN 1. Mostly benign but can be malignant. Endocrine Society 2009 Guideline: Evaluation and Management of Adult Hypoglycemia Disorders JCEM 2005:90; JCEM 2009:94; Determination of Nonsurgical vs. Surgical Cases 17
18 What Needs To Be Done For The Patient? All cases need complete hormone evaluation at baseline after any glandular adenoma is found. Majority of cases will need long term imaging and possible lab follow-up over time. Pituitary Cases 85-90% managed medically 10-15% are surgical Non-prolactin functional adenomas Roughly < 10% of all cases Macroadenomas with chiasm impingement 1% of all cases Prolactinomas with apoplexy No firm data but small % of all prolactinomas JCEM 2006:91; Clev Clin J of Med 2008:75: Medicine 1999:78; Thyroid Cases Overall rate of surgery < 50% of all cases and declining. Less endemic goiter leading to less obstructive complaints. Low rate of toxic nodules requiring surgery. Improved US imaging for long term follow-up of non-functional nodules. Improved FNA diagnostics to aid in long term follow-up. J Endocrinol Invest 1997:20; Thyroid 2006:16;1-33 Revised, Thyroid 2009:19;
19 Parathyroid Cases Surgery is based on guidelines which outline importance of specific clinical findings most importantly age. Localization by imaging also key as less common to do exploratory neck surgery. High resolution US is replacing nuclear medicine parathyroid scan. Endo Practice 2009:15; Adrenal Cases Most functional lesions need to be removed to offer clinical improvement. Subclinical conditions can be followed with labs. Surgery is based on factors such as age and comorbid conditions. Largest proportion are just followed over time. NEJM 2007:356: Pancreas Cases These are rare conditions. All require laboratory confirmation as first step. Confirmation of source by imaging is needed to direct surgery. Intraoperative US is the most helpful. Most require surgery to offer cure of condition. Gastrinoma is exception and can be medically managed. JCEM 2005:90; JCEM 2009:94;
20 End Conclusions All glandular adenomas need complete hormonal evaluation at the time the adenoma is found before any intervention in form of biopsy or surgery is attempted. Most cases are nonsurgical and require long term medical follow-up, preferably by an endocrinologist. High resolution US is becoming the main image modality for a good portion of glandular adenomas. 20
Everything You Ever Wanted to Know About the Thyroid
Everything You Ever Wanted to Know About the Thyroid (but were afraid to ask ) Caroline Messer, MD Board Certified Internist, Endocrinologist, and Physician Nutrition Specialist Topics Thyroid Nodules
More informationloving life YOUR GUIDE TO YOUR THYROID
loving life YOUR GUIDE TO YOUR THYROID one THE THYROID two HYPOTHYROIDISM three HYPERTHYROIDISM four TREATING HYPERTHYROIDISM five THYROID NODULES AND GOITRES one THE THYROID What is the thyroid? The thyroid
More informationLOYOLA UNIVERSITY MEDICAL CENTER RESIDENCY PROGRAM IN GENERAL SURGERY CLINICAL ROTATION DESCRIPTION
LOYOLA UNIVERSITY MEDICAL CENTER RESIDENCY PROGRAM IN GENERAL SURGERY CLINICAL ROTATION DESCRIPTION Loyola University Medical Center Department of Surgery Endocrine Surgery RESIDENT COMPLEMENT: ROTATION
More informationTHYROID CANCER. I. Introduction
THYROID CANCER I. Introduction There are over 11,000 new cases of thyroid cancer each year in the US. Females are more likely to have thyroid cancer than men by a ratio of 3:1, and it is more common in
More informationGuidance for Preconception Care of Women with Thyroid Disease
Before, Between & Beyond Pregnancy The National Preconception Curriculum and Resources Guide for Clinicians Guidance for Preconception Care of Women with Thyroid Disease Avi Alkalay, MD Department of Obstetrics
More informationThyroid Differentiated Cancer: Does Size Really Count? (New ways to evaluate thyroid nodules)
Thyroid Differentiated Cancer: Does Size Really Count? (New ways to evaluate thyroid nodules) Jeffrey S. Freeman, D.O., F.A.C.O.I. Chairman, Division of Endocrinology and Metabolism Philadelphia College
More informationOrdering and interpreting thyroid tests in children. Paul Kaplowitz, MD, PhD Children s National Medical Center, Washington, DC
Ordering and interpreting thyroid tests in children Paul Kaplowitz, MD, PhD Children s National Medical Center, Washington, DC Objectives To review indications for thyroid testing To discuss which tests
More informationThe Role of Genetic Testing in the Evaluation of Thyroid Nodules. Thyroid Cancer and FNA. Thyroid Cancer. Pure Follicular Cancers.
