PEDIATRIC Section 11: Adrenal

Question 1

The most common extra-cranial solid childhood malignancy.

Answer 1

Neuroblastomas

Question 2

They typically occur in very young kids (you can be bom with this

Question 3

95% of neuroblastoma occur before age?

Answer 3

10

Question 4

WHere does Neuroblastoma occur?

Answer 4

abdomen more than the thorax
adrenal 35%
retroperitoneum 30%
posterior mediastinum 20%
neck 5%).

Question 5

Neuroblastoma is stage 3 if?

Answer 5

it CROSSES the MILINE + Contralateral positive Nodes

Question 6

Stage 4 neuroblastoma

Answer 6

< 1 y.o.
Distal mets
Skin - Liver - Bone MARROW
Excellent prognosis

Question 7

Does Stage 4 neuroblastoma go to the cortex?

Answer 7

NOPE. It;s the marrow

Question 8

Nuroblastoma Associations

Answer 8

• NF-1, Hirschsprungs, DiGeorge, Beckwith Wiedemann
• Most are sporadic

Question 9

paraneoplastic syndrome associated with neuroblastoma.

Answer 9

Opsomyoclonus (dancing eyes, dancing feet)

Question 10

common way for orbital neuroblastoma mets to present

Answer 10

“Racoon Eyes”

Question 11

Describe neuroblastoma bone mets

Answer 11

Neuroblastoma bone mets are on the “lucent metaphyseal band DDx”

Question 12

Sclerostic bone mets in Neuroblastoma are common?/uncommon?

Answer 12

UNCOMMON

Question 13

What are eleveated in nueroblastoma

Answer 13

Urine chatecolamines

Question 14

< 2y.o + Calcifications + Vessel encasement (doesn’t invade) + Poor marin + Bone mets

Answer 14

Neuroblastoma

Question 15

Around 4y.o. (never 2 months + Calcify rarely (10%) + INVADES vessels (no encasement ) + Well circumscribed + No Bone mets (unless clear cell) + Prefers lungs

Answer 15

WIlms

Question 16

Neonatal Adrenal Hemorrhage can occur in what setting?

Answer 16

birth trauma or stress.

Question 17

Neonatal adrenal hemorrhage is associated with what hemorrhage?

Answer 17

Scrotal hemorrhage

Question 18

the most common cause of an adrenal “mass” in a neonate

Answer 18

Adrenal hemorrhage

Question 19

Whay does 70% of adrehnal hemorrhages occur on the right?

Answer 19

due to the compression of the right adrenal gland between the liver and right kidney

Question 20

If the hemorrhage occurs on the left - think?

Why?

Answer 20

Think about renal vein thrombosis

left adrenal vein drains into the renal vein — where as the right one dumps into the IVC

Question 21

Renal vein thrombosis (and overall adrenal hemorrhage) is more common in the infants of what?

Answer 21

Diabetic mothers

Question 22

“Next Step” Adrenal mass of a neonate.

Answer 22

followup ultrasound imaging.

Question 23

With follow up imaging you should see something like this (depending on the interval);

Answer 23

Time 0: Adrenal hemorrhage is a well-defined ~ inhomogeneous isoechoic mass, no doppler flow

Time 1: Liquefaction - mass becomes more complex, strands and bands - classically starts to get a hypo echoic / cystic center area.

Time 2: Size continues to decrease

Time 3: Calcifications occure (peripheral curvilinear)

Time 4: Normal adrenal gland and size + calcifications persist

Question 24

21 alpha hydroxylase deficiency causes?

Answer 24

Congenital adrenal hyperplasia