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ENDOCRINE > ADRENAL > Flashcards

ADRENAL Flashcards

1
Q

described layer of adrenal cortex

A

GFR
G.-salt - all Doster on
F.-sugar - cortisol
R.-sex

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2
Q

described vascular anatomy of right adrenal

A

venous drainage directly and IVC

artery off of renal

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3
Q

described vascular anatomy left adrenal

A

venous drainage into renal vein

arterial branch directly off of aorta

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4
Q

which is cephalad renal artery or vein

A

renal artery superior and posterior

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5
Q

relationship of the splenic artery to vein

A

artery more cranial

vein runs in pancreas

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6
Q

cons syndrome

A

hyperaldosteronism
Glomerulosa
Hypokalemia

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7
Q

Exogenous causes of Cushing syndrome

A

Bronchial carcinoid
Small cell lung cancer
Produces excessive ACTH

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8
Q

most common cause of Cushing’s disease

A

ACTH producing pituitary adenoma

Causes bilateral adrenal cortical hyperplasia

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9
Q

Treatment of pituitary adenoma causing Cushing disease

A

transsphenoidal micro-adenectomy

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10
Q

Cushing’s syndrome ACTH independent causes

A

adrenocortical tumor
Adenomatous
Adrenal cortical carcinoma (CAREFUL, hormone active cancer like parathyroid)
Bilateral adrenal hyperplasia

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11
Q

ACTH dependent Cushing’s syndrome

A

Hypothalamus releases excess cortical troponin releasing hormone
Pituitary adenoma (CAREFUL, ACTH independent in his ADRENAL adenoma)
extra pituitary ACTH tumor is colon bronchial carcinoma, small cell lung cancer

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12
Q

initial screening test or Cushing’s syndrome

A

glucocorticoid or hormone measurement:
24-hour urine excretion of 3 cortisol
17 hydroxy corticosteroid
plasma cortisol level

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13
Q

with test is used to discriminate between Cushing syndrome and Cushing’s disease

A

dexamethasone suppression test
Cushing’s SYNDROME will not be suppressed below 12 microgram per decaliter
because of a time as adrenocortical tumor or adrenals being stimulated by non-pituitary sources ACTH (bronchial carcinoid and small cell)

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14
Q

direct test to determine hypersecretion indicate palmar adrenal pelvis of Cushing’s syndrome such as adenoma or nodular hyperplasia or carcinoid

A

plasma ACTH measurement via him he no half a

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15
Q

was test of choice for patient suspected of pituitary adenoma causing Cushing’s disease

A

MRI of pituitary

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16
Q

Next test of choice for patient suspected of pituitary adenoma causing Cushing’s disease when MRI is negative

A

inferior petrosal sinus sampling for ACTH

CT scan of the chest (rule out bronchial carcinoid as most common cause; and small cell lung cancer)

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17
Q

test of choice to identify adrenal lesion

A

CT scan

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18
Q

most common finding when adrenal pathology is causing Cushing’s syndrome

A

in her lateral mass 2 cm or greater may be atrophic and normal contralateral gland

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19
Q

when his adrenal mass suspicious for carcinoma with imaging

A

larger than 4-6 cm

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20
Q

treatment of Cushing’s

A

surgery:
Transsphenoidal micro-adenectomy for pituitary cause cure approaches 95%

Bilateral total adrenalectomy was indicated with pituitary therapy fails

medical treatment can be offered : To suppress corticosteroid:
Metyrapone
ketoconazole
aminogluthemide
Pregnancy at nearly all patient’s will develop tolerance to these medications)
Gen. he reserved for poor surgical candidate

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21
Q

Nelson syndrome

A

seen after bilateral adrenalectomy 20%
with loss of negative feedback from adrenals->
progression of ACTH secreting pituitary adenoma
-hyperpigmentation
-exophthalmos
- visual field loss

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22
Q

primary adrenal Cushing’s syndrome

A

adrenal adenoma
Solitary adenoma is cause a 80-90%

adrenal tissue and the contralateral gland becomes atrophic because of down regulation the back inhibition ACTH from circulating cortisol level

Operative approach of choice laparoscopic adrenalectomy outpatient he received perioperative steroid dose is remaining adrenal tissue stays poorly functional for many months

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23
Q

Primary adrenal hyperplasia

A

(Careful, this is NOT adrenal adenoma)