Where does Molecular Analysis of FNA Specimens fit into the evaluation of thyroid nodules? The Role of Genetic Testing in the Evaluation of Thyroid Nodules Ultrasound TSH Risk factors Jill E. Langer, MD
More informationThyroid Tests. National Endocrine and Metabolic Diseases Information Service
Thyroid Tests National Endocrine and Metabolic Diseases Information Service What is the thyroid? The thyroid is a 2-inch-long, butterfly-shaped gland weighing less than 1 ounce. Located in the front of
More informationThyroid Cancer Diagnosis and Management. Jerome Hershman, M.D. Internal Medicine Grand Rounds University of Missouri, Columbia October 21, 2010
Thyroid Cancer Diagnosis and Management Jerome Hershman, M.D. Internal Medicine Grand Rounds University of Missouri, Columbia October 21, 2010 DISCLOSURE NOTHING TO DISCLOSE in regard to financial conflict
More informationAnatomy: The sella is a depression in the sphenoid bone that makes up part of the skull base located behind the eye sockets.
Pituitary Tumor Your doctor thinks you may have a pituitary tumor. Pituitary tumors are benign (non-cancerous) overgrowth of cells that make up the pituitary gland (the master gland that regulates other
More informationTHYROID DISEASE IN CHILDREN
THYROID DISEASE IN CHILDREN Douglas G. Rogers, M.D. Center for Pediatric and Adolescent Endocrinology Cleveland Clinic Foundation Unfortunately neither I nor any immediate family members have any financial
More informationUpdate on Surgical Treatment of Pituitary Tumors. Kristen Riley, MD, FACS Associate Professor, Division of Neurosurgery, Department of Surgery
Update on Surgical Treatment of Pituitary Tumors Kristen Riley, MD, FACS Associate Professor, Division of Neurosurgery, Department of Surgery Pituitary Tumors Pituitary adenoma: common intracranial neoplasm
More informationRECOMMENDATIONS. INVESTIGATION AND MANAGEMENT OF PRIMARY THYROID DYSFUNCTION Clinical Practice Guideline April 2014
INVESTIGATION AND MANAGEMENT OF PRIMARY THYROID DYSFUNCTION Clinical Practice Guideline April 2014 OBJECTIVE Alberta clinicians optimize laboratory testing for the investigation and management of primary
More informationThyroid Disorders. Hypothyroidism
1 There are a number of problems associated with the thyroid gland. Hypothyroidism, hyperthyroidism, and thyroid nodules will be presented here. The thyroid gland is located in the middle of the neck,
More informationUpdate on thyroid cancer surveillance and management of recurrent disease. Minimally invasive thyroid surgery
Update on thyroid cancer surveillance and management of recurrent disease Minimally invasive thyroid surgery July 2006 Michael W. Yeh, MD Program Director, Endocrine Surgery Assistant Professor, David
More informationReleasing Nuclear Medicine Patients to the Public: Dose Calculations and Discharge Instructions
Educational Objectives Releasing Nuclear Medicine Patients to the Public: Dose Calculations and Discharge Instructions Robert E. Reiman, MD Radiation Safety Division Duke University Medical Center Durham,
More informationThyroid Cancer. What is cancer?
What is cancer? Thyroid Cancer The body is made up of hundreds of millions of living cells. Normal body cells grow, divide to make new cells, and die in an orderly fashion. During the early years of a
More informationThyroid Cancer. What is thyroid cancer? The thyroid gland
Thyroid Cancer What is thyroid cancer? Cancer starts when cells in the body begin to grow out of control. Cells in nearly any part of the body can become cancer, and can spread to other areas of the body.
