Path 11 Schneider Flashcards Preview

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Flashcards in Path 11 Schneider Deck (30):
1

Cushing disease

Only pituitary adenoma/microadenomas -> ACTH

2

Most common ectopic ACTH production

Small cell lung CA

3

Dexamethasone suppression test

Won't suppress ectopic ACTH or Hypercorticism Autonomous

4

Cushing disease morphologic change

Bilateral hyperplasia of adrenal Zona Fasciculata
-Atrophy in C syndrome

5

Cushing syndrome clinical appearance

-Moon facies
-Central obesity
-Abdominal striae (skin atrophy)
-Osteoporosis
-Muscle wasting
-Emotional disturbance

6

Conn syndrome

Primary aldosteronism

7

Primary aldosteronism causes

Adrenocortical adenoma (aldosteronoma)
-Zona Glomerulosa hyperplasia (less)
-Adrenocortical carcinoma (least)

8

Primary aldosteronism clinical (4)

-HTN
-Hypokalemia
-Sodium and water retention
-Decreased serum Renin

9

Secondary aldosteronism causes

-Renal ischemia/tumor
-Profound edema (cirrhosis, CHF, neprhotic syndrome)

10

Secondary aldosteronism mechanism

Renin-angiotensin stimulation
-Serum renin increased (opposite of primary aldosteronism)

11

Primary v secondary aldosteronism

-Unilateral v bilateral ZG hyperplasia
-Decreased v increased serum Renin

12

Adrenal virilism

Congenital cortisol enzyme defect -> ACTH compensation -> adrenal hyperplasia -> adrogenic steroid production

13

Adrenal virilism enzyme

21-hydroxylase deficiency (salt wasting form -> hypotension)
11-hydroxylase deficiency (less common, salt retention -> HTN)

14

21-hydroxylase function

17-hydroxyprogesterone -> 11-deoxycortisol

15

21-hydroxylase deficiency

17-hydroxyprogesterone -> androstenedione

16

Adrenal virilism morphology

Zona Reticularis adenoma, carcinoma, hyperplasia

17

Pituitary deficiency

Secondary adrenal failure - No ACTH
-No hyperpigmentation - No B-MSH

18

Addison disease

Primary adrenocortical deficiency
-Autoimmune or tuberculosis

19

Addison clinical

-Hypotention
-Hyperpigmentation
-Decreased electrolytes except potassium

20

Tuberculosis histo

Caseating granuloma
Langhans giant cell

21

Waterhouse-Friderichsen syndrome (3)

Catastrophic adrenal insufficiency & vascular collapse
-Meningococcal meningitis
-Hemorrhagic necrosis of adrenal cortex due to DIC

22

Adrenal cortical adenoma

Loss of function?

23

Chromaffin cell tumors

Adrenal - Pheochromocytoma
Extra-adrenal - Paraganglioma

24

Pheochromocytoma

Surgically correctable HTN
-due to catecholamine hyperproduction
-usually benign

25

Pheochromocytoma test

Urine vanillylmandelic acid
-metanephrine
-normetanephrine

26

Pheochromocytoma EM

Membrane-bound secretory granules (black)

27

Neuroblastoma

Malignant childhood catecholamine tumor
-"Small blue cell" tumor

28

Neuroblastoma origin

Adrenal medulla

29

Neuroblastoma presentation

Large abdominal mass
-HTN

30

Neuroblastoma cause

N-myc oncogene amplification
-Copy number related to aggressiveness
-Occasionally converts into benign ganglioneuroma