Adrenal Glands Flashcards
(153 cards)
1
Q
What’s another term for adrenal glands?
A
Suprarenal gland
2
Q
In the fetus, the adrenal glands are…
A
10-20 times larger than in the adult and large in reference to the kidney
3
Q
The cortex, in utero, aids the…
A
Aids the placenta in synthesizing estrogen
4
Q
Adrenal glands (blank) over the first year after birth
A
Decrease in size
5
Q
What structure makes up 90% of the adrenal gland and surrounds the medulla?
A
Cortex
6
Q
Name the layers of the adrenal gland from outer to inner:
A
Zona glomerulosa, Zona fasciculate, Zona reticularis
7
Q
Zona glomerulosa regulates…
A
electrolytes, sodium, and potassium
(Salt)
8
Q
Zona glomerulosa produces..
A
Aldosterone
9
Q
Zona fasciculate produces…
A
Glucocorticoids
(Sugar)
10
Q
Zona reticularis stimulates production of…
A
Testosterone and estrogen
(Sex)
11
Q
What is the central portion of the adrenal gland?
A
Medulla
12
Q
The adrenal medulla is responsible for regulating…
A
Blood pressure and heart rate
13
Q
What is secreted by the central portion of the gland?
A
The central portion of the gland is the medulla, which secretes epinephrine and norepinephrine
14
Q
Which gland is shaped line a triangle or pyramid similar to the shape of a Y or V?
A
The right adrenal gland
15
Q
Which gland has a more semilunar or crescent shape?
A
The left adrenal gland
16
Q
Adrenal length in adults:
A
3 - 5 cm
17
Q
Adrenal width in adults:
A
2-3 cm
18
Q
Adrenal thickness in adults:
A
3 - 6 mm
19
Q
Infant adrenal gland measures (blank) of renal length
A
1/3
20
Q
Adult adrenal gland measures (blank) of renal length
A
1/13
21
Q
Which layer of the adrenal gland helps regulate blood pressure?
A
Zona glomerulosa
22
Q
Which layer of the adrenal gland helps regulate blood sugar?
A
Zona fasciculate
23
Q
What three arteries supply both of the adrenal glands?
A
Suprarenal branch of the inferior phrenic artery,
Suprarenal branch of the aorta,
Suprarenal branch of the renal artery
24
Q
Venous drainage of the adrenal gland consists of a (blank) vein that extends from the (blank) of each gland
A
consists of a SINGLE vein that extends from the HILUS of each gland
25
The right suprarenal vein empties into the…
IVC
26
Left suprarenal vein empties into the…
Left renal vein
27
Adrenals are located ___________, ____________, & _____________ to the kidneys
Anterior, medial, and superior
28
Adrenals are located (blank) to the crus of the diaphragm
Lateral
29
Right adrenal lies (blank) and (blank) to the IVC
Posterior and lateral
30
Left adrenal gland lies (blank) to the aorta
Lateral and adjacent
31
Left adrenal lies (blank) to the pancreatic tail, stomach, and lesser sac
Posterior
32
Adrenal agenesis is most commonly associated with…
Unilateral renal agenesis
33
What type of gland are the adrenals?
Paired endocrine glands
34
Steroids are produced from the..
Cortex
35
What three steroids are produced from the adrenal gland?
Mineralocorticoids, Glucocorticoids, and Gonodal hormones
36
What steroid is produced by the Zona glomerulosa?
Mineralcorticoids
37
What steroids are produced by the Zona fasciculate layer?
Glucocorticoids
38
What steroids are produced by the Zona reticularis layer of the cortex?
Gonodal hormones
39
Mineralcorticoid steroids are responsible for…
Homeostasis of sodium and potassium, producing aldosterone, and aiding the body to respond to stress (fight or flight) (Zona Glomerulosa)
40
Glucocorticoids steroids are responsible for…
The production of cortisol or hydrocortisone
(Zona fasciculate)
41
The Gonodal hormone steroids are responsible for…
Producing androgens
(Zona reticularis)
42
Catecholamines are secreted by the:
Adrenal medulla
43
What two catacholamines are being secreted by the adrenal medulla?
epinephrine and norepinephrine
44
Oversecretion of the cortex steroids or hormones can be caused by…
A pituitary tumor or adrenal cortical tumor.
45
What is a common cause of oversecretion of catecholamines?
Medullary tumors
46
What is another term for Cushings disease/syndrome?
Hypercortisolism
47
What is the most common malignant tumor in infancy?
Neuroblastoma
48
10-year-old little Timmy presents to the ER complaining of headaches and palpations. Labs show elevated urinary catecholamine and vanillylmandelic acid. Ultrasound shows a focal mass with high vascularity on his right side. What is the most likely diagnosis?
