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7. ENDOCRINE > 1. Adrenal > Flashcards

1. Adrenal Flashcards

1
Q

Congenital absent kidneys will result to what adrenal?

A

Pancak adrenals

Flat
Straight
Discoid

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2
Q

Each adrenal gland gets arterial blood from these 3 arterial supplies

A

Superio - phrenic
middl - aorta
inferior - renal artery

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3
Q

There are 4 zones to the adrenal, each of which makes different stuff.

A

Zona Glomerulosa
Zona Fasiculata
Zona Reticularis
Medulla

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4
Q

Makes Aldosterone

A

Zona gromerulosa

Prolonged stimulation = hypertrophy

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5
Q

Makes cortisol

A

Zona Fasciculata

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6
Q

Makes Androgens

A

Zona Reticularis

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7
Q

Makes Catecholamines

A

Medulla

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8
Q

Age related trivia: The relative size of the adrenal changes as you age.
* Second Trimester:
* Third Trimester:
* Adulthood:

A
  • Second Trimester: Adrenal is Half the Size of the Kidney
  • Third Trimester: Adrenal is 1/3 the Size of the Kidney
  • Adulthood: Adrenal is 1/13 the Size of the Kidney
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9
Q

In babies, the cortex is ____
the medulla is ____

A

Normal Adrenal -
Hypoechoic Cortex,
Hyperechoic Medulla,
Hypoechoic Cortex - like an Oreo, with a creamfilling.

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10
Q

If you see a Pediatric Adrenal Cases you should think about:

A

(a) normal
(b) congenital
(c) neuroblastoma
(d) hemorrhage
(e) hyperplasia

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11
Q

There are three classic congenital cases

A

Pancake (Discoid)
Horseshoe
Adrenal Cyst

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12
Q

This occurs when the limbs of the adrenal glands fuse in the midline, and is associated with asplenia (right isomerism)

A

Horseshoe adrenals

Remember, they can show you bilateral trilobed lungs, a horizontal midline liver, an absent spleen, malrotation, and congenital heart disease (total anomalous pulmonary venous return - most commonly) — all in association with this horseshoe adrenal gland.

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13
Q

in a newborn - an adrenal cyst usually get resected because you can’t tell them apart from ?

A

Neuroblastoma

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14
Q

they form in the adrenal medulla (usually), and typically look like an enlarged gland with a hyperechoic component.

A

Neuroblastoma

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15
Q

This occurs most commonly in the setting of trauma or stress (neonates).

What this typically looks like on ultrasound is an enlarged gland with an anechoic component.

A

Hemorrhage

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16
Q

Hemorrhage of the adrenal in the setting of M fulminant meningitis (from Neisseria Meningitidis).

A

Waterhouse-Friderichsen Syndrome

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17
Q
A

Adrenal Hyperplasia

So what does “looks like a brain ” mean ? That means the surface is wrinkled, like it has gyri and sulci.

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18
Q

Congenital adrenal hypertrophy is caused by

A

21-Hydroxylase Deficiency in 90% of the cases

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19
Q

21-Hydroxylase Deficiency clicial manifestation

A

Genital ambiguity (girls)

Salt losing pathology (boys) - life threatening

Limb > 4 mm
loss of centrl hyperechoic stripe

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20
Q

I say “Genital ambiguity”,

A

21-Hydroxylase Deficiency

21
Q

bilateral adrenal gland hyperplasia =

A

overproduction o f ACTH

22
Q

This is an overproduction ofACTH by a pituitary adenoma,

A

Cushing Disease = too much coritsol

23
Q

This is actually the most common cause of excess cortisol (75%)

A

Cushing Disease

24
Q

Cushing syndrome:

A

overproduction of ACTH by:
1. An ACTH secreting tumor - small cell tumor
2. Overproduction of ACTH via an adrenal adenoma
3. Straight up adrenal hyperplasia

+

Taking chronic high dose sterioid

Any way you end up with a fat moon face and big gross lines all over you belly counts as “syndrome.”

25
Q

classic mimic of an adrenal mass on imaging.

A

Infradiaphragmatic extralobar sequestration

The ultrasound will show a heterogeneous suprarenal mass

CT picture clearly showing the blood supply from the aorta (or branches o f the aorta):

26
Q

It is really hard to tell Infradiaphragmatic extralobar sequestration from an adrenal mass with out any “hints.”

Examples of hints:

A

Hx of history “male neonatal with respiratory distress and cyanosis. ”

27
Q

Normal adrenal

A

Triple Stripe
- Hypoechoic Cortex,
- Hyperechoic Medulla
- Hypoechoic Cortex
- Smooth Surface

28
Q

Hyperplasia:

A

Big
Longer than 20 mm
Looks like a “brain”

“Genital ambiguity”, = 21-OH Deficiency

29
Q

Hemorrhage:

A

Big with an anechoic (or echogenic) component
Gets smaller over time
Seen with “stress” or trauma

30
Q

Neuroblastoma

A

Big with an echogenic (or anechoic) component
Does NOT gets smaller over time

31
Q

These things are easily the most common tumor in the adrenal gland

A

Adrenal Adenoma

32
Q

Absolute washout result of adenoma

A
33
Q

Relative washout result of adenoma

A
34
Q

what is a mimic of adenoma washout?

A

Hypervascular mets

Portal venous HU values > 120 should make you think about a met.

35
Q
A

Adrenal Adenoma

Signal drop out In and Out of Phase

36
Q

Real Life = Mass in Adrenal =

A

Adenoma

37
Q

If adnreal HU on PVP is > 120 =

A

MEts from RCC/HCC or pheo

38
Q

Two different tumors that smash together to look like one mass.

A

“Collision Tumors”

usually one of them is an Adenoma

39
Q

Syndrome of excessive aldosterone production. This is most commonly caused by a benign adenoma (70%).

A

Conn’s Syndrome

40
Q
A

Pheochromocytoma

T2 bright. a heterogeneous mass with AVID ENHANCEMENT

41
Q

if they show you HU measurements > 120 on arterial or portal venous phase =

A

you can NOT call the thing an adenoma.

42
Q

Rule of 10s of pheocromocytoma

A

10% are extraadrenal (Organ of Zuckerkandl - usually at the IMA
10% are bilateral
10% are in children
10% are hereditary
10% are NOT active (no HTN)

43
Q

Associated Syndrome of Pheochromocytoma

A

First
Von Hippel Lindau

then think MEN Ila and Ilb

44
Q

Carney Triad

A

Extra-Adrenal Pheo
GIST
Pulmonary Chondroma (hamartoma).

Don’t confuse this with the Carney Complex
(Cardiac Myxoma, and Skin Pigmentation).

45
Q

Benign tumor that contains bulk fat

A

Myelolipoma

46
Q
A

Myelolipoma

> 4 cm, can bleed + retroperitoneal hemorrhage

47
Q

Adrenal calcifications are often a result of ?

A

prior trauma + infection (TB)

Certain tumors (cortical carcinoma, neuroblastoma, myelolipoma) can have calcifications. Melanoma mets are known to calcify.

48
Q
A

Bilateral enlarged calcified adrenals. It’s a fat metabolism error thing that kills before the first year of life.

49
Q
A

Cortical Carcinoma

LARGE (4 cm -10 cm),
May be functional (Cushings)
Calcify in about 20% of cases
Bad news & met everywhere (direct invasion often first).

not likely to be less than 5 cm + often has central necrosis.

7. ENDOCRINE (3 decks)

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