Flashcards in EXAM #2: REVIEW Deck (91)
What is the mnemonic to remember the parents vessels of the suprarenal arteries?
Inferior phrenic= superior suprarenal a.
Aortic= middle suprarenal a.
Renal= inferior suprarenal a.
What is the expected gross finding in the setting of ACTH excess i.e. Cushing's? Be specific.
Hypertrophy of the adrenal cortex limited to the Fasiculata and Reticularis
What is the order in which the catecholamines are synthesized?
What capillaries receive the hormones from the adrenal cortex?
What is the origin of the cortical and medullary arteries?
Supracapsular arterial plexus
Draw the synthesis pathway of the cortical steroids.
What are the physiologic actions of cortisol? What is the mnemonic to remember these actions?
Mnemonic= BIG FIB
B= Blood pressure increase
I= Insulin resistance
G= Gluconeogenesis, lipolysis, proteolysis
F= Fibroblast activity increased
B= Bone resorption
How does ACTH increase adrenal steroid synthesis?
Activation of the Melanocortin-2 Receptor
What is the function of 11β-HSD type II?
Inactivation of cortisol to corticosterone in mineralcorticoid rich tissues
What is the function of 11β-HSD type I?
Activation of corticosterone to cortisol in glucocorticoid rich tissue
How does cortisol increase blood glucose?
1) Increases gluconeogenesis
2) Decreases glucose utilization by cells
Where do adrenal carcinomas commonly metastasize?
2) Lymph nodes
What are the two primary cortical neoplasms?
1) Cortical adenoma
2) Cortical carcinoma
How are cortical adenomas typically described grossly?
Well circumscribed, yellow-orange lesions
How are cortical adenomas typically described histologically?
Vacuolated with mild nuclear pleomorphism
What is the underlying pathology of Addison's Disease?
Chronic autoimmune destruction of the adrenal cortex
How will secondary adrenal insufficiency appear grossly?
Atrophy of the adrenal gland, with sparing of the Glomerulosa and Adrenal Medulla
What morphological features differentiate a cortical adenoma from a cortical carcinoma?
2) Large size
4) Mitotic figures
5) Vascular invasion
What are three clinical manifestations of a Neuroblastoma?
1) Abdominal mass
2) Diastolic hypertension
3) Blue-berry muffin baby
Describe the gross appearance of adrenal hyperplasia.
Yellow, thickened, and multinodular
What are the 10% rules of pheochromocytomas?
10% of pheochromocytomas are:
Describe the gross appearance of a cortical carcinoma.
- Yellow on cut surface
- Large with areas of hemorrhage, cystic change, and necrosis
Describe the gross appearance of a pheochromocytoma.
- Pale gray-brown
- Associated with hemorrhage, necrosis, cystic change
- Highly vascular
Describe the morphology of the adrenal gland in Addison's Disease.
1) Small glands
2) Lipid depletion of the adrenal cortex
3) Variable lymphocytic infiltrate in the adrenal cortex
*Note that the adrenal medulla is SPARED
List six features of an adrenal tumor that are concerning for malignancy.
2) Large (greater than 4cm)
5) High CT attenuation (greater than 20 HU)
6) Extension into local structures
How is Conn Syndrome diagnosed?
1) Urine aldosterone
2) Saline suppression test
How is adrenal cancer treated?
Surgery if possible; otherwise, palliative measures
What do you need to remember about the clinical presentation of adrenal cancer?
B/c of local invasion, can have a mix of adrenal syndromes at presentation
If CT is equivocal in a patient with likely pheochromocytoma, what is the next best step?
Fluoroscope guided renal vein sampling