Pheochromocytoma
49
A 22 month old baby presents to the ultrasound department following abnormal lab results demonstrating elevated catecholamines. The patient also presents with mild pallor and abnormal sweating. Upon evaluation, you observe a solid focal mass that is displacing the right kidney inferiorly. What diagnosis best fits?
Neuroblastoma
50
A patient has been experiencing excessive sweating, headaches, high blood pressure, as well as tachycardia. Upon the ultrasound exam, posterior to the right lobe of the liver, a highly vascular, 4 cm solid mass is visualized. Which laboratory findings correlated with a pheochromocytoma in the medulla?
Elevated levels of urinary catecholamines
51
A 45 year old female arrives for a renal ultrasound exam. While scanning you see a well-defined, markedly hyperechoic mass anterior to the right kidney that measures 4 cm. The patient has normal labs and has not had any symptoms. What pathology is suspected?
Myelolipoma
52
A 42 year old male undergoing abdominal ultrasound for evaluation of hypertension presents with a 3.5 cm well-defined, hypoechoic, homogeneous mass superior to the upper pole of the left kidney. It demonstrates no calcifications or internal vascularity. Which feature would most strongly suggest a benign adrenal adenoma rather than a malignant mass?
Homogeneous echo texture with smooth margins
53
What is the most common solid tumor of infancy?
Neuroblastoma
54
An ultrasound order was placed for a 35 year old male with reports of excessive sweating, tachycardia, and palpations. After reviewing the lab report, it shows elevated urinary catecholamine. What is the most likely diagnosis?
Pheochromocytoma
55
In the adrenal glands, the cortex surrounds the medulla and secreted various steroids. What steroid produces hydrocortisone?
Glucocorticoids
56
Which part of the adrenal glands cortex secretes epinephrine/norpinephrine to help run the fight or flight for the body?
Medulla
57
Which disease is characterized by adrenal gland hypofunction due to damage to the adrenal cortex, often caused by autoimmune processes, tumors, metastases, or infections?
Addisons disease
58
A 1 year old male presents with a palpable right lower quadrant mass. His parents report progressive fatigue, unexplained weight loss, and recurrent fever. Ultrasound reveals a solid, heterogeneous mass causing medial displacement of the right kidney. What is the most likely diagnosis?
Neuroblastoma
59
Which hormone is produced by the adrenal medulla and is responsible for the npdys fight or flight response?
Epinephrine
60
What is the anatomical position of the right adrenal gland in relation to the inferior vena cava?
Posterior and lateral
61
A 49 year old male presents with hypertension, tachycardia, and a severe headache with no fever. Laboratory findings show elevated levels of urinary vanillylmandelic acid and elevated levels of urinary catecholamine. His abdominal ultrasound shows a focal solid mass with high vascularity near the kidney and the liver. What is the most likely diagnosis?
Pheochromocytoma
62
A 43 year old male presents to the emergency department with hypertension, a severe headache, and heightened anxiety. Laboratory studies reveal elevated urinary catecholamines and vanillylmandelic acid. Imaging demonstrated a highly vascular solid mass in the right adrenal gland. What is the most likely diagnosis?
Pheochromocytoma
63
Which zone of the adrenal cortex is responsible for homeostasis of sodium and potassium, aids the body in stress response, and produces the mineralocorticoid aldosterone?
Zona glomerulosa
64
A man presents to the ER with hypertension, tachycardia, and a headache. A RAS is ordered, and upon sonographic examination, a focal solid mass that is highly vascular is visualized. What pathology could this represent?
Pheochromocytoma
65
A mother brings her 18 month old son in with symptoms of fever, a palpable abdominal mass, and tachycardia. His lab work shows elevated levels of epinephrine and norepinephrine. An ultrasound is ordered of his abdomen and sonographically you notice that the right kidney is displaced and the adrenal gland is heterogeneous with a focal solid mass that contains complex areas and calcifications, the left adrenal gland has a cortex that is hypoechoic and a medulla that is hyperechoic. What pathology is being described?
Neuroblastoma
66
Samantha is a 35 year old female who has an ultrasound appointment due to her elevated levels of urinary catecholamines and urinary vanillylmandelic acid. As she lays down to be scanned she informs the sonographer that she has hypertension, palpitations, excessive perspiration, and headaches. What is the most likely diagnosis?
Pheochromocytoma
67
Which pathology is treated with surgical removal or pharmacological treatment?
Pheochromocytoma
68
Which part of the adrenal gland secreted catecholamines?
Medulla
69
A patient comes in through the ER with a fever and pain on their right side. They have an elevated WBC count . While scanning, you find a complex cystic mass that has hyperechoic foci with posterior shadowing, seen superior to the right. Kidney. What is the most likely diagnosis ?