Treatment most often requires bilateral adrenalectomy

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24
Q

Primary hyperaldosteronism general characteristics and findings

A 
Conn syndrome
Excess aldosterone from
 women and fourth and fifth Decades
INCREASE sodium
Decrease potassium
 decreased magnesium
Increase  extracellular volume  
resulting hypertension
Resulting metabolic alkalosis (TETANY)
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25
Q

Primary hyperaldosteronism causes

A

Conn syndrome
Excess aldosterone from:
cortex pathology (like adrenal causes of Cushing’s) just effect faciculata
solitary adenoma
diffuse hyperplasia
Nodular hyperplasia
Adrenal cortical carcinoma is because less than 1% of cases

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26
Q

Diagnosis of Conn’s syndrome

A 
Classic triad:
 #1 hypertension
#2 hypokalemia
#3 increased aldosterone
Concomitant low plasma renin activity
 elevated plasma urine aldosterone
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27
Q

syndrome associated with Collins syndrome

A

MEN I!

familial concha syndrome

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28
Q

secondar hyperaldosteronism

A

normal response to volume or salt depletion

Associated with cirrhosis, nephrotic syndrome, congestive heart failure

29
Q

treatment of primary hyperaldosteronism

A

surgical!

unilateral aldosterone secreting adenoma is treated with adrenalectomy

30
Q

blood pressure normalizes and 70%

A

the remainder acquired her modest antihypertensive therapy

31
Q

treatment of primary hyperaldosteronism

A

if cannot be localized to one adrenal glands-manage with spinal tone and symptomatic treatment

Bilateral adrenal hyperplasia is the cause of hyperaldosteronism (not Cushing’s syndrome) DO NOT perform bilateral adrenalectomy

32
Q

Adrenal cortical carcinoma

A

Most her LARGE ( mean diameter 12 cm)
Encapsulated, friable, central necrosis and hemorrhage

Often difficult to differentiate via cellular characteristics

Venous or capsular invasion and distant metastases most reliable signs of malignancy

Can see cellular pleomorphism and mitotic fields

33
Q

presentation of adrenal cortical carcinoma

A

over 50% present with Cushing’s syndrome

15% virilization/feminization and purely aldosterone secreting carcinoma

10% hormone secreting only found on biochemical study

half have metastases: Lung, liver

children more likely to excess androgen

boys may have percoucious puberty

34
Q

diagnosis of adrenal cortical carcinoma

A

CT scan:
Predilection for extension through adrenal vein or into
renal vein (left side)
the vena cava (right side)

mass 2 cm: Workup for functional status

If functional:

35
Q

Treatment of adrenocortical carcinoma

A

Surgical excision with removal of all visible tumors

Excision of involved regional lymph nodes

En bloc resection therefore the nephrectomy contiguous structures; hepatic metesectomy may be needed

Postop corticosteroid

Chemotherapy with meds for unresectable tumor:
Mitotane

36
Q

incidentally discovered 4-6 cm adrenal mass

A

Greater than 6 cm adrenalectomy

37
Q

Were pheochromocytomas found

A

Organ of Zuckerkandl:
inferior to the takeoff of the inferior mesenteric artery and anterior to the aorta

This is are of chromaffin dense tissue

38
Q

what does pheochromocytoma secrete

A

most secrete both norepinephrine and epinephrine

39
Q

Best test for pheochromocytoma

A

PLASMA metanephrines the

40
Q

imaging locations studies for pheochromocytoma

A

MIBG scane

selectively taken up by Chromafin cells

41
Q

addisonian crisis

A

adrenal insufficiency

42
Q

Which is more and veins or arteries adrenal gland

A

venous drainage

43
Q

which sided easier to get adrenal venous sample from

A

left adrenal vein more straight and long

right adrenal vein sure posterior IVC bleeding risk

44
Q

was sided heart to do an adrenalectomy

A

right side:
need to retract liver
need to is a mobilized duodenum
shortening draining an IVC bleeding risk

45
Q

cancer that metastasized to adrenal glands

A

breast
Melanoma
Lung

46
Q

utility of fine-needle aspiration with adrenal gland

A

not helpful

only used when adrenal metastasis is suspected

47
Q

most common symptoms of pheochromocytoma

A

hypertension
Easily sustained rather than episodic

headache

48
Q

Hallmark of MEN II

A

medullary thyroid carcinoma 100%
( multifocal and bilateral)
pheochromocytoma 40%
parathyroid hyperplasia 33%

