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Surgery M4 part 1 > Adrenal Glands > Flashcards

Adrenal Glands Flashcards

1
Q

Where is the adrenal medulla derived from?

A

neuroectoderm

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2
Q

What is the blood supply of the adrenal glands?

A
  • superior suprarenal artery —- from phrenic artery
  • middle suprarenal artery —- from aorta
  • inferior suprarenal artery —- renal artery
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3
Q

What is the venous drainage of the adrenal glands?

A

on the right: IVC
on the left: left renal vein

LIKE TESTICULAR

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4
Q

What does the adrenal medulla secrete?

A

Catecholamines

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5
Q

What are the secretions of the adrenal cortex?

A

zona glomerulosa —- mineralocorticoids
zona fasciculata —- glucocorticoids
zona reticularis —- sex hormones

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6
Q

what is the origin of pheochromocytoma?

A

chromaffin cells from adrenal medulla

neuroectoderm

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7
Q

pheochromocytoma has a rule of?

A

10%

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8
Q

What are the features of a suspected malignant pheochromocytoma?

A
  • necrosis or hemorrhage
  • high KI-67 positive cells ad size of tumor
  • increased PASS >4
  • capsular or vascular invasion (like follicular thyroid carcinoma)
  • nuclear DNA ploidy ad increased NSE
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9
Q

What are the syndromes associated with familial pheochromocytoma?

A
  • Von Recklinghausen disease (cafe au lait spots)
  • Von-Hippel-Lindau syndrome
  • MENIIa or MENIIb
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10
Q

How do we suspect pheochromocytoma in young age?

A

persistent or paroxysmal hypertension (90%)

sympathetic overactivity

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11
Q

DD of pheochromocytoma?

A
  • hyperthyroidism (exclude by hormonal assay)
  • anxiety status
  • cardiac conditions
  • carcinoids (functioning)
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12
Q

How do u diagnose pheochromocytoma in a suspected case?

A

Laboratory
- Vanil Mandelic acid (VMA) in urine >7mg/24hrs
- urinary noradrenaline or other catecholamines (MORE SPECIFIC)
Radiological
- Xray (if calcified)
- ultrasound & IVU
- SPECT scan (search for gamma rays and identifies neuroendocrine cells)
- MRI

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13
Q

What method of investigation is used to confirm the presence of cells originating from neuroectoderm in extra adrenal locations?

A

Iodine Labelled Metaiodobenzylguanidine (I, MIBG)

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14
Q

What’s the most important preoperative procedure?

A

Control hypertension

  • alpha-blocker given 4 weeks prior to surgery to control hypertension
  • beta-blocker is given only after patient is fully alpha-blocked and given 1 week before surgery
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15
Q

What is used to control hypertension inside the surgery?

A

IV sodium nitroprusside

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16
Q

how should adrenal cortical tumors be managed & what are the investigations used?

A

> 6cm requires resection

  • US abdomen
  • CT scan
  • hormonal assay
17
Q

Houns field unit density is considered positive for pheochromocytoma when?

A

density is > 18

18
Q

What is the only indication of biopsy in pheochromocytoma?

A

non functioning

or metastasis to adrenals

19
Q

How is the adrenal incindentaloma treated?

A
  • if functional treat and resect
  • if non-functional but >4cm - >6cm and rapidly increasing in size, surgical resection
  • if non-functional and <4cm, should be followed up after 6, 12, and 24 months by MRI and hormonal evaluation
20
Q

How should pheochromocytoma be managed intraoperatively?

A
  • careful anesthetic management
  • adrenal vein should be ligated first
  • avoid breaks in capsule of tumor
  • careful handling & hemodynamic monitoring
21
Q

What postop care should be done?

A
  • proper monitoring to avoid hypovolemia & hypoglycemia
  • specimen should be sent for BICHROMATE STAINING
  • steroids must be given (if bilateral)
  • screen for recurrence every 6-12 months radiologically & by urinary VMA
22
Q

How is a malignant pheochromocytoma managed?

A
  • early: adrenalectomy

- advanced: debulking

23
Q

What is the aetiology of incindentalomas?

A
  • non functioning adenomas
  • Cushing’s adema, pheochromocytoma or Conn’s adenoma
  • Ganglioneuroma, myelolipoma or adrenal cyst
  • adrenocortical carcinoma
  • secondaries
24
Q

What investigations should be done in a suspected cortisol producing neoplasm?

A
  • overnight dexamethasone suppression test
  • 24 hour urinary cortisol excretion assay
  • ACTH to differentiate between adrenal causes & pituitary causes
24
Q

What investigations should be done in a suspected cortisol producing neoplasm?

A
  • overnight dexamethasone suppression test
  • 24 hour urinary cortisol excretion assay
  • ACTH to differentiate between adrenal causes & pituitary causes
25
Q

What investigations should be done in suspected pheochromocytoma?

A
  • 24 hour urinary excretion of catecholamines & VMA

- serum metanephrines

26
Q

What investigations should be done incase of suspected hyperaldosteronism?

A
  • HTN+hypokalemia
  • serum potassium, renin & aldosterone
  • 24h urine aldosterone level

Surgery M4 part 1 (47 decks)

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