Abscess
70
A neonate born to a diabetic mother presents with an incidental abdominal mass on ultrasound. The mass appears anechoic, with follow up showing gradual evolution into a complex echogenic structure. What is the most likely diagnosis?
Adrenal hemorrhage
71
Which condition is characterized by hypercorticolism and may involve the pituitary gland?
Cushing’s syndrome
72
What is the venous drainage for each adrenal gland?
Left suprararenal into left renal vein; right suprarenal into IVC
73
Which adrenal mass has a median age of occurrence of 22 months and is the most common solid tumor of infancy?
Neuroblastoma
74
What syndrome may include pituitary involvement?
Cushings disease / syndrome
75
What congenital disorder causes an increase in production of androgens?
Adrenogenital (AG) syndrome
76
What disease / syndrome causes an increase in release of aldosterone?
Conn’s disease
77
What is the most common symptom of Conns disease?
Hypertension
78
What is the most common cause of Conns disease?
Usually due to adrenal cortical tumor
79
What disease / syndrome causes a decreased secretion of cortical hormones?
Addisons disease
80
What are the three main causes of Addisons disease?
Damaged adrenal cortex, primary tumor, or metastasis
81
What six lab values are found with adrenal pathologies?
Aldosterone, cortisol, ACTH, catecholamines, total metanephrines, vanillylmandelic acid
82
What are four common indications for an adrenal exam?
Decreased hematocrit, hypertension, virilism, hirsutism
83
Where are the adrenal glands found?
In the retroperitoneum
84
What transducer should be used to evaluate adrenal glands?
Highest frequency allowed for body habitus with wide field of view
85
How should the patient be positioned for right adrenal?
Supine, LPO, or LLD
86
How would you image the adrenal glands coronally?
Via using the liver as an acoustic window
87
Where is the right adrenal gland in reference to the right kidney?
Right adrenal is superior to right kidney
88
Where is the right adrenal gland in reference to the IVC?
The right adrenal is posterolateral to the IVC
89
How would an enlarged right adrenal gland affect the IVC?
An enlarged right adrenal gland will compress or displace the IVC anteriorly
90
How should the patient be positioned for Left adrenal?
Right anterior oblique (RAO) and RLD
91
Where is the left adrenal in reference to the upper pole of the left kidney?
Left adrenal is superior and anterior to the upper pole
92
Where is the left adrenal in reference to the aorta?
Adjacent and lateral
93
What window should be used to best visualize the left adrenal?
A fluid filled stomach
94
What is the normal appearance of the adrenals in pediatric patients?
Cortex is hypoechoic and medulla is hyperechoic
95
What is the normal appearance of the adrenals in adults?
Not routinely visualized
96
Functional or nonfunctional benign adrenal tumor of epithelial origin:
Adrenal adenoma
97
What are the three clinical presentations for an adrenal adenoma?
1. Asymptomatic
2. Cushing’s syndrome / hypercortisolism
3. Conns disease / hyperaldosteronism
98
Describe the possible sonographic appearances of an adrenals adenoma
- Small hypoechoic focal round mass
- normal appearing
- diffusely enlarged adrenal glands
- Varies in size
- can be unilateral or bilateral
99
What pathology appears Hypoechoic, complex, solid, with areas of necrosis or hemorrhage and possible calcification?
Adrenal adenoma
100
Correlative or prior imaging for Adrenals:
CT
101
Primary adrenal malignant tumor of epithelial origin that sonographically appears as complex with calcifications as well as variable size and echogenicity:
Adrenal adenocarcinoma
102
What % of adenocarcinoma are functional tumors? (Hormone secretion)
50%
103
Describe the clinical presentations for adenocarcinoma:
Asymptomatic
Cushing’s syndrome (high cortisol)
AG syndrome (adrenogenital)
Precocious puberty (early)
Conns syndrome (hypertension and high aldosterone)
104
Pediatric sarcoma which occurs in the adrenal medulla or autonomic nervous system:
Neuroblastoma
105
Half of Neuroblastoma occur at less than _______ and the median age of occurrence is ___________
Less than 2 years of age
Median age is 22 months
106
T/F
Neuroblastoma affect females more than males
False
Equal occurrence
107
Describe the clinical presentations for Neuroblastoma:
Asymptomatic,
Palpable mass,
Fatigue**,
Weight loss**,
Pallor
Fever
Hypertension
Tachycardia
Sweats
108
Lab findings for Neuroblastoma:
Elevated catecholamines
109
Describe the sonographic appearance of a Neuroblastoma:
Typically unilateral,
Focal solid mass,
Heterogeneous with areas of cystic degeneration and calcification
Renal displacement
110
Where do Neuroblastoma metastasize to most often?
