Abdo- adrenal glands Flashcards
What do adrenal glands consist of (2 regions)?
- medulla (10%)
2. cortex (90%)
are the adrenal glands periotoneal or retroperitoneal?
retroperitoneal
where are the adrenal glands located?
- fascia
- space
- anterior to
- lateral to
- gerota’s fascia
- within perinephric space
- anterior, medial, superior to each kidney
- lateral to diaphragmatic crura
where is the right adrenal located?
posterolateral to IVC
where is the left adrenal located?
- lateral to aorta
- posteromedial to splenic artery and tail of panc.
superior suprarenal artery arises from?
the inferior phrenic artery
middle suprarenal artery arises from?
lateral aspect of the aorta
inferior suprarenal artery arises from?
the renal artery
right suprarenal vein drains?
directly into ivc
left suprarenal vein drains into?
the left renal vein
adreal functions?
- endocrine gland
- produces hormones
the medulla of the adrenal secretes?
epinephrine and norepinephrine
the cortext of the adrenal secretes?
- glucocorticoids
- gonadal hormones
- mineral corticoids
decreases hematocrit is suspicious for?
internal bleeding
leukocytosis is suspicious for?
infection
adrenal gland lab values?
- hematocrit
- leukocytosis
- ACTH
- aldosterone
- potassium
- sodium
- glucocorticoids
elevation associated with ACTH what? (3)
- adrenal tumor
- cushing disease
- lung tumor
ACTH function?
- regulates cortisol production
- produced in pituitary gland
aldosterone function?
- steroid secreted by the cortex
- regulated sodium and water levels
- affects blood volume and pressure
elevated aldosterone is associated with?
hyperaldosteronism
decreased aldosterone is associated with?
hypoaldosteronism and Addison’s disease
potassium function?
- essential to normal function of every organ system
- maintains nutrients inside and outside of the cells
elevation of potassium is associated with?
addisons disease
decreased potassium is associated with?
- cushing disease
- hyperaldosteronism
sodium is a major component in determining?
blood volume
decreased sodium is associated with?
Addison’s disease
glutocorticoids function?
- regulation of the metabolism of glucose
- fluctuates over a 24hr period
- hormone that is synthesized in adrenal cortex
corticol is released in response to?
stress and low level of blood glucose
whay does adrenal gland look like on ultrasound?
- hypoechoic
- sometimes highly echogenic fat is seen surrounding gland
adrenal gland measurement?
- Length, AP, width
L: 3-6cm
AP: 3-6mm
W: 2-4 cm.
Neonatal adrenal gland apperance on U/S?
- thin echogenic core surrounded by a thick transonic zone
- echogenic core (medulla)
- 1/3rd the size of kidney
what is addisons disease?
- atrophy of the adrenal cortex
when does addisons disease occur?
with decreased production of cortisol and sometimes aldosterone
primary causes of reduced adrenal cortical tissue associated with addisons disease? (5)
Autoimmune process Tuberculosis (TB) Inflammatory process Primary neoplasm Metastases
what is cushings syndrome caused by?
- excessive secretion of cortisol
cushings syndrome results from? (5)
- adrenal hyperplasia
- cortical adenoma
- adrenal carcinoma
- elevated ACTH from pituitary adenoma
cushings syndrome S/S?
- Truncal obesity and pencil-thin extremities
- “Buffalo hump” or “moon face”
- Hypertension and renal stones
- Irregular menses
- Psychiatric disturbances
if adrenal tumor is present, what may increase and cause masculinizing effects in women?
secretion of androgens
functioning adrenal adenomas on U/S?
- usually small (2-5cm)
- hypoechoic
conns syndrome occurance?
- occurs in 0.5% of patients with sustained hypertension
what is Conn’s syndrome caused from?
- excessive secretion of aldosterone
- usually because of cortical adenoma of the glomerulosa cells
less frequent causes of conn’s syndrome?
- adrenal hyperplasia (more in men)
- adrenal carcinoma
adenomas measure?
0.5 - 3 cm in diameter
what can be identified in Conn’s syndrome?
contralateral adrenal atrophy
clinical s/s in Conn’s syndrome?
