this is short presentation of some cases of endocrinal diseases and possible imaging finding which helps to definitive diagnosis and management.

1. IMAGING IN ENDOCRINE
(HORMONAL) DISEASES
Dr. Abhijeet Bhambure
Junior Resident
Dept. Radio-diagnosis
KIMS, Karad.

8. 40 F with increased prolactin
levels.
T1 slight low SI , T2 slight high
SI
Pituatary microadenoma (<
10mm)
The differential diagnosis:
pituitary microadenoma or
Rathke's cleft cyst (the two can
be indistinguishable).
Pituatary macroadenoma (>10mm) generally
asymmtomatic, but can present symtoms related
to mass effect.
This case 40/m c/c vision impairment
Mass extending to suprasellar region

9. This patient presented with nasal obstruction.
She went to an ENT specialist who saw a large endonasal mass and she was
referred to the neurosurgeon for planned major skull base resection.
The neurosurgeon had seen something similar before, and checked her prolactin-
level.
This was 4000 (25 or less is normal). Endonasal biopsy revealed prolactinoma.
After treatment with bromocriptine the mass shrunk down and no surgery was
necessary.

13. Hyperplasia and Goiter
Approximately 80% of nodular thyroid disease is caused by hyperplasia of the gland
Its etiology includes
iodine deficiency (endemic),
disorders of hormonogenesis (hereditary familial forms),
and poor utilization of iodine as a result of medication.
- When hyperplasia leads to an overall increase in size or volume of the gland, the term
goiter is used.
- Histologically, the initial stage is cellular hyperplasia of the thyroid acini, followed by
micronodule and macronodule formation.

14. Hyperplastic (adenomatous) nodule.
Longitudinal ultrasound images. A, Oval
homogeneous nodule
(arrows) with thin, uniform halo. B, Three
hyperechoic nodules,
typical of hyperplasia. C, Solitary
hyperechoic nodule, which was
benign on fine-needle aspiration biopsy.

16. The most common type of thyroiditis is chronic autoimmune lymphocytic thyroiditis,
or Hashimoto’s thyroiditis. It typically occurs as a painless, diffuse enlargement of
the thyroid gland in a young or middleaged woman, often associated with
hypothyroidism.
Hashimoto’s thyroiditis is diffuse, coarsened, parenchymal echotexture, generally more
hypoechoic than abnormal thyroid. In most cases the gland is enlarged. Multiple,
discrete hypoechoic micronodules from 1 to 6 mm in diameter are strongly suggestive
of chronic thyroiditis; this appearance has been called micronodulation.
Micronodulation is a highly sensitive sign of chronic thyroiditis.
These lobules are surrounded by multiple linear echogenic fibrous septations. These
fibrotic septations may give the parenchyma a “pseudolobulated” appearance.
Both benign and malignant thyroid nodules may coexist with chronic lymphocytic
thyroiditis, and FNA is often necessary to establish the final diagnosis

21. It is due to end organ receptor
defect making them refractory to
the action of PTH

39. ADDISONS DISEASE

40. 18-year-old female in a trauma—motor vehicle
versus pedestrian.
dense hematoma in the right adrenal gland, measuring 56 HU, with mild adjacent stranding
(arrow). Normal left adrenal gland. Left pneumothorax and collapse of the left lung identified on
the coronal image.
This could result to severe adrenal insufficiency

42. • Pheochromocytoma
• Pheochromocytomas are paragangliomas arising from
the adrenal medulla. They are hormonally active in
90% of cases. Morphologic findings on CT and MRI
include large variation in size, homogeneity, and
margination of the tumours and significant
enhancement in most cases. On MRI tumours have a
low SI on T1-weighted images and a very high SI on T2-
weighted images
• Pheochromocytomas are sometimes called the 10%
tumorbecause they are associated with a 10% risk of
malignancy, 10% of the tumors are bilateral, 10% are
hormonally inactive and 10% are extra-adrenal (figure).
Usually, tumors are larger than 3 cm when seen. They
are highly vascular, and larger tumors are prone to
hemorrhage and necrosis, even when they are benign

48. Gastrointestinal Neuroendocrine
Tumor Syndrome
111
In-octreotide (Octreoscan) will
concentrate in gastrointestinal tract
carcinoid tumours as well as in liver
metastases, and is generally
considered the test of choice due to
its high sensitivit
Carcinoid syndrome

50. 75/ M with seizure episodes following hypoglycemia
Typically insulinomas present with Whipple's triad consisting of: fasting hypoglycaemia
(<50 mg/dL) symptoms of hypoglycaemia (due to subsequent catecholamine release)
immediate relief of symptoms after the administration of IV glucose
Most insulinomas are small (90% are <2 cm at presentation 3
) and hypervascular. They
may contain calcifications. Malignant tumours tend to be larger. Equally distributed
between the head, body, and tail of the pancreas.

54. The normal ovary contains over two million
primary oocytes at birth, about 10 of which
mature each menstrual cycle.
Of the 10 Graafian follicles that begin to
mature, only one becomes the dominant
follicle and grows to a size of 18-20 mm by
mid-cycle, when it ruptures to release the
oocyte.
The other nine follicles become atretic and
fibrous.
After release of the oocyte, the dominant
follicle collapses, and the granulosa cells in
the inner lining proliferate and swell to form
the corpus luteum of menstruation.
Over the course of 14 days the corpus
luteum degenerates, leaving the small
scarred corpus albicans.

55. Follicular cyst
A dominant Graafian
follicle sometimes fails to
ovulate and does not
involute. When it becomes
larger than 3 cm, it is
called a follicular cyst.
Corpus luteum cyst
A corpus luteum may seal and
fill with fluid or blood, forming a
corpus luteum cyst.
The transvaginal ultrasound
images show a small complex
ovarian cyst with wall vascularity
on power Doppler analysis.
The characteristic circular
Doppler appearance is called
the 'ring of fire'.

56. Hemorrhagic ovarian cyst
When a Graafian follicle or
follicular cyst bleeds, a
complex hemorrhagic ovarian
cyst (HOC) is formed.
Ovarian hyperstimulation syndrome
- Theca lutein cysts
Hormonal overstimulation more often
occurs in molar pregnancy,
erythroblastosis fetalis or in plural
pregnancies.
On imaging there is - usually bilateral -
ovarian enlargement with multiloculated
cyst that can totally replace the ovary.

60. TESTIS

62. MEN SYNDROME

63. MEN 2

65. Thank you!