More informationBenign Pituitary Tumor
PATIENT EDUCATION patienteducation.osumc.edu The pituitary gland is a small, pea-sized endocrine gland in the center of the brain. Also known as the master gland, the pituitary gland helps control the
More informationThyroid Cancer: Resection, Dissection, Surveillance and Recurrence. Cord Sturgeon, MD
Thyroid Cancer: Resection, Dissection, Surveillance and Recurrence Cord Sturgeon, MD Associate Professor of Surgery Northwestern University Feinberg School of Medicine Director of Endocrine Surgery Chicago,
More informationThyroid-Stimulating Hormone (TSH)
Thyroid-Stimulating Hormone (TSH) Table of Contents Test Overview Why It Is Done How To Prepare How It Is Done How It Feels Risks Results What Affects the Test What To Think About References Credits Test
More informationAACE Advances in Medical and Surgical Management of Thyroid Cancer, 2015. Tampa, Florida.
AACE Advances in Medical and Surgical Management of Thyroid Cancer, 2015. Tampa, Florida. Dev Abraham MD, MRCP (UK), ECNU Professor of Medicine, Division of Endocrinology, Huntsman Cancer Institute, University
More informationSurgical Management of Papillary Microcarcinoma 趙 子 傑 長 庚 紀 念 醫 院 林 口 總 院 一 般 外 科
Surgical Management of Papillary Microcarcinoma 趙 子 傑 長 庚 紀 念 醫 院 林 口 總 院 一 般 外 科 Papillary microcarcinoma of thyroid Definition latent aberrant thyroid occult thyroid carcinoma latent papillary carcinoma)
More informationIncidence of Incidental Thyroid Nodules on Computed Tomography (CT) Scan of the Chest Performed for Reasons Other than Thyroid Disease
International Journal of Clinical Medicine, 2011, 2, 264-268 doi:10.4236/ijcm.2011.23042 Published Online July 2011 (http://www.scirp.org/journal/ijcm) Incidence of Incidental Thyroid Nodules on Computed
More informationAthyroid nodule is a palpable
PRACTICAL THERAPEUTICS Thyroid Nodules MARY JO WELKER, M.D., and DIANE ORLOV, M.S., C.N.P. Ohio State University College of Medicine and Public Health, Columbus, Ohio Palpable thyroid nodules occur in
More informationGraves disease in childhood Antithyroid drug therapy
83rd Annual Meeting of the ATA October 620, 203 Duration of antithyroid drugs treatment Disclosure Nothing to disclose Pr Juliane Léger Paediatric Endocrinology Department Paris Diderot University Hôpital
More informationHypothyroidism. Written by Donald Yung Edited by Dianna Louie. Basic Embryology and Anatomy
Hypothyroidism Written by Donald Yung Basic Embryology and Anatomy The thyroid gland consists of two lobes connected by an isthmus and is located anterior to the trachea at the base of the neck. During
More informationCommon Endocrine Disorders. Gary L. Horowitz, MD Beth Israel Deaconess Medical Center Boston, MA
Common Endocrine Disorders Gary L. Horowitz, MD Beth Israel Deaconess Medical Center Boston, MA Objectives Describe the typical laboratory values for TSH and Free T4 in hypo- and hyperthyroidism Explain
More informationThyroid Problems after Childhood Cancer
Thyroid Problems after Childhood Cancer Some people who were treated for cancer during childhood may develop endocrine (hormone) problems as a result of changes in the function of a complex system of glands
More informationDisclosures. Definitions. CDC Website
Disclosures Deborah Grady, MD, MPH Professor of Medicine Deputy Editor, JAMA Internal Medicine Co-Director, Center for Healthcare Value Co-Director, Clinical and Translational Science Institute Salary
More informationClassification of thyroid disorders
Hypothalamus TRH Hypophyse TSH Thyroïde T3 T4 Organes cibles T3 Foie Classification of thyroid disorders T3, T4 overt hyperthyroidism subclin. hyperthyroidism normal values sublin. hypothyroidism overt
More informationGoiter. This reference summary explains goiters. It covers symptoms and causes of the condition, as well as treatment options.
Goiter Introduction The thyroid gland is located at the base of your neck. If the gland becomes abnormally enlarged, it is called a goiter. Goiters usually do not cause pain. But a large goiter could cause
More informationTSH. TSH is an integral part of a thyroid panel useful for the determination and potential differentiation of hypothyroidism.