Metastasizes to bone an regional lymph nodes most frequently.
Also to the orbit, liver, brain, and lung.
111
Chromaffin cell tumor originating in the adrenal medulla or chromaffin tissue of the sympathetic paraganglia
Pheochromocytoma
112
Incidence of pheochromocytoma:
Peak incidence is in the second to fifth decades of life with a higher prevalence on the right side.
10% are extra-adrenal, usually arising from the para-aortic sympathetic nerve chain.
113
List the clinical presentations for Pheochromocytoma
Hypertension,
Headache,
Palpitations,
Tachycardia,
Anxiety,
Excessive perspiration
114
If malignant, where do Pheochromocytomas most often metastasize to?
Liver, nodes, lung, and bone
115
Describe the sonographic appearance of Pheochromocytoma
Focal solid mass,
Unilateral or bilateral,
Variable appearance
Highly vascular
116
What are the lab findings for Pheochromocytoma?
Elevated urinary catecholamine and urinary vanillylmandelic acid
117
Growth of malignant cells in the adrenals from a distance primary site:
Metastases
118
What are the most common primary sites for metastases?
The lung, breast, or stomach
119
What is the clinical presentations for metastases?
Asymptomatic
Addisons disease (hypofunction / decrease cortical hormones)
120
Describe the sonographic appearance of metastases of adrenals
Focal mass
Unilateral or bilateral
Varying echogenicity
Variable size
121
Focal collection of pus from disintegration of tissue:
Abcess
122
Clinical presentation for adrenal abscess
Fever
Pain / purulent
Leukocytosis
(Symptoms of infection)
123
What are the sonographic findings for an adrenal abscess?
Focal mass
Variable echogenicity
Acoustic enhancement
Fluid-fluid levels (oil and water)
Hyperechoic foci with shadowing
124
Cancerous masses typically display:
Shadowing
125
Direct invasion typically means that the mass is
Unilateral
126
Chronic, granulamatous infection
Tuberculosis
(Mycobacterium tuberculosis)
(Will see bright granulomas)
127
Infection caused by inhalation of fungal spores:
Histoplasmosis
(Histoplasma capsalutum)
128
Infection by species specific herpes type virus
Cytomegalovirus
129
What are the three infectious diseases which can occur in the adrenals?
Tuberculosis, histoplasmosis, cytomegalovirus
130
What is the clinical presentations for infectious diseases?
Addisons disease
131
Sonographic appearance of an acute infectious disease:
Bilateral enlargement and inhomogeneous
132
Sonographic appearance of chronic infectious diseases:
Calcification
133
What are the three types of adrenal hemorrhage?
Spontaneous, post traumatic, neonatal
134
Describe posttraumatic hemorrhage
Trauma at birth,
Hypoxia (not enough oxygen)
Anoxia (no oxygen)
135
Describe neonatal hemorrhage
Septicemia
Infant of diabetic mother
Adrenal tumor
136
What is the clinical presentations for adrenal hemorrhage?
Decreased hematocrit
Abdominal pain
Asymptomatic
137
Describe the sonographic appearances of an adrenal hemmorhage:
Depends on age of bleed
Anechoic early
Complex to homogenously echogenic with thrombus organization
Complex to anechoic with resolution and reabsorption
Residual calcification may be present following reabsorption
138
List the types of adrenal cysts
Endothelial, pseudocyst, epithelial, parasitic
(Parasitic more complex)
139
Clinical presentation for adrenal cyst
Asymptomatic
140
Describe the sonographic appearance of an adrenal cyst
Round
Anechoic
Thin walled
Acoustic enhancement
141
What adrenal cysts may sonographically appear with wall calcifications?
Pseudocysts and parasitic cysts
142
Adrenal glands are located in the:
Perirenal Retroperitoneal space
143
The adrenal medulla produces:
Norepinephrine
144
What adrenal abnormality includes pituitary involvement?
Cushing’s syndrome
145
Pheochromocytoma of the adrenal is sonographically demonstrated as:
A solid highly vascular mass
146
Adrenal hemorrhage is frequently seen in:
Neonates that experience anoxia
147
Adrenal adenoma may appear as..
Focal mass or as generalized enlargement
148
What scanning plane is recommended to visualize the right adrenal?
Oblique
149
The largest normal adrenal glands would be seen in:
Neonates
150
The right adrenal typically has what shape?
Triangular
151
Which disease results in hypofunction of adrenal physiology?
Addisons
152
What are the three most common indications for evaluation of adrenal gland?
Hypertension, decreased he,attrition, hirsutism
153
In neonates with adrenal hemorrhage, the most likely lab value to be evaluated would be:
Hematocit
