3.2.3 Adrenal Pathology Flashcards
How would this person look without Cushing’s?
What is the rule of 10s in regards to pheochromocytoma?
Chromaffin cells release what? What are chromaffin cells innervated by?
Epinephrine
Pre-ganglionic fibers that release acetylcholine
What are some of the sources of adrenal hyperfunction?
What are the important anatomical features of the adrenal gland?
Cortex - Steroid hormones
Medulla - Catecholamines
What are the main causes of Addison’s disease (5)?
Granulomatous inflammation
Metastatic carcinoma
Amylodosis
Surgical removal
Idiopathic
What are the specific lab findings associated with pheochromocytoma?
Elevated metanephrines and chromogranin A
Elevated urinary catecholamines
Presence of adrenal mass on CT
What is the arrow pointing to in this cell?
Adrenal medulla, ganglion cells (black arrow), Trichrome, 40x. The remaining cells are the small clusters of pheochromocytes.
Endocrine hyperfunction is usually due to what?
Increased tropic hormone
Neoplasms
Exogeneous artificial hormones
What is the clinical triad associated with pheochromocytoma?
Clinical triad - Headache, sweating, and heart palpitations
If hypertension is also found it raises the probability of pheochromocytoma to 90%
What is this an image of?
Adrenal gland - normal
Slide photo: Normal adrenal, trichrome stain. Note that the thin zona glomerulosa can easily be seen under the capsule, even at low power. The lipid-rich zona fasciculata is also discernible. The zona reticularis has less fat, and the medulla can be clearly separated from it.
What lung neoplasm commonly leads to Cushing’s Syndrome?
Small cell carcinoma
What is this an image of? Go ahead an identify the layers TANNER!
What are the two main acute causes of adrenal hypofuction?
Waterhouse-Friedrichson syndrome
Steroid withdrawl
What is this an image of?
Diffuse hyperplasia
Diffuse hyperplasia is found in 60% to 70% of cases of Cushing syndrome.
Adrenal gland hypofunction is typically due to?
Inflammation
Surgical excision
Circulating defect
Congenital enzyme defect
Neoplasm compressing normal gland
What are the characteristics of Cushing’s Syndrome?
Increased mineralcorticoids - Salt and water retention and potassium depletion
Increased glucocorticoids - obesity, hyperglycemia, decreased protein, euphoria
Increased androgens - hirsutism, acne, amenorrhea, and polycythemia
What is the differenct between the two figures in this image?
Left is normal
RIght is atrophied (Sheehan syndrome)
What in Conn’s syndrome?
Mineralcorticoid-secreting adenoma often in the glomerulosa
How will Addison’s disease present in clinic?
Increased skin pigmentation
Hypotension
Loss of Libido
Hyponatremia
Hyperkalemia (Na and K are due to overlap of glucocorticoid and mineralcorticoid)
Hypoglycemia
What is this an image of?
Pheochromocytoma
Note the small amount of normal adrenal. The tumor at the top of the slide is separated from it by a fibrous pseudocapsule, which is often a sign of a benign prognosis.
What is this an image of?
Pheochromocytoma
You can see the fine capillaries surrounding nests of cells (zellballen), most easily seen in the middle of the photomicrograph . There is mild atypia, meaning that the nuclei are of different size, shape, and darker blue color (more DNA) as compared to normal.
What is this an image of?
Anaplasia in adrenal carcinoma.
Atypical cells with big blue nuclei
How would you treat pheochromocytoma?
Surgical removal
Pre-surgical preparation with alpha and beta blockers
What is this an image of?
Primary hyperplasia
Primary adrenal neoplasms, such as adrenal adenoma and carcinoma, and primary cortical hyperplasia are responsible for about 10% to 20% of cases of endogenous Cushing syndrome. This form of Cushing syndrome is also designated ACTH-independent Cushing syndrome or adrenal Cushing syndrome because the adrenals function autonomously. The biochemical sine qua non of adrenal Cushing syndrome is elevated serum levels of cortisol with low levels of ACTH
What is this an image of?
Adrenal, carcinoma. Note necrosis, evident grossly.
The carcinomas associated with Cushing syndrome, by contrast, tend to be larger than the adenomas. These tumors are unencapsulated masses frequently exceeding 200 to 300 gm in weight, having all of the anaplastic characteristics of cancer, as will be detailed later. With functioning tumors, both benign and malignant, the adjacent adrenal cortex and that of the contralateral adrenal gland are atrophic, owing to suppression of endogenous ACTH by high cortisol levels.
What is this an image of?
This would be a classic example of what a pheochromocytoma should look like on the national boards. Look for expansion of the gray-brown medulla, which is normally quite thin. You can see the lipid-rich adrenal cortex around it.
What is this an image of?
Waterhouse-Friedrichson syndrome (Most commonly caused by Nesseria Meningitis)
Infarction of the adrenal gland
What is this image of and what causes it?
Sheehan syndrome - caused by ischemic necrosis due to blood loss
What is this an image of?
Pheochromocytoma
What is this an image of?
Cortical Adenoma
