3.2.3 Adrenal Pathology Flashcards

1
Q

How would this person look without Cushing’s?

A
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2
Q

What is the rule of 10s in regards to pheochromocytoma?

A
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3
Q

Chromaffin cells release what? What are chromaffin cells innervated by?

A

Epinephrine

Pre-ganglionic fibers that release acetylcholine

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4
Q

What are some of the sources of adrenal hyperfunction?

A
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5
Q

What are the important anatomical features of the adrenal gland?

A

Cortex - Steroid hormones

Medulla - Catecholamines

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6
Q

What are the main causes of Addison’s disease (5)?

A

Granulomatous inflammation

Metastatic carcinoma

Amylodosis

Surgical removal

Idiopathic

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7
Q

What are the specific lab findings associated with pheochromocytoma?

A

Elevated metanephrines and chromogranin A

Elevated urinary catecholamines

Presence of adrenal mass on CT

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8
Q

What is the arrow pointing to in this cell?

A

Adrenal medulla, ganglion cells (black arrow), Trichrome, 40x. The remaining cells are the small clusters of pheochromocytes.

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9
Q

Endocrine hyperfunction is usually due to what?

A

Increased tropic hormone

Neoplasms

Exogeneous artificial hormones

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10
Q

What is the clinical triad associated with pheochromocytoma?

A

Clinical triad - Headache, sweating, and heart palpitations

If hypertension is also found it raises the probability of pheochromocytoma to 90%

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11
Q

What is this an image of?

A

Adrenal gland - normal

Slide photo: Normal adrenal, trichrome stain. Note that the thin zona glomerulosa can easily be seen under the capsule, even at low power. The lipid-rich zona fasciculata is also discernible. The zona reticularis has less fat, and the medulla can be clearly separated from it.

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12
Q

What lung neoplasm commonly leads to Cushing’s Syndrome?

A

Small cell carcinoma

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13
Q

What is this an image of? Go ahead an identify the layers TANNER!

A
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14
Q

What are the two main acute causes of adrenal hypofuction?

A

Waterhouse-Friedrichson syndrome

Steroid withdrawl

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15
Q

What is this an image of?

A

Diffuse hyperplasia

Diffuse hyperplasia is found in 60% to 70% of cases of Cushing syndrome.

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16
Q

Adrenal gland hypofunction is typically due to?

A

Inflammation

Surgical excision

Circulating defect

Congenital enzyme defect

Neoplasm compressing normal gland

17
Q

What are the characteristics of Cushing’s Syndrome?

A

Increased mineralcorticoids - Salt and water retention and potassium depletion

Increased glucocorticoids - obesity, hyperglycemia, decreased protein, euphoria

Increased androgens - hirsutism, acne, amenorrhea, and polycythemia

18
Q

What is the differenct between the two figures in this image?

A

Left is normal

RIght is atrophied (Sheehan syndrome)

19
Q

What in Conn’s syndrome?

A

Mineralcorticoid-secreting adenoma often in the glomerulosa

20
Q

How will Addison’s disease present in clinic?

A

Increased skin pigmentation

Hypotension

Loss of Libido

Hyponatremia

Hyperkalemia (Na and K are due to overlap of glucocorticoid and mineralcorticoid)

Hypoglycemia

21
Q

What is this an image of?

A

Pheochromocytoma

Note the small amount of normal adrenal. The tumor at the top of the slide is separated from it by a fibrous pseudocapsule, which is often a sign of a benign prognosis.

22
Q

What is this an image of?

A

Pheochromocytoma

You can see the fine capillaries surrounding nests of cells (zellballen), most easily seen in the middle of the photomicrograph . There is mild atypia, meaning that the nuclei are of different size, shape, and darker blue color (more DNA) as compared to normal.

23
Q

What is this an image of?

A

Anaplasia in adrenal carcinoma.

Atypical cells with big blue nuclei

24
Q

How would you treat pheochromocytoma?

A

Surgical removal

Pre-surgical preparation with alpha and beta blockers

25
Q

What is this an image of?

A

Primary hyperplasia

Primary adrenal neoplasms, such as adrenal adenoma and carcinoma, and primary cortical hyperplasia are responsible for about 10% to 20% of cases of endogenous Cushing syndrome. This form of Cushing syndrome is also designated ACTH-independent Cushing syndrome or adrenal Cushing syndrome because the adrenals function autonomously. The biochemical sine qua non of adrenal Cushing syndrome is elevated serum levels of cortisol with low levels of ACTH

26
Q

What is this an image of?

A

Adrenal, carcinoma. Note necrosis, evident grossly.

The carcinomas associated with Cushing syndrome, by contrast, tend to be larger than the adenomas. These tumors are unencapsulated masses frequently exceeding 200 to 300 gm in weight, having all of the anaplastic characteristics of cancer, as will be detailed later. With functioning tumors, both benign and malignant, the adjacent adrenal cortex and that of the contralateral adrenal gland are atrophic, owing to suppression of endogenous ACTH by high cortisol levels.

27
Q

What is this an image of?

A

This would be a classic example of what a pheochromocytoma should look like on the national boards. Look for expansion of the gray-brown medulla, which is normally quite thin. You can see the lipid-rich adrenal cortex around it.

28
Q

What is this an image of?

A

Waterhouse-Friedrichson syndrome (Most commonly caused by Nesseria Meningitis)

Infarction of the adrenal gland

29
Q

What is this image of and what causes it?

A

Sheehan syndrome - caused by ischemic necrosis due to blood loss

30
Q

What is this an image of?

A

Pheochromocytoma

31
Q

What is this an image of?

A

Cortical Adenoma