01-27 Adrenals

Question 1

Describe the anatomy/fxn of adrenal gland

Answer 1

Cortex (G-F-R):
—zona Glomerulosa → aldo
—zona Fasiculata → cortisol
—zona Reticularis → sex steroids

Medulla - full of chromaffin cells → NE/Epi

Question 2

histo ∆s between cortical adenomas vs. cortical carcinomas

Answer 2

SIZE: adenomas usu < 2.5cm
BORDER: adenomas usu circumscribed vs. carcinomas which are invasive
NECROSIS: present in carcinomas
HISTOLOGY: carcinomas have few/no clear cells, nuc pleio, atypia, mitotic figures

Question 3

Pheos
—Where?
—Gross?
—Histo Appearance?
—Determining malig?

Answer 3

WHERE: Medulla
GROSS: can be so big that the cortex is just a little thin strip
HISTO: ~maintains medulla appearance w/ some nuclear pleomorphism, necrosis, mitotic figures
MALIG: only way to know is if it met

Question 4

What causes the hyperpigmentation seen with some adrenal disease?

Answer 4

high ACTH as seen with 1° adrenal insufficiency

Question 5

S/Sx of cortisol deficiency

Answer 5

—anorexia/wt loss (~universal)
—fatigue/lethargy (~universal)
—n/v/stomach discomfort
—hyopTN, hypoNa
—hypoGly
—impaired stress tolerance
—hyperpigmentation: low cort → high ACTH → hyperpigment

Question 6

S/Sx of aldo def

Answer 6

—hypotension
—hypoNa+
—hyperK+

Question 7

S/Sx of adrenal androgen def

Answer 7

♀: loss of axillary/pubic hair; low libido

Question 8

Path of autoimmune adrenalitis
—incidence
—gross
—histo

Answer 8

Most common cause of adrenal insuff
—grossly small gland
—histo: necrotic cell remnants + lymphs and PMNs in cortex regions (medulla is SPARED)

Question 9

Waterhouse-Friderichsen Syndrome

Answer 9

infx-related adrenal hemorrhage (can be bilat)
—”Waterhouse-Friderichsen syndrome has also been reported with sepsis from Streptococcus pneumoniae, Neisseria gonorrhoeae, Escherichia coli, Haemophilus influenzae, and Staphylococcus aureus”

Question 10

adrenal mets

Answer 10

“Metastases are among the commonest cause of tumors in the adrenal gland.
—Squam. CC from lung and
—melanoma
are among the most common sources of adrenal metastases.”