49
Q

distinguishing features of MEN IIA versus IIB

A

IIb:
does not have parathyroid hyperplasia
Marfanoid habitus
Tongue neuroma

50
Q

workup for hyperaldosteronism in

A

high urine potassium ( low serum potassium)
low plasma renin
high aldosterone to ring and ratio pregnancies greater than 20)
( must be tested with spironolactone or angiotensin converting enzyme inhibitor)

with laboratory diagnosis next test and CT scan

51
Q

most common cause of primary hyperaldosteronism

A

adrenal adenoma

other causes are patent bilateral adrenal hyperplasia

52
Q

Causes secondary hyperaldosteronism

A

renal artery stenosis
Cirrhosis
Congestive heart failure

53
Q

Most common cause of congenital adrenal hyperplasia - described findings

A 
21  hydroxylase deficiency
 decrease in both cortisol and aldosterone
Salt wasting with hypernatremia
Hypokalemia
  ambiguous genitalia
Postnatal virilization
Salt metabolism problems
54
Q

Most common cause of Cushing syndrome would not from steroid administration

A

ACTH producing pituitary adenoma

This is called Cushing’s disease and

55
Q

Cushing syndrome ACTH dependent

A

ACTH pituitary adenoma

Ectopic ACTH syndrome

E

56
Q

Cushing syndrome ACTH independent

A

Adrenal carcinoma
Adrenal adenoma but careful PITUITARY adenoma is ACTH DEPENDENT
Adrenal hyperplasia

57
Q

best test progressive syndrome

A

24-hour urine cortisol level

58
Q

Most common extra adrenal site for pheochromocytoma

A

organ of Zuckerkandl:
Para-aortic
Takeoff of the inferior mesenteric artery and oriented aortic bifurcation

59
Q

Most common symptoms of Cushing’s syndrome

A

Progressive truncal obesity

Other findings:
Proximal muscle weakness
Wide purple stiae
  spontaneous ecchymosis
Hypokalemic metabolic alkalosis
60
Q

Neuroblastoma

A 
most common abdominal malignancy and children
Third most common overall malignancy and kids
Presents with abdominal mass
Surgical resection best treatment
Drives from neural crest
Catecholamines produced
Prognosis better at younger age
N-myc  are worse prognosis
 POSTERIOR mediastinum
61
Q

Associated findings with neuroblastoma

A

dancing eyes - dancing feet syndrome:
Cerebellar ataxia, nystagmus, involuntary movement
Catecholamine release
Periorbital metastasis
Proptosis and periorbital ecchymosis
Skin metastasis-blueberry muffin
Severe diarrhea from vasoactive intestinal peptide

62
Q

With tumor is associated with aniridia and hemihypertrophy

A

Wilms tumor

63
Q

CT findings other than size associated adrenal cortical carcinoma

A

necrosis, hemorrhage, local invasion

64
Q

how common is adrenal cortical carcinoma functional

A

60% hormone excess

Cushing’s/ virilization

65
Q

first biochemical abnormality detected in the majority of MEN I

A

95%-earliest manifestation of hypercalcemia from parathyroid hyperplasia
Mass most common pancreas lesion: Diffuse bilateral hyperplasia or multiple microadenoma-most common functional pancreatic tumor gastrinoma

pituitary lesions usually adenomas and anterior pituitary

66
Q

drug of choice to block pheochromocytoma

A

Phenoxybenzamine
alpha-blocker
Other alpha-blocker is:
aDoxazosin

67
Q

most common pituitary neoplasm associated with MEN I

A 
prolactinoma
Make a visual field defect
Amenorrhea
 galactorrhea
 hypogonadism in men
68
Q

algorithm for Cushing’s syndrome testing

A

24-hour urine cortisol test
If elevated: Low dose dexamethasone suppression test
If Suppression: No Cushing’s syndrome
failure to suppress: Yes Cushing’s syndrome

ACTH low:
Primary adrenal source or diagnosis one obtain a CT scan

ACTH high:
Pituitary or ectopic source

get ACTH suppression
If suppression-pituitary get MRI

If no suppression-ectopic:
broncho-carcinoid
Small cell lung cancer

69
Q

associated symptoms of pheochromocytoma

A

MENIIa/b
von Hippel-Lindau
Recklinghausen disease

ENDOCRINE (4 decks)

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