Adrenal Flashcards
MEN IIA
Medullary thyroid cancer
Pheochromocytoma
Hyperparathyroidism
Auto Dominant
MEN I
Pituitary: prolactinoma - tx: bromocriptine, sx
Hyperparathyroidism: 4 gland hyperplasia- tx: bilateral resection, MC manifestation
Pancreas: tumors- MC non-functional tumors
MEN II B
Medullary thyroid CA
Pheochromocytoma
Mucosal neuromas/marfanoid habitus
Auto Dominant
Addison disease
Adrenal insufficiency
MC- iatrogenic
Primary: autoimmune destruction of adrenal cortex
Lab findings in Addison’s dz (adrenal insuff)
HyperK, hypoNa, hypoCl, hypoglycemia
Acidosis
Increased BUN
Dx of adrenal insufficiency
Cosyntropin stimulation test
ACTH given - measure cortisol levels
Cortisol <20 = insufficiency
Arterial supply of adrenal gland
Inferior phrenic artery- superior adrenal artery
Aorta- middle adrenal artery
Renal artery- inferior adrenal artery
Venous drainage of the adrenal gland
Left adrenal vein- also receives left phrenic vein-> drains into left renal vein
Right adrenal vein-> drains into the IVC
Surgically control venous drainage first- can spill catecoleamines
Innervation of the adrenal gland
Cortex: no innervation
Medulla: splanchnic nervous system
Embryonic origin adrenal cortex?
Medulla?
Cortex: mesoderm- from gonads- extra adrenal tissue may be found there
Medulla: ectoderm
Adrenal incidentaloma work up
- Functioning or non-functioning
- Benign or mal
- Primary or secondary
Functioning vs non-functioning
Hyperfunctioning- always resect
Dx: urine levels Catecholamines, metanephrines, VMA
Hyperplasia: + negative feedback
Adenoma: + negative feedback
CA: no negative feedback
Secondary lesions- mets mostly from….
1: breast
Reasons to resect adrenal mass
Hyperfunctioning
Greater than 4-6cm
Growing
Suspicious on CT- irregular boarders, heterogeneity
Perc needle bx on adrenal mass
Contraindicated if Reasons for resection
No on functioning tumor!!!!
What is conn syndrome?
Characteristics?
Primary hyperaldosteronism
HTN, hypoK, polyuria, polydypsia, mm weakness, alkalosis
Treatment of adrenal adenoma causing conn syndrome
Hyperfunctioning
Unilateral adrenalectomy
Preop treat with spirolactone: help normalize K
Treatment of conns syndrome due to hyperplasia
Medical mgmt: spironolactone, calcium channel blockers, K
Secondary hyperaldosteronism signs and caused by….
High plasma aldosterone, high plasma renin
Caused by: renovascular HTN, diuretic use
Cushing’s syndrome : hypercortisolis
Symp: HTN, weight gain, DM, central obesity, buffalo hump, hirsutism, acne, purple stria , mental status changes
Dx: 24 urine and serum cortisol level
Adrenal cortical carcinoma
Usually women, >6cm, left sided, functional
Tx: adrenalectomy with possible adjacent organ resection
No chemo/rad
Pheochromocytoma
Tumor of medulla
Chromaffin cells
May be other places: organ of zuckerkandl (aortic bifurcation), retroperitoneum
HTN
Screen for MEN
Dx of pheo
Urine Catecholamines- DA, epi, norepinephrine, VMA, metanephrines
MIBG I131 scan- identify extra-adrenal pheos