- muscle weakness
- hypertension
- abnormal electrocardiogram
is hyperaldosteronism is caused by an adenoma what occurs?
it is removed
what is adrenal myelolipoma?
- rare benign neoplasm
- composed of mature adipose tissue and a variable amount of hematopoietic elements
how are adrenal myelolipoma lesions discovered?
- most lesions are small and asymptomatic
- discovered incidentally
what is adrenal adenoma?
- benign non-functioning
what is the most common primary adrenal tumor?
adrenal adenoma
adrenal adenoma size?
typically 2.5 cm
adreal adenoma risks?
- older patients
- diabetes
- hypertension
A significant percentage of the malignant adrenal adenomas may be the result of?
metastases
sono findings adrenal adenomas?
- 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
What is this an image of?
adrenal adenoma
What is a primary adrenal carcinoma?
- rare
- may be hyperfunctional or nonfunctional
Hyperfunctional malignant tumors are more common in?
women
Adrenal malignant tumors may cause? (3)
- cushings
- Conns
- adrenogenital syndrome
Functional tumors tend to be?
- smaller than nonfunctional tumors because they are typically diagnosed earlier
adrenal malignant tumors apperance?
homogeneous with the same echogenicity as the renal cortex
Larger neoplasms tend to be?
- nonfunctional
- heterogeneous
- central area of necrosis and hemorrhage.
small adrenal malignant tumors sono findings?
- 2-6 cm
- well-defined
- homogeneous
larger adrenal malignant tumors tend to have?
- necrosis with central hemorrhage
- often calcify
adrenal malignant tumors in colour doppler?
is hypervascular with a high incidence of invasion of the adrenal or renal vein, IVC, hepatic veins, and lymph nodes.
what is this?
- malignant adrenal tumor
what is metastasis?
- 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
sono appearance of metastasis?
- vary in size and echogenic
- non specific appearance
- large masses may contain areas of necrosis and hemorrhage
what can be confused with metastasis?
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
what is this?
metastasis
what is pheochromocytoma?
- Neuroendocrine tumor of the medulla
- Hyperfunctioning
- Secrete norepinephrine and epinephrine into blood
clinical presentation of Pheochromocytoma?
Hypertension Severe headache Palpitations Tachycardia Excessive perspiration
who is Pheochromocytomas most commonly seen in?
- 40-60 years
- rare but curable cause of hypertension
Pheochromocytomas sono apperance?
- 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
what is this an image of?
- adrenal medulla tumors: pheochromocytoma
what is the most common malignancy of the adrenal glands in childhood?
Adrenal Neuroblastoma
what is the most common tumor of infancy?
- Adrenal Neuroblastoma
- 30% of all neonatal tumors
what is Adrenal Neuroblastoma?
Well-encapsulated tumor that displaces the kidney inferiorly and laterally and elevates levels of the vanillylmandelic acid (VMA) and homovanillic acid (HVA)
More than 90% of fetal neuroblastomas are located in?
- adrenal glands
- 50% have cystic components
Adrenal Neuroblastoma develop within?
adrenal medulla
Adrenal Neuroblastoma clinical presentation?
- usually asymptomatic
- palpable abdominal mass
Adrenal Neuroblastoma prognosis?
- 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
Adrenal Neuroblastoma sono features?
- 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
Adrenal Neuroblastoma colour doppler?
- help demonstrate capsular flow and low-resistance arterial waveforms
When a large, solid, upper abdominal mass is identified in an infant or young child, the differential diagnosis should include? (3)
Neuroblastoma
Wilms tumor (nephroblastoma)
Hepatoblastoma
what is this?
Adrenal Neuroblastoma
adrenal hemorrhage?
- 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
adrenal hemorrhage is more common in?
neonates who experience traumatic delivery with stress, asphyxia, and septicemia
adrenal hemorrhage in neonate colour doppler?
- very vascular
- proportionally larger than in adult
What is this?
adrenal hemorrhage
adrenal abscess on sono?
- 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
Tuberculosis?
- Acutely-bilateral diffuse enlargement
- Inhomogenous- due to caseous necrosis
Chronically-more atrophic and calcified
Histoplasmosis?
- Caused by breathing in spores of a fungus, found in bird and bat droppings
- Adrenal calcifications