TSH Background Thyroid hormone synthesis and secretion is regulated via a negative feed-back control system, which involves the hypothalamus, anterior pituitary, and the thyroid gland. Thyrotrophin-releasing
More informationPancreatic Cancer. The Killer that must be discovered early. Dr Alfred Kow Wei Chieh
Pancreatic Cancer The Killer that must be discovered early 27 th June 2015 Dr Alfred Kow Wei Chieh Consultant Department of Surgery Division of HPB Surgery & Liver Transplantation & Assistant Dean (Education)
More informationPerioperative management of patients undergoing pituitary surgery
Endocrinol Metab Clin N Am 32 (2003) 355 365 Perioperative management of patients undergoing pituitary surgery Mary Lee Vance, MD Division of Endocrinology and Metabolism, Department of Medicine, University
More informationThyroid Gland Disease. Zdeněk Fryšák 3rd Clinic of Internal Medicine Nephrology-Rheumatology-Endocrinology Faculty Hospital Olomouc
Thyroid Gland Disease Zdeněk Fryšák 3rd Clinic of Internal Medicine Nephrology-Rheumatology-Endocrinology Faculty Hospital Olomouc t 1/2 = 5-7d t 1/2 = < 24 hrs Normal Daily Thyroid Secretion Rate:
More informationMEDICAL POLICY SUBJECT: MOLECULAR MARKERS IN FINE NEEDLE ASPIRATES OF THE THYROID EFFECTIVE DATE: 11/19/15
MEDICAL POLICY SUBJECT: MOLECULAR MARKERS IN FINE NEEDLE PAGE: 1 OF: 5 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases,
More informationA Focus on Thyroid Cancer
A Focus on Thyroid Cancer Guest Expert: Robert, MD Chairman and William H. Carmalt Professor of Surgery www.wnpr.org www.yalecancercenter.org Welcome to Yale Cancer Center Answers with Dr. Ed and Francine,
More informationTreating Thyroid Cancer using I-131 Maximum Tolerable Dose Method
Treating Thyroid Cancer using I-131 Maximum Tolerable Dose Method Christopher Martel, M.Sc., CHP Lisa Thornhill,, NRRPT, RT(NM) Boston University Medical Center Thyroid Carcinoma New cases and deaths in
More informationOpen the Flood Gates Urinary Obstruction and Kidney Stones. Dr. Jeffrey Rosenberg Dr. Emilio Lastarria Dr. Richard Kasulke
Open the Flood Gates Urinary Obstruction and Kidney Stones Dr. Jeffrey Rosenberg Dr. Emilio Lastarria Dr. Richard Kasulke Nephrology vs. Urology Nephrologist a physician who has been trained in the diagnosis
More informationTHYROGEN-STIMULATED RADIOACTIVE IODINE (I-131) THERAPY FOR THYROID CANCER FOLLOWED BY WHOLE BODY SCAN
MANFRED BLUM, M.D. F.A.C.P. NYU School of Medicine 530 First Avenue New York, N.Y. 10016 OFFICE:Phone (212) 263-7444 Fax (212) 263-0401 LAB: Phone (212) 263-7410 Fax: (212) 263-7519 Rev.7/1/09 FORM 4B
More informationEndocrine Causes of Chronic Fatigue Syndrome (CFS)/Chronic Fatigue Immune. Deficiency Syndrome (CFIDS):
1 Endocrine Causes of Chronic Fatigue Syndrome (CFS)/Chronic Fatigue Immune Deficiency Syndrome (CFIDS): A Brief Guide for Patients and Primary Care Physicians Theodore C. Friedman and Camille Kimball
More informationBRAF in the diagnostic evaluation of thyroid nodules
Symposium 13 Molecular markers in thyroid cancer: current role in clinical practice BRAF in the diagnostic evaluation of thyroid nodules Laura Fugazzola University of Milan, Italy Papillary carcinoma BRAF
More informationENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES AND IMMUNITY DISORDERS
ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES AND IMMUNITY DISORDERS DISORDERS OF THYROID GLAND (240 246.9) 240 SIMPLE AND UNSPECIFIED GOITRE 240.0 GOITRE, SPECIFIED AS SIMPLE 240.9 GOITRE, UNSPECIFIED
More informationValidation of BRAF Mutational Analysis in Thyroid Fine Needle Aspirations: A Morphologic- Molecular Approach
