Adrenal Flashcards
What is the arterial supply to the adrenals?
- superior: phrenic
- middle: aorta
- inferior: renal artery
What is the venous drainage of the adrenals?
- left into the renal vein
- right into the IVC
What are the zones of the adrenals?
- Glomerulosa: aldosterone (salt)
- Fasicularis: glucocorticoids (sugar)
- Reticularis: androgens/estrogen (sex)
The adrenal cortex and medulla are derived from which embryologic layers?
- cortex: mesoderm
- medulla: ectoderm
What features of an adrenal incidentaloma are concerning?
- size > 4cm
- HU > 10
- enlarging on serial imaging
- hormonally active
What tests are used to screen for a functional adrenaloma?
- urine metanephrines/VMA/catecholamines
- urine hydroxycorticosteroids
- serum K
- plasma renin and aldosterone levels
What are the congenital adrenal hyperplasias?
think that 1 means elevated (aldosterone/testosterone)
21
17
11
How can you differentiate primary from secondary hyperaldosteronism?
- primary: low renin
- secondary: high renin
What lab test is diagnostic of secondary hyperaldosteronism?
aldosterone/renin > 25
How is hyperaldosteronism diagnosed?
- perform a salt load suppression test, urine aldosterone will remain elevated
- then localize with CT/MRI/NP-59 scintigraphy/venous sampling
What is the most common cause of hyperaldosteronism?
bilateral idiopathic adrenal hyperplasia
How is hyperaldosteronism treated?
- spironolactone, potassium replacement, and calcium channel blockers
- adrenalectomy
How is hypocortisolism diagnosed?
- see decreased cortisol and aldosterone with high ACTH
- perform a cosyntropin stim test and will see persistently low cortisol
How does acute adrenal insufficiency present?
with refractory hypotension, fevers, lethargy, pain, and nausea/vomiting
What is the most common cause of Cushing’s?
exogenous corticosteroids
