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Flashcards in Pathology of the Adrenal II Deck (57):
1

adrenal crisis

primary acute adrenocortical insufficiency

2

addison disease

primary chronic adrenocortical insufficiency

3

secondary adrenocortical insufficiency

low pituitary function

4

rapid withdrawal of steroids

primary acute adrenocortical insufficiency can occur

5

massive adrenal hemorrhage

damages the adrenal cortex causing primary acute adrenocortical insufficiency


newborns - following prolonged and difficult delivery with considerable trauma and hypoxia

6

patients on anticoagulant therapy

primary acute adrenocortical insufficiency

7

waterhouse friederichsen syndrome

complication of disseminated bacterial infection

leads to primary acute adrenocortical insufficiency

massive bilateral adrenal hemorrhage

8

infection, hypotension, widespread purpura

disseminated intravascular coagulation

can lead to waterhouse friederichsen syndrome

9

common infection with waterhouse friedrichsen

neisseria meningitidis

psendomonas
pneumococci
h. flu
staphylococci

10

addison disease

primary chronic adrenocortical insufficiency

autoimmune adrenalitis

11

autoimmune polyendocrine syndrome

type 1 and type 2

main cuases of autoimmune adrenalitis

12

infection with addison

tuberculosis and fungi

primary chronic adrenocortical insufficiency

13

metastatic neoplasms

may involve adrenals
-lead to addison disease

majority lung and breast**

14

tuberculous and fungal disease of adrenal

granolomatous inflammation

15

priamry autoimmune adrenalitis

irregularly shrunken glands

difficult to identify in suprarenal adipose tissue

16

metastatic carcinoma to adrenal

enlarged and obscured architecture

17

progressive weakness and fatigability

initial manifestations of addisons

doesn't come to attention until glucocorticoids and mineralocorticoids are significantly decreased

18

anorexia, nausea, vomiting, weight loss, diarrhea

seen in addisons

19

hyperpigmentation

seen in addisons

-sun exposed areas and pressure points

20

cause of hyperpigmentation in addisons

elevated POMC from anterior pituitary

is precursor of both ACTh and MSH

21

hyperkalemia, hpyonatremia, volume depletion, hypotension

seen in addisons

potassium retention and sodium loss with decreased mineralocorticoids

22

waterhouse friedrichsen

acute adrenocortical insufficiency

23

addison

chronic adrenocortical insufficiency

24

APS1 mutation

AIRE

autoimmune attack against multiple endocrine organs and auto Abs against IL-17

25

secondary adrenocortical insufficiency

hypothalamus and pituitary dysfunction

reduced ACTH

NO hyperpigmentation**
-no elevation of MSH

26

no hyponatremia or hyperkalemia

in secondary adrenocortical insufficiency
-because near-normal aldosterone synthesis

just no cortisol and androgen output

27

secondary hypoadrenalism morph

decreased in size and still yellow color

28

adrenocortical neoplasms

adults - adenomas and carcinomas equally

children - more carcinomas

29

TP53 mutation

li fraumeni syndrome

familial cancer syndromes with adrenocortical carcinomas

30

epigenetic imprinting disorder

beckwith wiedemann syndrome

familial cancer syndromes with adrenocortical carcinomas

31

virilizing neoplasm of adrenal

carcinoma

32

hyperaldosteronism and cushing causing adrenal neoplasm

functional adenoma

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bilateral adrenal enlargement

mets until proven otherwise

34

functionality of adrenocortical neoplasms

determined by clinical evaluation and measure of hormones and hormone metabolites

35

majority of adrenocortical adenomas

incidentalomas

36

adrenocortical carcinoma

associated with virilism

large and invasive lesions

37

lung cancer

mets to adrenals

38

metastasis to adrenal

more common than primary adrenocortical carcinoma

39

53yo M, feels bad, weight loss, smoker, bronchogenic lung cancer

b/l mets to adrenals

40

adrenal incidentaloma

incidental finding in asymptomatic patient


majority - of no clinical importance - nonsecreting cortical adenomas

41

needle biopsy of adrenal

NO - lots of blood supply

42

chromaffin cells

in adrenal medulla

43

adrenal medulla products

catecholamines - NE and E

44

paraganglion system

neuroendocrie cells dispersed in extra-adrenal system of clusters and nodules

bronchiomeric
intravagal
aorticosympathetic

45

pheochromocytoma

neoplasm of chromaffin cells

adrenal medulla noeplasm

46

neuroblastoma

neuronal neoplasm - in children

47

53yo intermittent HA, sweating, tremors, HTN, metanephrines on urine

pheochromocytoma

48

surgically correctable HTN

pheochromcytoma

also - renal artery stenosis

49

rule of 10s**

for pheochromocytoma

10% extra-adrenal - paraganglionomas

10% bilateral

10% biologically malignant

10% not associated with HTN

50

HTN with pheochromocytoma

2/3 have paroxysmal episodes

51

mutations for pheochromocytoma

RET
NF1
VHL
SDHD
SDHC
SCHB

52

adrenal colors**

yellow - cortex
red - medulla

53

zellballen

in pheochromocytoma

54

paroxysmal HTN in pheochromocytoma

precipitated by stress, exercise, postural changes, palpation in region of tumor

55

catecholamine cardiomyopathy

cardiac complications with pheochromocytoma

myocardial instability and ventricular arrhythmias

56

diagnosis of pheochromcytoma

increased urinary catecholamines, VMA, and metanephrines**

57

tx of pheochromocytoma

benign tumors - surgical excision

adrenergic block agents to prevent HTN crisis