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Abdo- adrenal glands Flashcards

1
Q

What do adrenal glands consist of (2 regions)?

A
  1. medulla (10%)

2. cortex (90%)

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2
Q

are the adrenal glands periotoneal or retroperitoneal?

A

retroperitoneal

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3
Q

where are the adrenal glands located?

  • fascia
  • space
  • anterior to
  • lateral to
A
  • gerota’s fascia
  • within perinephric space
  • anterior, medial, superior to each kidney
  • lateral to diaphragmatic crura
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4
Q

where is the right adrenal located?

A

posterolateral to IVC

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5
Q

where is the left adrenal located?

A
  • lateral to aorta

- posteromedial to splenic artery and tail of panc.

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6
Q

superior suprarenal artery arises from?

A

the inferior phrenic artery

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7
Q

middle suprarenal artery arises from?

A

lateral aspect of the aorta

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8
Q

inferior suprarenal artery arises from?

A

the renal artery

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9
Q

right suprarenal vein drains?

A

directly into ivc

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10
Q

left suprarenal vein drains into?

A

the left renal vein

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11
Q

adreal functions?

A
  • endocrine gland

- produces hormones

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12
Q

the medulla of the adrenal secretes?

A

epinephrine and norepinephrine

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13
Q

the cortext of the adrenal secretes?

A
  • glucocorticoids
  • gonadal hormones
  • mineral corticoids
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14
Q

decreases hematocrit is suspicious for?

A

internal bleeding

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15
Q

leukocytosis is suspicious for?

A

infection

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16
Q

adrenal gland lab values?

A
  • hematocrit
  • leukocytosis
  • ACTH
  • aldosterone
  • potassium
  • sodium
  • glucocorticoids
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17
Q

elevation associated with ACTH what? (3)

A
  1. adrenal tumor
  2. cushing disease
  3. lung tumor
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18
Q

ACTH function?

A
  • regulates cortisol production

- produced in pituitary gland

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19
Q

aldosterone function?

A
  • steroid secreted by the cortex
  • regulated sodium and water levels
  • affects blood volume and pressure
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20
Q

elevated aldosterone is associated with?

A

hyperaldosteronism

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21
Q

decreased aldosterone is associated with?

A

hypoaldosteronism and Addison’s disease

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22
Q

potassium function?

A
  • essential to normal function of every organ system

- maintains nutrients inside and outside of the cells

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23
Q

elevation of potassium is associated with?

A

addisons disease

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24
Q

decreased potassium is associated with?

A
  • cushing disease

- hyperaldosteronism

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25
Q

sodium is a major component in determining?

A

blood volume

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26
Q

decreased sodium is associated with?

A

Addison’s disease

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27
Q

glutocorticoids function?

A
  • regulation of the metabolism of glucose
  • fluctuates over a 24hr period
  • hormone that is synthesized in adrenal cortex
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28
Q

corticol is released in response to?

A

stress and low level of blood glucose

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29
Q

whay does adrenal gland look like on ultrasound?

A
  • hypoechoic

- sometimes highly echogenic fat is seen surrounding gland

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30
Q

adrenal gland measurement?

- Length, AP, width

A

L: 3-6cm
AP: 3-6mm
W: 2-4 cm.

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31
Q

Neonatal adrenal gland apperance on U/S?

A
  • thin echogenic core surrounded by a thick transonic zone
  • echogenic core (medulla)
  • 1/3rd the size of kidney
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32
Q

what is addisons disease?

A
  • atrophy of the adrenal cortex
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33
Q

when does addisons disease occur?

A

with decreased production of cortisol and sometimes aldosterone

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34
Q

primary causes of reduced adrenal cortical tissue associated with addisons disease? (5)

A 
Autoimmune process
Tuberculosis (TB)
Inflammatory process
Primary neoplasm
Metastases
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35
Q

what is cushings syndrome caused by?

