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Fiser > Chapter 21 - Adrenal > Flashcards

Chapter 21 - Adrenal Flashcards

1
Q

Arteries to adrenals and where they come from

A

Superior adrenal from inferior phrenic artery

Middle adrenal from aorta

Inferior adrenal from renal artery

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2
Q

Adrenal veins from where

A

R from IVC

L from renal vein

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3
Q

Layers of adrenal and embryonic derivation

A

Medulla is deep - from ectoderm (neural crest??)

Cortex is mesoderm

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4
Q

Which part of adrenal has ‘GFR’ layers? Deep or superficial?

A

Cortex does which is superficial to the medulla

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5
Q

Layers of cortex and what they secrete

A

Glomerulosa - aldosterone
Fasciculata- cortisol
Reticularis - androgen

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6
Q

Innervation to adrenals by layer

A

Cortex none

Medulla sympathetic splanchnic nerves

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7
Q

How many CT scans show adrenal incidentaloma

What percentage are mets

A

1-2%

5%

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8
Q

First step when adrenal mass is found

A

Check for functionality (DONT biopsy first).

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9
Q

Labs to check for functionality

A

*** not 100% on this but for now

  1. For pheo: 24 hour urine catecholamines (spec) or plasma metaneph (sens)
  2. For Cushing: low dose dex then confirm with either 24 hour cortisol or late night salivary cortisol
  3. For Conn(?): serum to aldo:renin ratio (high aldo low renin is suggestive, 20x). Adrenal vein sampling to localize mass.

You can also do a salt load suppression test which is best (urine aldo stays high)

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10
Q

How do you do low dose dex suppression test

A

Give 1mg oral at 11-midnight

Test cortisol level before 10 am

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11
Q

Step two after adrenaloma

A

Family history

May want to look for primary

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12
Q

INDICATIONS FOR SURGERY WITH ADRENAL MASS - CT scan

A

KNOW THESE

  • non homogenous
  • > 4-6 cm
  • functioning
  • enlarging
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13
Q

How to just follow the incidentaloma

A

CT every three months for a year then yearly

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14
Q

Common mets to adrenals

A

Lung, breast, melanoma, renal

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15
Q

Cancer hx w assymptomatic renal mass

A

BIOPSY

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16
Q

Cortisol feedback loop

A

Hypothal: CRH
Pituitary: ACTH
adrenal cortex fascic: cortisol which has negative feedback on CRH production

17
Q

What makes androgens/cortisol/aldo

A

Cholesterol> progesterone

18
Q

Action of aldosterone

A

Stimulates Renal sodium resorption and secretion of potassium and hydrogen ion

19
Q

What normal stimulates aldosterone secretion

A

Angiotensin II and hyperkalemia

20
Q

Almost always cancer if mass is secreting

A

Estrogens and androgens

21
Q

Benign adrenal mass findings

A

HU < 10 +
<4 cm +
Non functioning +
Washout >50% (more fat) +

22
Q

Symptoms of hyperaldosteronism

A
  • HTN secondary to NA retention without edema
  • hypokalemia
  • weakness
  • polydipsia
  • polyuria
23
Q

Causes of primary aldosteronism (aldo is just high on its own)

A

Aldo secreting adenoma makes up 85%

Other stuff- hyperplasia, Ovarian tumors and cancer are rare

24
Q

Causes of secondary hyperaldosteronism

Renin is also high (more common than primary)

A

CHF, renal artery stenosis, liver failure, diuretics, barrters syndrome (renin rumor)

25
Q

Best tests in order of better for diagnosing primary hyperaldosteronism

A
  1. Salt load suppression test, urine aldosterone will stay high
  2. Aldosterone to renin ratio over 20
26
Q

Labs in Conn syndrome (hyperaldosteronism)

A 
Low K
High Na
High urine K
Metabolic alkalosis (bc hydrogen ions)**
Low renin
27
Q

How to treat hyperaldo from hyperplasia

A

Not localized so try

Spironolactone
Calcium channel blockers
Potassium
Na restriction

If you do bilateral adrenalectomy, need fludricortisone

28
Q

RAAS PATHWAY triggers

A

Stems from decreased intravascular volume and decreased sodium concentration

29
Q

Most common causes of high cortisol in order - top 4

A
  1. Iatrogenic
  2. Pituitary adenoma (Cushing disease)
  3. Ectopic ACTH (usually small cell lung cancer)
  4. Adrenal adenoma
30
Q

Symptoms of Cushing syndrome

A 
Obesity
Muscle weakness 
Fatigue 
Hirsutism
Osteopenia 
Moon facies
Striae
Buffalo hump

Fiser (2 decks)

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