Adrenal Tumors
Also covered as: FAP syndrome · tubular adenomas · stage 4 colon cancer · hematochezia · adrenal cortical neoplasm
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Answers come only from this collection's statement ledger and cite the exact moment · not medical advice
Content of this collection
Foundations
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Topics in 10: Neuroblastoma
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Drs Daniel von Allmen, Todd Ponsky and Rae Hanke come together to provide you the essentials on the diagnosis and management of Neuroblastoma. Intro and outro tracks are adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist U
podcast · 10:25 · Dec 2020
Case-Based Learning
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Neuroblastoma
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Drs Erika Newman, Dan von Allmen and Tony Sandler join Dr. Todd Ponsky in a discussion covering the latest in neuroblastoma. Contributing editor: Rachel (Rae) Hanke, MD
Case 1: Mother who presents with 26 week fetus
with a pr
podcast · 56:19 · Dec 2020
In-Depth Reviews
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Thyroid Disorders
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An interactive discussion about malignant and benign pediatric thyroid disorders between Todd Ponsky, MD and Diana Diesen, MD. Dr. Diesen is assistant professor of surgery and pediatric surgery fellowship program director at the University
podcast · 45:51 · Dec 2020
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Every statement below comes from the recorded discussions, with its speaker and moment.
Thyroid Disorders
Thyroid nodules are less common in children than adults, but when detected in children they are more likely to be malignant
epidemiologicalDiana Deason6:23 ↗
When children present with thyroid cancer, they are more likely to have extension outside of the thyroid, regional lymph node involvement, and distant metastasis compared to adults
clinicalDiana Deason6:31 ↗
Risk factors for thyroid nodules and cancer include previous exposure to radiation or alkylating agents, such as treatment for Hodgkin's lymphoma, leukemia, or CNS tumors
clinicalDiana Deason4:08 ↗
Thyroid conditions and cancers have familial predisposition including MEN syndromes, PTEN hamartoma tumor syndromes, and APC-associated polyposis syndromes
clinicalDiana Deason4:27 ↗
Current ATA recommendations state that hyperfunctioning nodules (hot nodules) do not need to be biopsied if they are going to be resected
guidelineDiana Deason8:08 ↗
Ultrasound features suspicious for thyroid malignancy include hypoechoic mass, irregular margins, increased blood flow, and microcalcifications
clinicalDiana Deason9:57 ↗
In adults, lesions less than 1 centimeter are not biopsied, but in pediatric patients size cutoffs cannot be used as in adults; ultrasound characteristics and clinical context determine biopsy indication
guidelineDiana Deason11:12 ↗
Papillary thyroid cancer in children shows bilateral disease in up to 30% of patients and multifocal disease in up to 65% of pediatric patients
epidemiologicalDiana Deason15:00 ↗
Current recommendations for papillary thyroid cancer are total or near-total thyroidectomy due to risk of bilateral disease, multifocal disease, increased recurrence risk with lobectomy alone, and ability to optimize for radioactive iodine therapy
guidelineDiana Deason15:00 ↗
Nerve monitoring is used routinely during thyroidectomy; while it does not decrease risk of nerve injury, it is helpful in identifying the recurrent laryngeal nerve, especially in patients with bulky cervical disease
opinionDiana Deason17:07 ↗
There is no evidence to support prophylactic lateral neck dissection in pediatric thyroid cancer
guidelineDiana Deason18:33 ↗
After total thyroidectomy, PTH level less than 10-15 in recovery indicates higher risk for hypocalcemia and warrants starting calcium replacement or calcitriol
clinicalDiana Deason19:37 ↗
Low-risk papillary thyroid cancer (disease confined to thyroid with no metastatic lymph nodes) requires only postoperative thyroglobulin monitoring with TSH goal of 0.5-1, ultrasound at 6 months then annually for 5 years, and no radioactive iodine
guidelineDiana Deason21:12 ↗
Intermediate-risk patients (extensive central neck disease or any lateral neck disease) and high-risk patients (extensive regional disease, local invasion, or distant metastasis) receive radioactive iodine postoperatively
guidelineDiana Deason21:48 ↗
High-risk papillary thyroid cancer patients have TSH suppression goal of less than 0.1, while low-risk patients have goal of 0.5-1
guidelineDiana Deason27:31 ↗
Follicular lesions are indeterminate specimens representing about one-third of FNA results, with three subtypes: follicular lesion of undetermined significance, follicular lesion concerning for neoplasm, and suspicious/suggestive of malignancy with follicular component
clinicalDiana Deason23:05 ↗
Follicular lesions of undetermined significance have 5-15% malignancy risk in adults but approximately 28% in pediatric literature
epidemiologicalDiana Deason24:07 ↗
Follicular neoplasms have reported malignancy rate of 15-30% but more recent data suggests 50-60% in pediatric patients
epidemiologicalDiana Deason24:18 ↗
Most recent ATA recommendations are that all indeterminate lesions in children be resected due to higher malignancy risk compared to adults
guidelineDiana Deason23:50 ↗
Frozen section cannot distinguish follicular adenoma from follicular carcinoma but can identify papillary component
clinicalDiana Deason25:04 ↗
Follicular carcinoma with significant vascular invasion or tumor greater than 4 centimeters requires completion thyroidectomy; minimal vascular invasion with smaller tumor can be monitored
guidelineDiana Deason26:10 ↗
After lobectomy for benign disease, approximately 30% of patients may develop hypothyroidism at some point, requiring thyroid function monitoring
epidemiologicalDiana Deason27:01 ↗
For thyroid masses greater than 4 centimeters, the sensitivity and specificity of FNA is decreased, requiring careful follow-up even if benign
clinicalDiana Deason28:49 ↗
Benign FNA results should be followed with repeat ultrasound in 6-12 months with repeat biopsy if the mass is enlarging or develops suspicious features
guidelineDiana Deason29:02 ↗
Inadequate FNA specimens occur in roughly 1-3% of cases and should be repeated in 3-6 months to avoid picking up atypia from trauma of initial FNA
clinicalDiana Deason29:49 ↗
Sporadic medullary thyroid cancer is unusual in children, so routine calcitonin monitoring is not recommended for every pediatric patient with a thyroid nodule
guidelineDiana Deason31:34 ↗
Patients with medullary thyroid cancer and calcitonin level greater than 500 at presentation require imaging to exclude metastatic disease including CT neck, CT chest, MRI or CT abdomen, and possibly bone scan
guidelineDiana Deason33:01 ↗
MEN 2A patients can develop medullary thyroid cancer, pheochromocytomas, and hyperparathyroidism
clinicalDiana Deason33:36 ↗
MEN 2B patients can develop medullary thyroid cancer, pheochromocytomas, mucosal neuromas, and Marfanoid habitus with elongated features and joint laxity
clinicalDiana Deason33:47 ↗
MEN 2B patients with RET 918 mutation present with thyroid cancer very early, in infancy, with reported cases as young as 3 months
clinicalDiana Deason34:11 ↗