Ust-medicine2 David Endocrinology Imaging Workshop

Pituitary Gland Imaging

Pituitary Adenoma

PANHYPOPITUITARIS M

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PANHYPOPITUITARISM 52 yo male who presented with history of vomiting and generalized body weakness. Came in at the ER with altered sensorium and hypotension. Lab workups showed hyponatremia, hypoglycemia, central hypothyroidism, 8am serum cortisol < 1mg/dL.

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Adrenal Gland Imaging

Normal Adrenal Glands on CT Scan

CAH – bilateral adrenal hyperplasia

PRIMARY HYPERALDOSTERONIS M Go back to Main Menu

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Cushing’s Syndrome

Cushing’s Syndrome A 23 yo female consulted due to puffiness of the face and weight gain. No steroid intake.

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Cushing’s Syndrome

Moon Facies Go back to Main Menu

Buffalo Hump End

Cushing’s Syndrome

Purplish striae Go back to Main Menu

Hirsutism End

Cushing’s Syndrome Overnight 1 mg Dexamethasone Suppression Test: 15mg/dL (NV < 3mg/dL) 24hr Urine Free Cortisol: 320 ug/day Plasma ACTH: < 1mg/dL

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Cushing’s Syndrome 2 to Adrenal Adenoma

CT Scan showing a mass on the right adrenal gland. Go back to Main Menu

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Cushing’s Syndrome 2 to Adrenal Adenoma

Open Adrenalectomy Go back to Main Menu

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PRIMARY HYPERALDOSTERONISM 32 yo female with 2year history of hypertension, proximal muscle weakness, hypokalemia Plasma aldosterone: 35ng/dL Plasma renin: 0.01ng/mL/hr PAC/PRA: 3500 Go back to Main Menu

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PRIMARY HYPERALDOSTERONIS M CT Scan of the Adrenal Glands Hypertrophic Left Adrenal Gland

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PHEOCHROMOCYTOMA Go back to Main Menu

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PHEOCHOMOCYTOMA 20 yo female with 2year history of hypertension, intermittent headaches, palpitations and sweating. 24hr urine metanephrine 5.04mg/day (NV 0.9-1.3mg/day) Serum creatinine 0.7 mg/dL serum potassium 3.9mEq/L serum sodium 140mEq/L Go back to Main Menu

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PHEOCHROMOCYTOMA

CT Scan of the Adrenal Glands Go back to Main Menu

3.6 x 3.5 cm mass, Left Adrenal Gland End

PHEOCHROMOCYTOMA

Open Adrenalectomy Adrenal tumor, Left adrenal gland Go back to Main Menu

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PHEOCHROMOCYTOMA

Open Adrenalectomy Blood pressure would shoot up when the tumor got tinkered. Go back to Main Menu

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PHEOCHROMOCYTOMA

Open Adrenalectomy Blood pressure dropped when the blood vessels to the left adrenal gland got ligated.

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PHEOCHROMOCYTOMA

Left adrenal tumor measuring 6.3 x 4.2 x 3cm. Go back to Main Menu

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PRIMARY HYPERPARATHYROIDIS M Go back to Main Menu

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Primary Hyperparathyroidism 19 yo male Growth stunting Difficulty in ambulating Pseudogout Pathologic fracture Intact PTH 529mg/dL (NV 15-65pg/mL)

Ionized Calcium 2.01mmol/L (NV 1.15-1.3mmol/L)

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DEXA scan: osteoporosis End

Primary Hyperparathyroidism

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Primary Hyperparathyroidism Dual Phase TechnetiumSestamibi Scan of the Parathyroid Glands

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Primary Hyperparathyroidism Dual Phase TechnetiumSestamibi Scan of the Parathyroid Glands Go back to Main Menu

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Primary Hyperparathyroidism Ultrasound of the Neck Region

Hypervascular mass probable parathyroid adenoma

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Primary Hyperparathyroidism Ultrasound of the Neck Region Left Thyroid Gland

Hypervascular mass probable parathyroid adenoma Go back to Main Menu

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Radioactive iodine Scan 

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Usually done together with RAI uptake Reported as films or computer printouts Estimates the anatomic size of the gland Shows areas of intense uptake (hot), decreased uptake (warm) or nonuptake (cold)

Diffuse Toxic Goiter

Thyroiditis, thyrotoxic phase

Warm nodule

Hot nodule Cold nodule

Multinodular toxic goiter

Ultrasonography 

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Useful for assessing nature of nodules (cysts, complex, solid) Character of nodules (hypoechoic, calcifications) Assess size of gland and nodules if difficult to assess US-guided biopsy

GRAVE’S DISEASE

AUTONOMOUS NODULE

GRAVE’S DISEASE WITH COLD NODULE