EXAM #2: TUMORS OF THE ADRENAL GLAND Flashcards Preview

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Flashcards in EXAM #2: TUMORS OF THE ADRENAL GLAND Deck (31):
1

What do you need to remember about adrenal cancer?

1) Majority are metastatic at the time of diagnosis
2) B/c of invasion, multiple adrenal syndromes can be combined i.e. a mix of presentations

2

What are the concerning features of an adrenal tumor for malignancy?

1) Irregular
2) Large (greater than 4cm)
3) Calcification
4) Unilateral
5) High CT attenuation (greater than 20 HU)
6) Extension into local structures

3

What labs should be checked when you suspect an adrenal cancer?

1) Cortisol
2) Catecholamine metabolites
3) Androgens

4

How is adrenal cancer treated?

1) Surgery if possible
2) Palliation and symptomatic relief if not

5

What size of adrenal cancer can be approached laproscopically?

Less than 6cm

*Otherwise flank, midline, or thoracoabdominal

6

What causes 99% of Cushing Syndrome?

Iatrogenic Cushing's

7

What is the approach to diagnosing Cushing Syndrome?

1) Cortisol lab
2) Follow-up high cortisol with ACTH
3) Dexamethasone suppression
4) Imaging

8

What is the expected finding in Cushing Disease with a dexamethasone suppression test?

Cortisol will be LOW if pituitary is the source

9

What imaging is recommended for diagnosing Cushing Disease/ Syndrome?

CT unless Cushing Disease is suspected, then MRI

10

If an adrenal source is causing Cushing Syndrome, what is the treatment of choice?

Surgery

*Make sure you give a stress dose of steroids

11

What syndromes are associated with Pheochromocytoma?

1) Von Recklinghouse NF
2) Von Hippel Lindau
3) Tuberosclerosis
4) MEN 2a/ 2b

12

What lab test should you order in possible pheochromocytoma?

Metanephrine

13

What imaging modality is used to diagnose a pheochromocytoma?

CT

14

Where is the "Organ of Zuckerkandl?"

Bifurcation of the aorta

*Can be location of ectopic adrenal medulla tissue

15

How do you do pre-operative preparation for surgical excision of a pheochromocytoma?

Alpha-blocker, esp. Phenoxybenzamine

*Note that Beta blockers are NOT always needed but can be started pre-op

16

What is the most common approach to excision of a pheochromocytoma?

Laproscopic

17

What do you need to be prepared for after removing a pheochromocytoma?

Hypotension

18

If you find a pheochromocytoma during a different surgical procedure, what should you do?

1) Complete procedure rapidly
2) Do NOT manipulate tumor
3) Nitroprusside
4) Start alpha and beta blockade s/p

*Perform the procedure electively afterward--can't do the same day

19

If Conn Sydrome is leading to HTN, what is this called?

Secondary HTN

20

What electrolyte abnormality is associated with Conn Syndrome?

Hypokalemia, though most patients are normokalemic

21

What is the difference between Alodsterone Producing Adenoma (APA) and IPA?

APA= unilateral; treat with surgery

IPA= bilateral idiopathic, treated medically

22

How do you diagnose Conn Syndrome or hyperaldosterone syndrome?

1) Urine aldosterone
2) Saline suppression test

23

What imaging modality is preferred for diagnosing primary hyperaldosterone syndrome?

CT

24

If CT is equivocal, what is the next procedure that is performed for diagnosis?

Fluoroscope guided renal vein sampling

25

How is APA treated?

Laproscopy surgery

26

How is IPA treated?

Aldosterone receptor antagonist i.e. spironolactone

27

What is an "incidentaloma?"

Unsuspected adrenal mass seen on imaging

28

What are the three questions to ask yourself when you find and incidentaloma?

1) Is it functional?
2) What is the malignant potential
3) Does the patient have a primary tumor that this could be a met from?

29

After an H and P, what is the next thing you would do?

Pull a lab panel for the different adrenal tumors

30

What do you need to remember about biopsying adrenal masses?

ALWAYS check for pheochromocytoma first

31

What imaging cutoffs are used to evaluate an adrenal tumor?

Less than 4cm is rarely metastatic

Greater than 6cm is more likely malignant