Flashcards in Adrenal pathology Deck (25):
Describe the anatomy of adrenal glands
2 endocrine organs that are retroperitoneal, superomedial to kidneys
The 3 layers of the cortex are of _____ origin
Characteristic appearance of cushing
moon facies with flushing and acne, buffalo hump, truncal obesity and so forth
What are the 3 forms of endogenous forms of Cushing syndrome?
1. More ACTH--> more cortisol
2. Tumor or nodular hyperplasia
3. Lung cancer secreting a lot of ACTH
Hyperaldosteronism is most commonly due to what?
an aldosterone secreting cortical adenoma (Conn Syndrome)
All hyperaldosteronisms are characterized clinically by ____.
hypertension and hypokalemia
Describe what happens in adrenogenital syndrome
21-Hydroxylase or 11-beta-hydroxylase deficiency impairs the synthesis of both cortisol and aldosterone. The resultant decrease in feedback inhibition causes increased secretion of adrenocorticotropic hormone, resulting ultimately in adrenal hyperplasia and increased synthesis of testosterone.
What is the prototype of acute adrenal insufficiency
Descibe presentation/causes of Waterhouse-Friderichsen Syndrome
Overwhelming sepsis in adults, typically by N. meningitidis, leading to disseminated intravascular coagulopathy, hypotension, shock, and acute adrenal insufficiency
Other causal bacteria include Staphylococcus, pneumococcus, or Haemophilus
In newborns may be due to perinatal trauma/hypotension
What are causes of acute adrenal insufficiency other than Waterhouse-Friderichsen
Sudden withdrawal of exogenous corticosteroids, patients with chronic adrenal ins. with sudden stress
What is the key to survival in Waterhouse-Friderichsen
earliest possible clinical diagnosis with aggressive management
What happens to the skin and buccal mucosa in primary hypoadrenocorticism
hyperpigmented due to increased ACTH and MSH. Also look at freckles, nipples, palmar creases, old scars
Lab studies with chronic adrenal insufficiency
hyponatremia, hyperkalemia, metabolic acidosis, hypoglycemia, low serum cortisol. low urinary 17-OH steroids and failure to respond to various stimulation tests by increasing cortisol output
T or F It is common for these pt to die suddenly and unexpectedly before anyone thinks of adrenocortical insufficiency
What are primary adrenal neoplasms in the cortex? medulla?
Cortex: adrenal cortical adenoma, carcinoma
Medulla: neuroblastoma, pheochromocytoma
Size of adrenal cortical adenomas
2.5 cm diameter
How does adrenal cortical adenoma look on histo?
typical adrenal cortical tissue with cells arranged in ribbons and cords
Describe the difference in functioning and non-functional adrenal cortical adenoma
Functional: adjacent and opposite gland is atrophic
non-functional: adjacent and opposite gland is normal
Describe adrenal cortical carcinoma
Uncommon neoplasm, seen in kids or adults, more likely to be functioning, tumors greater than 5 cm diameter or 50 grams are more likely to be malignant. May be histologically bland or very aggressive.
____ is the most common tumor of childhood.
Neuroblastoma may occur anywhere in the sympathetic nervous system but where is most common?
adrenals and paraaortic ganglia
What is pheochromocytoma rule of 10%
10% familial, bilateral, malignant, in children, extra adrenal,
T or F. Pheochromocytoma is a surgically correctable cause of HTN
Adrenals are a common site of metastasis from ____.
lung, breast, many others