Validation of BRAF Mutational Analysis in Thyroid Fine Needle Aspirations: A Morphologic- Molecular Approach Kerry C. Councilman, MD Assistant Professor University of Colorado Denver Goals: BRAF Mutation
More informationPrior Authorization Form
Prior Authorization Form Growth Hormone This fax machine is located in a secure location as required by HIPAA regulations. Complete/review information, sign and date. Fax signed forms to CVS/Caremark at
More informationTHYROID NODULES, BUMPS, & LUMPS: WHEN IS MEDICAL THERAPY A USEFUL OPTION? Michael R. Broome DVM, DABVP
THYROID NODULES, BUMPS, & LUMPS: WHEN IS MEDICAL THERAPY A USEFUL OPTION? Michael R. Broome DVM, DABVP THYROID NODULES IN HUMAN PATIENTS In humans, thyroid nodules are common, occurring in over half of
More informationThyroid and Adrenal Gland
Thyroid and Adrenal Gland NAACCR 2011 2012 Webinar Series 12/1/11 Q&A Please submit all questions concerning webinar content through the Q&A panel. Reminder: If you have participants watching this webinar
More informationGUIDELINES & PROTOCOLS
GUIDELINES & PROTOCOLS ADVISORY COMMITTEE Effective Date: January 1, 2010 Scope This guideline applies to: the detection of thyroid dysfunction in adults (individuals 19 years of age and over) monitoring
More informationScreening for Cancer in Light of New Guidelines and Controversies. Christopher Celio, MD St. Jude Heritage Medical Group
Screening for Cancer in Light of New Guidelines and Controversies Christopher Celio, MD St. Jude Heritage Medical Group Screening Tests The 2 major objectives of a good screening program are: (1) detection
More informationSUNY DOWNSTATE MEDICAL CENTER SURGERY GRAND ROUNDS February 28, 2013 VERENA LIU, MD ROSEANNA LEE, MD
SUNY DOWNSTATE MEDICAL CENTER SURGERY GRAND ROUNDS February 28, 2013 VERENA LIU, MD ROSEANNA LEE, MD Case Presentation 35 year old male referred from PMD with an asymptomatic palpable right neck mass PMH/PSH:
More informationDifferential Diagnosis of Sellar Lesions
Differential Diagnosis of Sellar Lesions Manish K. Aghi, M.D., Ph.D. Assistant Professor California Center for Pituitary Disorders Department of Neurosurgery University of California, San Francisco (UCSF)
More informationCystic Neoplasms of the Pancreas: A multidisciplinary approach to the prevention and early detection of invasive pancreatic cancer.
This lecture is drawn from the continuing medical education program Finding Hope: Prevention, Early Detection and Treatment of Pancreatic Cancer, Nov, 2011. Robert P. Jury, MD Cystic Neoplasms of the Pancreas:
More informationTHYROID FUNCTION TESTS
Thyroid Stimulating Hormone (TSH): THYROID FUNCTION TESTS The thyroid stimulating hormone (TSH) assay measures the concentration of thyroid stimulating hormone in the serum. TSH assays have been classified
More information9. Discuss guidelines for follow-up post-thyroidectomy for cancer (labs/tests) HH
9. Discuss guidelines for follow-up post-thyroidectomy for cancer (labs/tests) HH Differentiated thyroid cancer expresses the TSH receptor on the cell membrane and responds to TSH stimulation by increasing
More informationHypothyroidism clinical features and treatment. 1. The causes of hypothyroidism
Hypothyroidism clinical features and treatment 1. The causes of hypothyroidism The thyroid is a gland in the neck which makes two thyroid hormones, thyroxine (T4) and tri-iodothyronine (T3). Thyroxine
More informationNeuroendocrine Tumors
Neuroendocrine Tumors Neuroendocrine tumors arise from cells that release a hormone in response to a signal from the nervous system. Neuro refers to the nervous system. Endocrine refers to the hormones.