A
  • excessive secretion of cortisol
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36
Q

cushings syndrome results from? (5)

A
  • adrenal hyperplasia
  • cortical adenoma
  • adrenal carcinoma
  • elevated ACTH from pituitary adenoma
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37
Q

cushings syndrome S/S?

A
  • Truncal obesity and pencil-thin extremities
  • “Buffalo hump” or “moon face”
  • Hypertension and renal stones
  • Irregular menses
  • Psychiatric disturbances
38
Q

if adrenal tumor is present, what may increase and cause masculinizing effects in women?

A

secretion of androgens

39
Q

functioning adrenal adenomas on U/S?

A
  • usually small (2-5cm)

- hypoechoic

40
Q

conns syndrome occurance?

A
  • occurs in 0.5% of patients with sustained hypertension
41
Q

what is Conn’s syndrome caused from?

A
  • excessive secretion of aldosterone

- usually because of cortical adenoma of the glomerulosa cells

42
Q

less frequent causes of conn’s syndrome?

A
  • adrenal hyperplasia (more in men)

- adrenal carcinoma

43
Q

adenomas measure?

A

0.5 - 3 cm in diameter

44
Q

what can be identified in Conn’s syndrome?

A

contralateral adrenal atrophy

45
Q

clinical s/s in Conn’s syndrome?

A
  • muscle weakness
  • hypertension
  • abnormal electrocardiogram
46
Q

is hyperaldosteronism is caused by an adenoma what occurs?

A

it is removed

47
Q

what is adrenal myelolipoma?

A
  • rare benign neoplasm

- composed of mature adipose tissue and a variable amount of hematopoietic elements

48
Q

how are adrenal myelolipoma lesions discovered?

A
  • most lesions are small and asymptomatic

- discovered incidentally

49
Q

what is adrenal adenoma?

A
  • benign non-functioning
50
Q

what is the most common primary adrenal tumor?

A

adrenal adenoma

51
Q

adrenal adenoma size?

A

typically 2.5 cm

52
Q

adreal adenoma risks?

A
  • older patients
  • diabetes
  • hypertension
53
Q

A significant percentage of the malignant adrenal adenomas may be the result of?

A

metastases

54
Q

sono findings adrenal adenomas?

A
  • Nonfunctioning adenomas demonstrate a well-defined, round, slightly hypoechoic, homogeneous mass
  • Mass is almost always detected as an incidental finding
  • Mass may be so large that it compresses adjacent structures
55
Q

What is this an image of?

A

adrenal adenoma

56
Q

What is a primary adrenal carcinoma?

A
  • rare

- may be hyperfunctional or nonfunctional

57
Q

Hyperfunctional malignant tumors are more common in?

A

women

58
Q

Adrenal malignant tumors may cause? (3)

A
  • cushings
  • Conns
  • adrenogenital syndrome
59
Q

Functional tumors tend to be?

A
  • smaller than nonfunctional tumors because they are typically diagnosed earlier
60
Q

adrenal malignant tumors apperance?

A

homogeneous with the same echogenicity as the renal cortex

61
Q

Larger neoplasms tend to be?

A
  • nonfunctional
  • heterogeneous
  • central area of necrosis and hemorrhage.
62
Q

small adrenal malignant tumors sono findings?

A
  • 2-6 cm
  • well-defined
  • homogeneous
63
Q

larger adrenal malignant tumors tend to have?

A
  • necrosis with central hemorrhage

- often calcify

64
Q

adrenal malignant tumors in colour doppler?

A

is hypervascular with a high incidence of invasion of the adrenal or renal vein, IVC, hepatic veins, and lymph nodes.

65
Q

what is this?

A
  • malignant adrenal tumor
66
Q

what is metastasis?

A
  • adrenal glands are the 4th most common site for mets (after lung, liver, bones)
  • bilateral in more than half of people
  • typically cause adrenal insufficiency
67
Q

sono appearance of metastasis?

A
  • vary in size and echogenic
  • non specific appearance
  • large masses may contain areas of necrosis and hemorrhage
68
Q

what can be confused with metastasis?

