endocrine system power point

what is the endocrine system

the collection of glands that produce hormones

what does the endocrine system regulate

metabolism, growth and development, tissue function, sexual function, reproduction, sleep, and mood

what can endocrine neoplasm cause

an array of hormonal imbalances which can result in different changes

what are the changes that endocrine neoplasms cause

emotions, appearance, function and abilities

what are principal organs of endocrine system

pituitary, thyroid, adrenal, parathyroid gland, pancreas

what do each of the organs of the endocrine system produce

hormones that affect various functions to meet metabolic needs

what does hormones enhance our ability to respond to

various stresses

what is the master regulatory gland of this system

pituitary

what is the range of the disorders of the endocrine organs

minor to potentially life threatening

what is the most widely recognized endocrine dysfunction is insufficient insulin produced by pancreas

diabetes mellitus

t/f: true primary malignancies of these organs are rare

true

what do primary malignancies of these organs impact

metabolic function and clinical syndromes

what is the most common of the endocrine malignancies

thyroid epidemiology

what percent is thyroid is all new cases of endocrine cancers

96%

what is the percent of thyroid is a represent of all cancers

2%

who has a higher chance of thyroid cancers

women

who has a 5x risk compared with males of thyroid

young adult females

what are all etiologic factors of thyroid all point to

exposure to ionizing radiation

what is the long latent period between the exposure and incidence of the thyroid

10-30 years

what is done particularly before puberty to the thyroid

external radiation to the thyroid gland

what percent of pts who receive bt 2-several hunderd cgy EBT to thyroid will later develop thyroid cancer

25%

what is the type of thyroid cancer people from external radiation to the thyroid gland

low grade papillary subtype

who is thyroid cancer more common an increase in

nagasaki and hiroshima survivors

who else can have an increase in thyroid cancer

people in the chernobyl incident and nuclear test in the marshall islands

radiation for _ can cause thyroid cancers

benign disease

what other type of cancer can lead to thyroid

hodgkin’s disease with mantle tx

what kind of indicators have an overall better prognosis than those with capsular invasion

lesions confined to gland

what kind of patients have better prognosis

well-differentiated thyroid cancer (papillary and follicular)

what is the most important prognostic factor

age

what age of thyroid cancer pts rarely die even if mets is present

45 or younger

what does not impact survival in thyroid cancer, just risk of recurrence

lymph node status

what lobes does the thyroid have

right and left

how long is the thyroid

5cm

where does the thyroid extend

to the level of midthyroid cartilage superiorly and sixth trachea ring inferiorly

where do the thyroid lobes connected in midline by

isthmus

how much do the thyroid glands weigh

25g

where is the thyroid close to

larynx, trachea, and esophagus

what are functional disorders of thyroid gland characterized by

hyperactivity and underactivity

what do most pts present with

palpable neck mass

how can the mass in thyroid cancer go undetected for years

indolent (slow growing and inactive nature)

what is the master regulatory gland of the endocrine system

pituitary

what is the pituitary under the influence for producing hormones

hypothalamus

what does TSH mean

thyroid-stimulating hormone

what does TSH stimulate when produced in pituitary cases

stimulation of thyroid cells to produce and release hormones

what are thyroid hormones critical for

carbohydrates and protein metabolism

where does the thyroid get iodine from

the blood

what are 8 ways that thyroid hormones are important

• process energy from food

• bone maintenance

• brain development

• regulate heart and digestive function

• mood

• impact nail and hair health

• regulate body weight

• muscle strength and control

what is used to evaluate function and anatomic location of palpable thyroid nodule through localization of hot or cold spots on the gland

radionuclide thyroid imaging

what are examples of radionuclide used in the thyroid imaging

I125, I123, TC88

what percent does solid nodules have probability of being cancer

30%

what will determine if the nodule is solid or cystic

US

which nodules are always benign

hot

what nodules are usually benign but are sometimes malignant

cold

what percent of palpable nodules are cold

90%

what are the 4 categories of the thyroid pathology and surgery

papillary and mixed papillary-follicular, follicular, medullary, anaplastic

which category is most common type

papillary and mixed papillary-follicular

which category is slow growing, not aggressive, excellent prognosis

papillary and mixed papillary-follicular

what is appropriate for papillary and mixed papillary-follicular because it is rarely invasive

resection of the thyroid gland or lobectomy

where can papillary and mixed papillary-follicular mets to

regional lymph nodes through lymphatic channels

what is the 2nd most common surgery of thyroid

follicular

what kind of prognosis does follicular have than papillary

worse overall

how can the follicular invade and met to

invade vascular channels and mets hematogenously to distant sites

what is adequate surgery for follicular

lobectomy

which surgery has the worse prognosis than all but the anaplastic type

medullary

how does medullary spread

regionally

which surgery has the worse prognosis of all

anaplastic

what is the life expectancy of anaplastic

short after diagnosis

what is the age occurrence of anaplastic

40-80

what can anaplastic cause invasion of

skin, trachea, etc

what is rarely appropriate in anaplastic

surgery

what is the treatment option for hyperthyroidism

surgery

what does the thyroid surgery include

thryoidectomy involves partial or total removal of thyroid gland

what is more common treatment to use instead of surgery for hyperthyroidism

antithyroid medications or radioactive iodine

what does thyroid cancer grow under the stimulation of

TSH

what happens to the tumor when you lower teh TSH levels

tumor activity decreases

what may be adequate after surgery to keep TSH levels low

thyroid hormonal suppression

what treatment is used to ablate thyroid tissue

radioactive tissue

what is radioactive iodine used to treat

papillary and follicular component cancers

what ablation dose and radionuclide is used after a thyroidectomy

50-100 mCi of I-131

what is the goal of thyroid ablation

ablate thyroid tissue and allow residual mets disease to accumulate I131

when will a second ablation dose needed

if trace dose of radioiodine reveals persistant thyroid activity

what is the dose when treating thyroid with EBRT

6500 at 180cGy

what can be used in the ap/pa ports of thyroid

post cord block to minimize dose

what kind of ports can be used for EBRT of thyroid

ap/pa neck and upper mediastinum, ant obliques or opposed obliques or IMRT

what kind of tumors are extremely rare

adrenal

where do adrenal glands sit

on superior pole

how much does adrenal weigh

20g each

where does the lymphatic drainage go into for adrenal

PAN

what is treatment of choice for adrenal tumors

surgery

when is XRT used in adrenal tumors

adjunct to surgery or as palliative treatment for mets

what is the outer portion of the gland

cortex

what is the inner portion of the gland

medulla

where is the most common spot to get adrenal cortex tumors

left

what was the median age of developing adrenal cortex tumors

50 years

what do most pts present with adrenal cortex tumors

pain or clinical manifestation of symptoms related to abnormal hormone production

what is critical for metabolic regulation for adrenal cortex tumors

cortex manufactures steroid hormones

where can adrenal cortex tumors grow

locally or spread to PAN, lung, liver, and brain

what is the survival for adrenal cortex tumors

5 year survival for all stages between 25-40%

what tumors are extremely rare

adrenal medulla tumors

what does adrenal medulla produce

adrenaline