Endocrine

M.Team
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Endocrine

Postby M.Team » Sat Jul 16, 2016 8:56 am

Which of the following adrenal lesions can be treated definitively by medical means?

a. Benign functional adrenocortical adenoma
b. Adrenocortical carcinoma
c. Congenital adrenal hyperplasia
d. Cushing disease
e. Pheochromocytoma
Answer: c

The treatment of adrenal tumors is primarily surgical removal. Although pharmaceutical agents are useful in preparing the patient for surgery or in palliating the patient with recurrent adrenal carcinoma, no agents render definitive therapy for adrenal tumors. Congenital adrenal hyperplasia stands alone among the primary, hyperfunctioning adrenal syndromes that are amenable to medical therapy for definitive treatment. Functioning benign lesions of the adrenal cortex that are not ACTH dependent, such as adenomas or macronodular hyperplasia, respond to metyrapone and aminoglutethimide, which are inhibitors of enzymes in the adrenal steroidogenic pathway. Both agents can effect a decrease in the production of cortisol when there is no increase in ACTH secondary to feedback stimulation. These drugs are not satisfactory long-term agents because of their high incidence of drug reactions, patient noncompliance, and continued growth of the lesions. They may be useful in patients whose surgery must be delayed. Although malignant, functioning adrenocortical lesions should be debulked whenever possible. Several chemotherapy agents offer adjunct therapy. The most noteworthy is mitotane (o,p,-DDD). This is a cytolytic agent that has a 30% to 70% response rate in terms of decreasing steroid output. Unfortunately, patient survival is not affected. As mentioned, nonoperative treatment with cortisone acetate and possibly fludrocortisone is definitive therapy for congenital adrenal hyperplasia. Cushing disease is best treated by transsphenoidal resection of the pituitary adenoma. Pheochromoctyoma requires definitive surgical resection although the preoperative pharmacologic preparation with catecholamine blockade is required.

M.Team
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Posts: 39
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Re: Endocrine

Postby M.Team » Sat Jul 16, 2016 8:57 am

The most common mass lesion in the sella turcica is which of the following?

a. Craniopharyngioma
b. Aneurysm
c. Benign pituitary cyst
d. Pituitary adenoma
Answer: d

Pituitary adenomas are the most common mass lesions in the sella turcica or parasellar region. They constitute 8% to 10% of all brain tumors. Occasionally, they are cystic and may be confused with other lesions. Craniopharyngiomas are the next most common tumor, although these are more often suprasellar in location. These are more common in children, but up to one third occur in adults. They are usually cystic and are calcified in 70% of children and 40% of adults. More rare lesions include meningiomas, germinomas, metastatic malignancies from lung and breast primaries, gliomas, dermoids and benign epidermoid. Rathke cysts, aneurysms, and a variety of inflammatory and granulomatous processes.


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