EXAM #2: PATHOLOGY OF THE ADRENAL GLAND

Question 1

What are the two primary adrenal cortical neoplasms?

Answer 1

1) Cortical adenoma

2) Cortical carcinoma

Question 2

What are the gross characteristics that are pathognomonic cortical adenoma?

Answer 2

“well circumscribed (benign), yellow-orange lesions”

*Can be in cortex only, or protrude into the medulla/subcapsular region

Question 3

How is a cortical adenoma differentiated from adrenal hyperplasia?

Answer 3

Solitary, circumscribed nodule

Question 4

How can you tell the difference between a functional and non-functional cortical adenoma?

Answer 4

Fucntional= normal adjacent tissue thickness

Nonfunctional= atrophy of adjacent tissue

Question 5

Describe the histologic appearance of a cortical adenoma.

Answer 5

Vacoulated with mild nuclear pleomorphism

Question 6

Describe the gross appearance of a cortical carcinoma.

Answer 6

• Yellow on cut surface
• Usually large with areas of hemorrhage, cystic change, and necrosis

*Note that this is NOT different from adenoma

Question 7

Where do adrenal carcinomas commonly metastasize?

Answer 7

1) Lung

2) Lymh nodes

Question 8

What characteristics differentiate a cortical adenoma from a cortical carcinoma?

Answer 8

1) Metastasis
2) Large size
3) Necrosis
4) Mitotic figures
5) Vascular invasion

Question 9

Describe the gross appearance of adrenal hyperplasia.

Answer 9

Yellow, thickened, and multinodular

*Note that being mutlinodular vs. singular differentiates from cortical adenoma

Question 10

What is the basic cause of Cushing’s Syndrome?

Answer 10

Elevated glucocorticoid levels (cortisol)

Question 11

What are the four etiologies of Cushing’s Diseases/ Syndrome?

Answer 11

1) Cushing Disease (an anterior pituitary tumor oversecreting ACTH)
2) Paraneoplasic Syndrome esp. small cell carcinoma making ACTH
3) Adrenal (tumor or hyperplasia) secreting cortisol
4) Iatrogenic (exogenous cortisol use)

Question 12

What are the classic clinical manifestations of Cushing’s Syndrome?

Answer 12

1) Central obesity
2) Moon facies
- Unable to see ears from inspection from the front
3) HTN
4) Neuropsychiatric abnormalities
5) Menstrual abnormalities
6) Cutaneous striae

*Also, osteoporosis

Question 13

Generally, what causes primary hyperaldosteronism?

Answer 13

• Increased aldosterone production from the adrenal gland

- Usually, an adrenal neoplasm or adrenal hyperplasia

Question 14

What is Conn Syndrome?

Answer 14

This is a solitary aldosterone producing adenoma

*Sometimes called an APA (Aldosterone Producing Adenoma)

Question 15

Describe the gross appearance of the tumor seen in Conn Syndrome.

Answer 15

• Singular
• Small
• Encapsulated

Question 16

What are the clinical manifestations of hyperaldosteronism?

Answer 16

1) Hypertension
- Elevated Aldosterone causing Na+ and water reabsorption in the principal cells of the collecting duct
2) Hyperkalemia

Question 17

What are the three major etiologies of adrenocortical insufficiency?

Answer 17

1) Primary acute adrenocortical insufficiency
2) Primary chronic adrenocrtical insufficiency (Addison Disease)
3) Secondary adrenocortical insufficiency

Question 18

What is Waterhouse-Friderichsen Syndrome?

Answer 18

Adrenal insufficiency secondary to massive adrenal hemorrhage

• Associated with N. meningitidis infection
• Esp. in children

Question 19

What is Addison Disease?

Answer 19

Chronic autoimmune destruction of the adrenal cortex

Question 20

How much of the adrenal gland must be destroyed in Addison Disease for there to be symptoms?

Answer 20

90%

Question 21

Describe the morphology of the adrenal gland in Addison Disease.

Answer 21

1) Small glands
2) Lipid depletion of the adrenal cortex
3) Variable lymphocytic infiltrate in the adrenal cortex

*Note that the adrenal medulla is SPARED

Question 22

What are the clinical manifestations of Addison Disease?

Answer 22

1) Fatigue
2) Anorexia
3) Nausea
4) Cutaneous hyperpigmentation
5) Hypotension

Question 23

What are the labs associated with Addison Disease?

Answer 23

1) Elevated ATCH
2) Hyperkalemia
3) Hyponatremia

Question 24

What is secondary adrenal insufficiency?

Answer 24

Disorder of the hypothalamus or pituitary associated with decreased ACTH production

Question 25

How does secondary adrenal insufficiency appear morphologically?

Answer 25

Atrophy of the adrenal gland WITH SPARING OF:

1) Zona glomerulosa
2) Adrenal medulla

Question 26

What are the 5x 10% rules in pheochromocytoma?

Answer 26

1) 10% malignant
2) 10% afunctional
3) 10% bilateral
4) 10% extraadrenal
5) 10% familial

Question 27

Describe the morphological appearance of a pheochromocytoma.

Answer 27

• Pale gray-brown
• Associated with hemorrhage, necrosis, cystic change
• Highly vascular

Question 28

What are the clinical manifestations of a pheochromocytoma?

Answer 28

1) Abrupt HTN
2) Tachycardia
3) Palpitations
4) Headache, sweating, tremor
5) Apprehension

Question 29

How is a pheochromocytoma diagnosed?

Answer 29

Measurement of urinary and serum catecholamine metabolites

Question 30

What scan is used to diagnose a pheochromocytoma?

Answer 30

MIBG scan

Question 31

Adrenal medulla tumors include neuroblastoma and pheochromocytoma. What patient population is a neuroblastoma associated with?

Answer 31

Kids

Question 32

What oncogene are neuroblastomas associated with?

Answer 32

N-myc

Question 33

How are neuroblastomas described histologically?

Answer 33

• Small blue cells

- Rosette structure

Question 34

What are the clinical manifestations of a neuroblastoma?

Answer 34

1) Abdominal mass
2) Diastolic HTN
3) “Blueberry muffin baby”– mets to skin