Adrenal Gland Pathology

Question 1

where are the adrenal glands located

Answer 1

retroperitoneal space - cranial and medial to the kidneys

Question 2

what blood vessel are the adrenals closely associated with

Answer 2

phrenicoabdominal vein

Question 3

what is the normal cortex to medulla ratio

Answer 3

factor of 3

(1:1:, 1:2, 1:3, 2:1, 3:1)

Question 4

is the zona glomerulosa distinct on histology

Answer 4

yes

Question 5

is the zona fasiculata and reticularis distinguishable from each other on histology

Answer 5

no

Question 6

what zone(s) produce cortisol

Answer 6

zona fasiculata
zona reticularis

Question 7

what zone(s) produce aldosterone

Answer 7

zona glomerulosa

Question 8

what is the primary regulator of cortisol

Answer 8

ACTH

Question 9

what is the primary regulator of aldosterone

Answer 9

ANG II

Question 10

adrenocortical hemorrhage

Answer 10

blood in the interstitium of the adrenal gland

Question 11

what species does adrenocortical hemorrhage occur and what are the causes

Answer 11

foals

stress, sepsis, toxemia

Question 12

can you differentiate between hemorrhage and congestion grossly

Answer 12

no - need histology

Question 13

adrenalitis

Answer 13

inflammation of the adrenal cortex

Question 14

what species is adrenalitis common in

Answer 14

dogs

Question 15

what are the causes of adrenalitis

Answer 15

granulomatous: fungal or parasitic
lymphocytic: immune mediated (affects all 3 layers)

Question 16

idiopathic adrenocortical atrophy (IAA)

Answer 16

atrophy of all three cortical layers

suspected to be caused by lymphocytic adrenalitis

Question 17

what endocrinopathy occurs secondary to IAA

Answer 17

hypoadrenocorticism (Addison’s disease)

Question 18

what lesion is associated with IAA

Answer 18

atrophied cortex

(1:6 to 1:10 cortex:medulla ratio)

Question 19

what species is IAA common in

Answer 19

dogs

Question 20

adrenal trophic atrophy

Answer 20

atrophy of the zona fasiculata and reticularis caused by low ACTH production from the pituitary

Question 21

pathogenesis of trophic atrophy

Answer 21

low ACTH –> under stimulation of fasiculata/reticularis –> low cortisol production

Question 22

is the zona glomerulosa affected in trophic atrophy

Answer 22

NO - because aldosterone secretion is NOT stimulated by ACTH

Question 23

what are the causes of trophic atrophy

Answer 23

1. pituitary masses - can cause over/under/no change in production of ACTH; if causes underproduction - leads to trophic atrophy
2. iatrogenic - chronic administration of exogenous glucocorticoids leads to negative feedback on pituitary –> shuts down ACTH production –> trophic atrophy

Question 24

adrenal disorders of growth

Answer 24

hyperplasia –> adenoma –> carcinoma

Question 25

is nodular hyperplasia of the adrenal gland associated with an endocrinopathy

Answer 25

NO

Question 26

can you differentiate medullary vs cortical adenomas grossly

Answer 26

NO

Question 27

what is a unique feature of adrenal carcinomas

Answer 27

can recruit hematopoietic cells - will see bone marrow cells present in tumor

Question 28

hyperadrenocorticism (Cushing's)

Answer 28

overproduction of cortisol from the adrenal cortex

Question 29

what species is Cushing's most common in

Answer 29

dogs

Question 30

clinical signs of Cushing's

Answer 30

- PU/PD/PP - truncal alopecia - pot-belly

Question 31

what are the types of Cushing's disease

Answer 31

1. pituitary dependent 2. adrenal dependent 3. iatrogenic

Question 32

pituitary dependent cushing's

Answer 32

most common form caused by a functional pituitary tumor leading to over secretion of ACTH

Question 33

what lesion is associated with pituitary dependent Cushing's

Answer 33

bilateral adrenal hypertrophy

Question 34

adrenal dependent Cushing's

Answer 34

less common form adrenal cortical adenoma/carcinoma leading to over secretion of cortisol

Question 35

what lesion is associated with adrenal dependent Cushing's

Answer 35

unilateral adrenal atrophy (of the contralateral adrenal gland) mass in one adrenal, other one atrophies

Question 36

iatrogenic Cushing's

Answer 36

caused by exogenous administration of glucocorticoids

Question 37

what lesion is associated with iatrogenic Cushing's

Answer 37

trophic atrophy atrophy of the zona fasiculata and reticularis

Question 38

hyperaldosteronism (Conn syndrome)

Answer 38

adenoma or carcinoma of the zona glomerulosa leads to hyper secretion of aldosterone --> excess water and Na retention --> hypertension treat w/ loop diuretics RARE in veterinary species

Question 39

is neoplastic metastasis to the adrenals common

Answer 39

yes - highly vascularized

Question 40

what is the most common endocrinopathy of ferrets

Answer 40

adrenal associated endocrinopathy (AAE)

Question 41

adrenal associated endocrinopathy (AAE)

Answer 41

hyperplasia/adenoma/carcinoma of the adrenals carcinomas more common than benign

Question 42

pathogenesis of AAE

Answer 42

early gonadectomy --> loss of GnRH suppression --> overstimulation of LH --> overproduction of sex steroids --> excess estrogen in blood

Question 43

what are clinical signs of AAE

Answer 43

females: enlarged vulva symmetrical hair loss PU/PD high estrogen in blood bone marrow suppression

Question 44

pheochromocytoma

Answer 44

tumor of the adrenal medulla (chromaffin cells)

Question 45

in what species are pheochromocytomas most common in

Answer 45

dogs, horses, ruminants, ferrets

Question 46

what is the main clinical sign of pheochromocytomas

Answer 46

episodic hypertension caused by episodic overproduction of epi/NE --> increases BP

Question 47

what is dangerous about surgical removal of pheochromocytomas

Answer 47

often cause dangerously high spikes in blood pressure due to massive release of epi/NE during manipulation