More informationNicole Kounalakis, MD
Breast Disease: Diagnosis and Management Nicole Kounalakis, MD Assistant Professor of Surgery Goal of Breast Evaluation The goal of breast evaluation is to classify findings as: normal physiologic variations
More informationHodgkin Lymphoma Disease Specific Biology and Treatment Options. John Kuruvilla
Hodgkin Lymphoma Disease Specific Biology and Treatment Options John Kuruvilla My Disclaimer This is where I work Objectives Pathobiology what makes HL different Diagnosis Staging Treatment Philosophy
More informationThyroglobulin. versie 071120 J. Billen LAG-UZ-KULeuven 1
Thyroglobulin Large glycoprotein Two identical polypeptide chains 660 kda Prohormone in the intra-thyroid T4 and T3 synthesis Produced only by normal thyrocytes or well-differentiated thyroid cancer (DTC)
More informationUK Guidelines for the Use of Thyroid Function Tests (July 2006)
Adapted Summary of UK Guidelines for the Use of Thyroid Function Tests (July 2006) Introduction The Use of Thyroid Function Tests Guidelines Development Group was formed in 2002 under the auspices of the
More informationPatient Guide to Radioiodine Treatment For Thyrotoxicosis (Overactive Thyroid Gland or Hyperthyroidism)
Patient Guide to Radioiodine Treatment For Thyrotoxicosis (Overactive Thyroid Gland or Hyperthyroidism) Your doctor has referred you to Nuclear Medicine for treatment of your overactive thyroid gland.
More information530 10016 (212) 263-7444 (212) 263-0401 LAB:
MANFRED BLUM, M.D. F.A.C.P. NYU School of Medicine 530 First Avenue New York, N.Y. 10016 OFFICE:Phone (212) 263-7444 Fax (212) 263-0401 LAB: Phone (212) 263-7410 Fax: (212) 263-7519 Rev. 7/1/09 FORM 2B
More informationGUIDELINES FOR THE MANAGEMENT OF LUNG CANCER
GUIDELINES FOR THE MANAGEMENT OF LUNG CANCER BY Ali Shamseddine, MD (Coordinator); as04@aub.edu.lb Fady Geara, MD Bassem Shabb, MD Ghassan Jamaleddine, MD CLINICAL PRACTICE GUIDELINES FOR THE TREATMENT
More informationIl percorso diagnostico del nodulo tiroideo: il ruolo dell analisi molecolare
Il percorso diagnostico del nodulo tiroideo: il ruolo dell analisi molecolare Maria Chiara Zatelli Sezione di Endocrinologia Direttore: Prof. Ettore degli Uberti Dipartimento di Scienze Mediche Università
More informationOxford Centre for Head and Neck Oncology The Thyroid Gland and Thyroid Cancer Information for patients
Oxford University Hospitals NHS Trust Oxford Centre for Head and Neck Oncology The Thyroid Gland and Thyroid Cancer Information for patients What is the thyroid gland? The thyroid gland is an endocrine
More informationPituitary Adenoma: A Two Part Approach
Pituitary Adenoma: A Two Part Approach I. A General Overview II. Hypersecretion/Incidentaloma Jose Manuel Calero, MD Outline I. General Overview 1) Definition 2) Classification Cell origin Hormone Secreted
More informationAnaplastic Thyroid Cancer:
1 Anaplastic Thyroid Cancer: A Doctor s Perspective for Patients and Families Living with the Disease By Maria E. Cabanillas, M.D., F.A.C.E. Associate Professor and Faculty Director of Clinical Research
More informationEvaluation of the Thyroid Nodule
Distinguishing between malignant and benign thyroid nodules is necessary to ensure proper management of malignant nodules. Jacques-Enguérrand Gourgue. Houngan. From the collection of Mr. and Mrs. J. Roderick
More informationBERGEN COMMUNITY COLLEGE DIAGNOSTIC MEDICAL SONOGRAPHY PROGRAM Division of Health Professions DMS 213 SYLLABUS
BERGEN COMMUNITY COLLEGE DIAGNOSTIC MEDICAL SONOGRAPHY PROGRAM Division of Health Professions DMS 213 SYLLABUS Course Title: DMS 213 - Abdominal Sonography 2 2 lec. 3 lab. 3 credits (5 hours) Required
More informationUs TOO University Presents: Understanding Diagnostic Testing
Us TOO University Presents: Understanding Diagnostic Testing for Prostate Cancer Patients Today s speaker is Manish Bhandari, MD Program moderator is Pam Barrett, Us TOO International Made possible by
More informationThyroid UK Response to Scottish Parliament in respect of The Consideration of Petition PE1463