A

Differentiating a common benign adenoma from a metastatic lesion can be difficult when no other evidence of metastatic disease is found and theadrenal mass is unilateral

69
Q

what is this?

A

metastasis

70
Q

what is pheochromocytoma?

A
  • Neuroendocrine tumor of the medulla
  • Hyperfunctioning
  • Secrete norepinephrine and epinephrine into blood
71
Q

clinical presentation of Pheochromocytoma?

A 
Hypertension
Severe headache
Palpitations
Tachycardia
Excessive perspiration
72
Q

who is Pheochromocytomas most commonly seen in?

A
  • 40-60 years

- rare but curable cause of hypertension

73
Q

Pheochromocytomas sono apperance?

A
  • 5-6cm in diameter-easily seen
  • More often in right gland
  • Well marginated
  • May be calcified
  • Heterogenous or homogenously solid
  • May have areas of necrosis or hemorrhage
74
Q

what is this an image of?

A
  • adrenal medulla tumors: pheochromocytoma
75
Q

what is the most common malignancy of the adrenal glands in childhood?

A

Adrenal Neuroblastoma

76
Q

what is the most common tumor of infancy?

A
  • Adrenal Neuroblastoma

- 30% of all neonatal tumors

77
Q

what is Adrenal Neuroblastoma?

A

Well-encapsulated tumor that displaces the kidney inferiorly and laterally and elevates levels of the vanillylmandelic acid (VMA) and homovanillic acid (HVA)

78
Q

More than 90% of fetal neuroblastomas are located in?

A
  • adrenal glands

- 50% have cystic components

79
Q

Adrenal Neuroblastoma develop within?

A

adrenal medulla

80
Q

Adrenal Neuroblastoma clinical presentation?

A
  • usually asymptomatic

- palpable abdominal mass

81
Q

Adrenal Neuroblastoma prognosis?

A
  • Spontaneous regression is common before the age of 1 year

- Otherwise, the prognosis is very poor; tumor is not very responsive to either irradiation or chemotherapy

82
Q

Adrenal Neuroblastoma sono features?

A
  • heterogeneously echogenic with poorly defined margins

Small percentage of neuroblastomas demonstrate internal calcifications with anechoic “cystic” areas

The “ultrasound lobule” (an area of increased echogenicity in the tumor) is characteristic for neuroblastomas

83
Q

Adrenal Neuroblastoma colour doppler?

A
  • help demonstrate capsular flow and low-resistance arterial waveforms
84
Q

When a large, solid, upper abdominal mass is identified in an infant or young child, the differential diagnosis should include? (3)

A

Neuroblastoma
Wilms tumor (nephroblastoma)
Hepatoblastoma

85
Q

what is this?

A

Adrenal Neuroblastoma

86
Q

adrenal hemorrhage?

A
  • Very rare in adults
  • Usually caused by severe trauma or infection
  • Posttraumatic hemorrhage usually unilateral and does not cause any major clinical problem
  • Bilateral hemorrhage may cause adrenal insufficiency
87
Q

adrenal hemorrhage is more common in?

A

neonates who experience traumatic delivery with stress, asphyxia, and septicemia

88
Q

adrenal hemorrhage in neonate colour doppler?

A
  • very vascular

- proportionally larger than in adult

89
Q

What is this?

A

adrenal hemorrhage

90
Q

adrenal abscess on sono?

A
  • hypoechoic or has a complex echo structure
  • Rarely Anechoic
  • If anechoic, need clinical and laboratory findings can differentiate the lesion from an ordinary cyst
  • Wall is irregular
  • Distal acoustic enhancement may be present
  • Air within the structure
91
Q

Tuberculosis?

A
  • Acutely-bilateral diffuse enlargement
  • Inhomogenous- due to caseous necrosis

Chronically-more atrophic and calcified

92
Q

Histoplasmosis?

A
  • Caused by breathing in spores of a fungus, found in bird and bat droppings
  • Adrenal calcifications

cnih (69 decks)

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