Carcinoid Tumors

The term karzinoid was originally introduced by Oberndorfer in 1907 to describe small intestinal tumors that behave in a less aggressive manner than the more common adenocarcinomas.1 Since then carcinoids have been described as benign or malignant, clinically functioning or nonfunctioning, and endocrine or nonendocrine tumors which arise from Kulschitzsky or enterochromaffin cells. These cells have characteristic light microscopy and histochemical features such as argen-taffin and argyrophilic...

Adrenal Incidentaloma

Godellas Introduction Computerized tomography (CT) is frequently used to evaluate patients with abdominal complaints. With the high quality of current CT scanners, many unsuspected adrenal masses are identified during this process. These masses are commonly called adrenal incidentalomas. They have a prevalence of 0.3-5 in patients having CT scans for reasons other than adrenal pathology or metastatic work-up.1-4 In patients undergoing CT scanning who do not have a history of...

Glucagonoma

Prinz While much less common than insulinomas or gastrinomas, glucagonomas are also neuroendocrine tumors that are associated with an extremely distinctive clinical syndrome. Glucagonomas are tumors that originate from the alpha cells of the pancreatic islets, which produce and secrete glucagon. The excess production of gluca-gon results in the characteristic glucagonoma syndrome, which includes diabetes, a unique rash, weight loss, anemia and thromboembolic...

Pathology Pathogenesis and Carcinogenesis

The pathology of papillary and follicular thyroid carcinoma differs in many aspects, but both malignancies originate from the thyroid follicular cell. Papillary carcinoma is an unencapsulated tumor with papillary and follicular architecture, consisting of single layers of thyroid cells arranged around vascular stalks that form papillae. The cells are characterized by overlapping nuclei with a ground-glass appearance, longitudinal grooves, and invaginations of cytoplasm into the nuclei....

Somatostatinoma

Somatostatin is a cyclic tetradecapeptide produced by the delta cells of the dispersed neuroendocrine cell system. Delta cells are predominantly found in the fundal and antral regions of the stomach as well as in the pancreatic islets. Lesser numbers of these cells can be found in the gastrointestinal tract. Somatostatin inhibits the secretion of most of the gut hormones including chole-cystokinin, gastric inhibitory peptide, gastrin, motilin, pancreatic polypeptide, secretin, and vasoactive...

Pheochromocytoma

Pheochromocytomas are catecholamine-producing neuroendocrine tumors arising from the adrenal medulla or extra-adrenal sympathetic ganglia (paragangliomas). Pheochromocytomas occur with a prevalence of approximately 1-2 per 100,000 adults.1 They account for 0.1-1 of cases of hypertension.2 The first report of a pheochromocytoma discovered at autopsy was by Frankel in 1886.3 The first successful removal of a pheochromocytoma was in 1926 by Cesar Roux in Lausanne, Switzerland.4 Later the same...

Info

Tc-99m sestamibi imaging in a patient with hyperparathyroidism. The white arrow indicates the location of a mediastinal parathyroid gland located in the right thymic lobe. sestamibi scanning, MRI with contrast enhancement or ultrasound is our next noninvasive study. In situations where review of previous surgical and pathologic data combined with imaging studies have not yielded convincing localization information, or in situations where these data are discordant, we proceed to...

Cushings Syndrome

Prinz Introduction Definition In 1932, Harvey W. Cushing defined a syndrome he called pituitary basophilism. Muscular weakness, truncal obesity, abdominal striae, diabetes and hypertension characterized this clinical complex. Today, the condition resulting from chronic glucocorticoid excess due to any source is known as Cushing's syndrome, as opposed to the pituitary-derived Cushing's disease. Cushing's syndrome is a rare disorder, with a prevalence of 10...

Thyroiditis

Thyrotoxicosis secondary to thyroiditis is uncommon. It is typically transient and self-limited. It may occur as a result of chronic lymphocytic or Hashimoto's thyroiditis, silent or painless thyroiditis, subacute or de Quervain's thyroiditis and h radioiodine-induced thyroiditis. Silent, subacute and radioiodine-induced thyroiditis M are all characterized by the inability to trap iodine, follicular cell destruction and release of preformed thyroid hormone resulting in thyrotoxicosis with a low...

Parathyroid Cancer

Godellas Introduction Cancer of the parathyroid gland is an exceptionally rare entity. Its classic presentation and course is similar to that, as first described by de Quervain in 1909, of a patient with a large, locally invasive neck mass, that progressed to lung metastases after removal of the neck lesion.1 Although not mentioned in his initial report, many patients also present with marked hypercalcemia. Unfortunately, it is frequently difficult to differentiate a parathyroid...

Aldosteronoma

Aldosteronomas, often referred to as aldosterone-producing adenomas, are the most common cause of primary aldosteronism, a surgically correctable type of hypertension that occurs in 0.5-2 of all hypertensive patients.1,2 As first described by Conn 45 years ago, primary aldosteronism is a syndrome characterized by hypertension, depletion of potassium, retention of sodium, and suppression of plasma renin activity (PRA), all of which are caused by an elevation in plasma aldosterone. Idiopathic...

Table 42 Symptoms and signs of thyrotoxicosis

Nervousness Anxiety Irritability Increased appetite Weight loss or gain Palpitations Heat intolerance Excessive sweating Tremulousness Tachycardia Systolic hypertension Supraventricular arrhythmias Widened pulse pressure Hyperreflexia Resting tremor Increased frequency of bowel movements Impaired fertility, oligomenorrhea or amenorrhea Reduced libido Warm, moist smooth skin Thinning hair or hair loss Onicholysis Muscle weakness Gynecomastia Eyelid retraction, lid lag and stare Once the...

Complications of Thyroid Surgery

Thyroid surgery has progressed dramatically since the mid-1850s when half or more of the patients undergoing this operation would die from the procedure. Currently, thyroidectomy is a very safe operation which has an associate mortality rate that approaches zero. In other words, the mortality of a thyroidectomy is really the mortality of a general anesthetic. The morbidity associated with thyroid surgery is also very low. Nevertheless, the complications of thyroidectomy remain a matter of...