Flashcards in Fiser ABSITE Ch. 21 Adrenal Deck (65):
What inhibits prolactin secretions?
What does the posterior pituitary produce?
What nuclei in the hypothalamus produces ADH? and Oxytocin?
What does the anterior pituitary produce?
FSH, LH, ACTH, TSH, prolactin, GH
Nonfunctional tumors of the pituitary are almost always what type? what is the tx?
macroadenomas, transsphenoid resection
What rx might cause a response in TSH and FSH/LH secreting pituitary tumors?
bromocriptine (dopamine agonist)
What is the most common pituitary adenoma?
prolactinoma (mostly microadenomas)
Prolactinoma macroadenoma of the pituitary should be resected if hemorrhage, visual loss, CSF leak or if pt wants what?
Prolactinoma microadenoma of the pituitary should be resected if ____ unsafe or ineffective (is OK in pregnancy)
Gigantism is a sx of acromegaly. Name 2 more.
Name the acromegaly preoperative rx that inhibits the release of GH.
How can acromegaly be life-threatening?
cardiac sx (valve dysfunction, cardiomyopathy)
Postpartum trouble lactating is usually the 1st sign of what syndrome?
Craniopharyngioma is a caclified cyst, remnants of what?
What syndrome occurs after bilateral adrenalectomy; increased CRH causes pituitary enlargement resulting in amenorrhea and visual problems?
Why is there hyperpigmentation in Nelson's syndrome?
bilateral adrenalectomy causes increased ACTH, beta-MSH (melanocyte-stimulating hormone) is a peptide byproduct of ACTH
What is the tx for Nelson's syndrome?
What syndrome is caused by adrenal gland hemorrhage that occurs after meningococcal sepsis infection; can lead to adrenal insufficiency.
What is the arterial supply of the adrenal gland and what is their origin?
Superior adrenal - inferior phrenic artery; Middle adrenal – aorta; Inferior adrenal - renal artery
What is the venous drainage of the adrenal glands?
Left adrenal vein goes to left renal vein; Right adrenal vein goes to inferior vena cava
What percentage of abdominal CT scans show adrenal incidentalomas? what percentage are mets or primary adrenal tumors?
When is surgery indicated for asymptomatic adrenal mass?
ominous characteristics (nonhomongenous), >4-6 cm, functioning, enlarging
How often to follow up for asymptomatic adrenal mass?
every 3 mos for first year and yearly after that
What is the most common mets to adrenal?
What is the workup for asymptomatic adrenal mass with a cancer history?
What are the 3 layers of the adrenal cortex and what do they produce?
GFR; Glomerulosa - aldosterone (salt); Fasciculata - glucocorticoids (sugar); Reticularis - androgens/estrogens (sex)
What is the innervation to the adrenal cortex? and the medulla?
none, splanchnic nerves
What does 4 things does aldosterone affect in the kidney?
sodium resorption, secretion of potassium, hydrogen ions, and ammonia
What does excess estrogens and androgens by adrenals almost always indicate?
What is the most common (90%) congenital adrenal hyperplasia?
21 hydroxylase deficiency
In 21 hydroxylase deficiency what hormone is produced in excess and what is the effect on BP?
increased testosterone causes precocious puberty in males and virilization in females. Is salt wasting so causes hypotension
What are the 2 treatments for 21 hydroxylase deficiency and 11 hydroxylase deficiency?
cortisol and genitoplasty
List the 3 types of congenital adrenal hyperplasia and their sexual development and BP sx.
21 hydroxylase deficiency causes precocious puberty in males virilization in females. It is salt wasting so it causes hypotension; 17 hydroxylase deficience causes ambiguous genitalia in males at birth and is salt saving; 11 Hydroxylase deficiency precocious puberty in males, virilization in females. Salt saving so it causes hypertension; 21 hypotensive boy, 17 hypertensive girl, 11 hypertensive boy
What is the name of the syndrome with hyperaldosteronism?
What are the two types of Conn's syndrome and their primary marker?
Primary disease has low renin (adenoma); Secondary disease has high renin (CHF, RAS, liver failure, diuretics, Bartter's syndrome - renin secreting tumor)
What is more common primary or secondary Conn's syndrome?
What is the #1 and #2 causes of primary hyperaldosteronism?
Localizing studies in hyperaldosteronesim include Localizing studies - MRI, and ___ (shows hyperfunctioning adrenal tissue; differentiates adenoma from hyperplasia; 90% accurate); ___ if others nondiagnostic
NP-59 scintigraphy; adrenal venous sampling
In the tx of hyperaldosteronism, hyperplasia is seldom cured (↑ morbidity with bilateral resection) Try medical therapy first with hyperplasia using ___, calcium channel blockers, and potassium. If bilateral resection is performed (usually done for refractory hypokalemia), patient will need ___ postoperatively
What is the number one cause of hypocortisolism?
withdrawal of exogenous steroids
What is the number one cause of hypercortisolism?
In the diagnosis of hypercortisolism what is done first (most sensitive test)? What is done 2nd?
24 hour urine cortisol, low dose overnight dexamethasone suppression test
What is the dx if low-dose overnight dexamethasone suppression test results in low urinary cortisol?
Cushing's disease (pituitary adenoma)
What is the #1 non-iatrogenic cause of Cushing's syndrome?
Cushing's disease (pituitary adenoma)
What is the #2 noniatrogenic cause of Cushing's syndrome? what is its most common cause?
Ectopic ACTH, small cell lung CA
Cortisol is not suppressed with either the low-dose or high-dose dexamethasone suppression test, what is the most likely diagnosis?
With ectopic ACTH resection of the primary tumor is the tx. What are two alternatives if resection is not possible?
medical suppression or bilateral adrenalectomy
Name the drug used for adrenocortical cancer with metastatic disease that is an adrenal-lytic
What is the origin of the adrenal medulla?
ectoderm neural crest cells
Catecholamine production starts with tyrosine. What are the next 4?
dopa -> dopamine -> norepinephrine -> epinephrine
What is the rate limiting step in the production of catecholamines and what is the enzyme?
tyrosine to dopa, tyrosine hydroxylase
PNMT is the enzyme only found in the adrenal medulla. What does it doe?
converts norepinephrine to epinephrine
What is the only type of pheochromocytomas that will produce epinephrine?
What is the most notable location for extra-adrenal neural crest tissue?
organ of Zuckerkandl
What are the 5 things in the 10% rule for pheochromocytoma?
malignant, bilateral, in children, familial, extra-adrenal
What type(s) of MEN syndrome are associated with pheo?
MEN IIA and IIB
Which side are most pheos on?
Extra-adrenal pheos are more likely what?
What type of scan is useful in finding the location of a pheo?
MIBG (noepinephrine analogue)
Why don't you use venography with pheo dx?
can cause hypertensive crisis
How do you control pressure in a pheo pt preoperatively?
alpha blocker (phenoxybenzamine) before beta blocker to prevent a hypertensive crisis from unopposed alpha blockade
What drug is used in the tx of pheo, inhibits tyrosine hydroxylase causing decreased synthesis of catecholamines?
What is an important step in the resection of a pheo?
ligate veins before manipulating tumor
Name 4 extra adrenal sites for pheo.
vertebral bodies, opposite adrenal gland, bladder, aortic bifurcation