Adrenal

Question 0

MEN IIA

Answer 0

Medullary thyroid cancer
Pheochromocytoma
Hyperparathyroidism

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Question 1

MEN I

Answer 1

Pituitary: prolactinoma - tx: bromocriptine, sx

Hyperparathyroidism: 4 gland hyperplasia- tx: bilateral resection, MC manifestation

Pancreas: tumors- MC non-functional tumors

Question 2

MEN II B

Answer 2

Medullary thyroid CA
Pheochromocytoma
Mucosal neuromas/marfanoid habitus

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Question 3

Addison disease

Answer 3

Adrenal insufficiency

MC- iatrogenic

Primary: autoimmune destruction of adrenal cortex

Question 4

Lab findings in Addison’s dz (adrenal insuff)

Answer 4

HyperK, hypoNa, hypoCl, hypoglycemia
Acidosis
Increased BUN

Question 5

Dx of adrenal insufficiency

Answer 5

Cosyntropin stimulation test

ACTH given - measure cortisol levels
Cortisol <20 = insufficiency

Question 6

Arterial supply of adrenal gland

Answer 6

Inferior phrenic artery- superior adrenal artery
Aorta- middle adrenal artery
Renal artery- inferior adrenal artery

Question 7

Venous drainage of the adrenal gland

Answer 7

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

Question 8

Innervation of the adrenal gland

Answer 8

Cortex: no innervation

Medulla: splanchnic nervous system

Question 9

Embryonic origin adrenal cortex?

Medulla?

Answer 9

Cortex: mesoderm- from gonads- extra adrenal tissue may be found there

Medulla: ectoderm

Question 10

Adrenal incidentaloma work up

Answer 10

1. Functioning or non-functioning
2. Benign or mal
3. Primary or secondary

Question 11

Functioning vs non-functioning

Answer 11

Hyperfunctioning- always resect
Dx: urine levels Catecholamines, metanephrines, VMA

Hyperplasia: + negative feedback
Adenoma: + negative feedback
CA: no negative feedback

Question 12

Secondary lesions- mets mostly from….

Answer 12

1: breast

Question 13

Reasons to resect adrenal mass

Answer 13

Hyperfunctioning
Greater than 4-6cm
Growing
Suspicious on CT- irregular boarders, heterogeneity

Question 14

Perc needle bx on adrenal mass

Answer 14

Contraindicated if Reasons for resection

No on functioning tumor!!!!

Question 15

What is conn syndrome?

Characteristics?

Answer 15

Primary hyperaldosteronism

HTN, hypoK, polyuria, polydypsia, mm weakness, alkalosis

Question 16

Treatment of adrenal adenoma causing conn syndrome

Answer 16

Hyperfunctioning
Unilateral adrenalectomy

Preop treat with spirolactone: help normalize K

Question 17

Treatment of conns syndrome due to hyperplasia

Answer 17

Medical mgmt: spironolactone, calcium channel blockers, K

Question 18

Secondary hyperaldosteronism signs and caused by….

Answer 18

High plasma aldosterone, high plasma renin

Caused by: renovascular HTN, diuretic use

Question 19

Cushing’s syndrome : hypercortisolis

Answer 19

Symp: HTN, weight gain, DM, central obesity, buffalo hump, hirsutism, acne, purple stria , mental status changes

Dx: 24 urine and serum cortisol level

Question 20

Adrenal cortical carcinoma

Answer 20

Usually women, >6cm, left sided, functional

Tx: adrenalectomy with possible adjacent organ resection

No chemo/rad

Question 21

Pheochromocytoma

Answer 21

Tumor of medulla
Chromaffin cells
May be other places: organ of zuckerkandl (aortic bifurcation), retroperitoneum

HTN
Screen for MEN

Question 22

Dx of pheo

Answer 22

Urine Catecholamines- DA, epi, norepinephrine, VMA, metanephrines

MIBG I131 scan- identify extra-adrenal pheos