PE1463/G Thyroid UK Response to Scottish Parliament in respect of The Consideration of Petition PE1463 Calling on the Scottish Parliament to urge the Scottish Government to take action to ensure GPs and
More informationCorporate Medical Policy Molecular Markers in Fine Needle Aspirates of the Thyroid
Corporate Medical Policy Molecular Markers in Fine Needle Aspirates of the Thyroid File Name: Origination: Last CAP Review: Next CAP Review: Last Review: molecular_markers_in_fine_needle_aspirates_of_the_thyroid
More informationManagement of Clients with Thyroid and Parathyroid Disorders
Management of Clients with Thyroid and Parathyroid Disorders Black, J.M. & Hawks, J.H. (2005) Chapters 45, (pp 1191-1216) 1216) Baptist Health School of Nursing NSG 4037: Adult Nursing III Carole Mackey,
More informationPituitary Disease - Its Effects and Symptoms
Pituitary masses and malfunction - role of an endocrine nurse Warrick Inder Endocrinologist, Princess Alexandra Hospital Associate Professor, University of Queensland Brisbane Early 1995 14 year old boy
More informationCONTEMPORARY MANAGEMENT OF RENAL ANGIOMYOLIPOMA
CONTEMPORARY MANAGEMENT OF RENAL ANGIOMYOLIPOMA Stephen A. Boorjian, MD Professor of Urology Vice Chair of Research Director, Urologic Oncology Fellowship Department of Urology Mayo Clinic, Rochester,
More informationTestosterone in Old(er) Men
Testosterone in Old(er) Men Disclosure Information J. Bruce Redmon, M.D. Associate Professor Division of Endocrinology I have no financial relationships to disclose. I will not discuss off label use and/or
More informationPediatric Oncology for Otolaryngologists
Pediatric Oncology for Otolaryngologists Frederick S. Huang, M.D. Division of Hematology/Oncology Department of Pediatrics The University of Texas Medical Branch Grand Rounds Presentation to Department
More informationThyroid Fine-Needle Aspiration Indications and Technique. Subcommittee members Zubair W. Baloch, MD, PhD Martha Bishop Pitman, MD
Thyroid Fine-Needle Aspiration Indications and Technique Subcommittee members Zubair W. Baloch, MD, PhD Martha Bishop Pitman, MD Thyroid FNA Indication Clinical Thyroid Nodule (s) > 1 cm? Hypo-functioning
More informationLocoregional recurrence or persistence of papillary carcinoma: radioiodine treatment
Locoregional recurrence or persistence of papillary carcinoma: radioiodine treatment Michele Klain, Marco Salvatore Department of Functional and Biomorphological Science University of Naples "Federico
More informationFrozen Section Diagnosis
Frozen Section Diagnosis Dr Catherine M Corbishley Honorary Consultant Histopathologist St George s Healthcare NHS Trust and lead examiner final FRCPath Practical 2008-2011 Frozen Section Diagnosis The
More informationCURRICULUM VITAE. Wiam Ibrahim Hussein, MBBS, FACP, FACE
CURRICULUM VITAE NAME: Wiam Ibrahim Hussein, MBBS, FACP, FACE ADDRESS: P.O.Box 16165 Manama, Kingdom of Bahrain CONTACT DETAILS: Telephone: (00973) 39726000 (Mobile) E-mail: drwiam@outlook.com DATE AND
More informationRecovering with T3 - by Paul Robinson. Introduction
Recovering with T3 - by Paul Robinson Introduction I am not a professional writer. Neither am I a doctor, a medical researcher or a biochemist. I am simply a man who has had his life derailed by thyroid
More informationA23: Oncologic Disease- Tumor Markers
A23: Oncologic Disease- Tumor Markers Diagnosis Tumor Markers and Genetic Markers Use for Specific Malignancy The following information is from multiple guideline sources as recommendations for use of
More informationGuidelines for the Use of Thyroid Function Tests. Grey s Hospital Laboratory. Pietermartizburg Complex. Compiled and adapted by
Guidelines for the Use of Thyroid Function Tests Grey s Hospital Laboratory Pietermartizburg Complex Compiled and adapted by Dr. R. Sirkar Chemical Pathologist UKZN August 2006 Compiled and Adapted by
More informationBreast Cancer: from bedside and grossing room to diagnoses and beyond. Adriana Corben, M.D.
Breast Cancer: from bedside and grossing room to diagnoses and beyond Adriana Corben, M.D. About breast anatomy Breasts are special organs that develop in women during puberty when female hormones are
More informationLaparoscopic Adrenal Gland Removal (Adrenalectomy) Patient Information from SAGES
Laparoscopic Adrenal Gland Removal (Adrenalectomy) Patient Information from SAGES What are the Adrenal Glands? The adrenal glands are two small organs, one located above each kidney. They are triangular
More informationLAB 12 ENDOCRINE II. Due next lab: Lab Exam 3 covers labs 11 and 12, endocrine chart and endocrine case studies (1-4 and 7).
111 LAB 12 ENDOCRINE II Assignments: Quiz : Endocrine Chart pages 112-114 Due next lab: Lab Exam 3 covers labs 11 and 12, endocrine chart and endocrine case studies (1-4 and 7). Objectives: Review the
More informationFirst floor, Main Hospital North Services provided 24/7 365 days per year
First floor, Main Hospital North Services provided 24/7 365 days per year General Radiology (X-ray) Fluoroscopy Ultrasound (Sonography) Nuclear Medicine P.E.T. imaging Computed Tomography (CT scan) Magnetic
More informationCommon Breast Complaints:
: Palpable mass Abnormal mammogram with normal physical exam Vague thickening or nodularity Nipple Discharge Breast pain Breast infection or inflammation The physician s goal is to determine whether the
More informationMultidisciplinary Thyroid Cancer and Parathyroid Disease Symposium:
Nonprofit Org. U.S. Postage PAID Pittsburgh, PA Permit No. 3834 UPMC/UPCI Sixth Annual Multidisciplinary Thyroid Cancer Herberman Conference Center, UPMC Shadyside Pittsburgh, Pennsylvania Cancer Pavilion
More informationCancer of the Thyroid Explained
Cancer of the Thyroid Explained Patient Information Introduction This leaflet tells you about the condition known as thyroid cancer. We hope it will answer some of the questions that you or those who care
More informationWriting Group for the AACE Thyroid Scientific Committee. Bernet V, Hupart KH, Parangi S and Woeber KA
Molecular Diagnostic Testing of Thyroid Nodules with Indeterminate Cytopathology Summary Highlights Writing Group for the AACE Thyroid Scientific Committee Bernet V, Hupart KH, Parangi S and Woeber KA
More informationRenal Cysts What should I do now?
Renal Cysts What should I do now? Dr Edmund Chiong Asst. Professor & Consultant Department of Urology National University Hospital What are renal cysts? Fluid-filled structures in the kidney that are not
More informationOvercoming the Socioeconomic Challenges of a Thyroidology Practice
Overcoming the Socioeconomic Challenges of a Thyroidology Practice RYAN HUNGERFORD, MD, FACE, ECNU ROGUE VALLEY PHYSICIANS, MEDFORD, OREGON Objectives Identify components of a successful thyroidology or
More informationNational Cancer Institute
National Cancer Institute What You Need To Know About Thyroid Cancer U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Cancer Institute Services This is only one of many
More informationGENERAL CODING. When you review old cases that were coded to unknown, make corrections based on guidelines in effect at the time of diagnosis.
GENERAL CODING When you review old cases that were coded to unknown, make corrections based on guidelines in effect at the time of diagnosis. Exception: You must review and revise EOD coding for prostate
More informationNon-Functioning Pancreatic Neuroendocrine Tumours
Non-Functioning Pancreatic Neuroendocrine Tumours NET Patient Foundation Non-Functioning Pancreatic Neuroendocrine Tumours This booklet is intended to provide patients and their carers with information
More informationAlison Marie Semrad DO, FACP, ECNU 4150 V Street Suite G0400 Sacramento, CA 95817-1460 asemrad@ucdavis.edu
Alison Marie Semrad DO, FACP, ECNU 4150 V Street Suite G0400 Sacramento, CA 95817-1460 asemrad@ucdavis.edu Medical Education: Thyroid Fellowship: University of California, Davis Medical Center (UCDMC);
More information