Adrenal Flashcards
An incidental mass on the adrenal gland has a 25% chance of being cancer (primary or met) if it is greater than how much?
> 6cm
(it’s only 2% for tumors
Do metastatic lesions to the adrenal glands have a high or low attenuation?
High (they are also highly vascular)
Are mets to the adrenal glands usually unilateral or bilateral?
Bilateral
What is the most common clinical sx associated with adrenal incidentaloma? How do you test for it?
Cushing syndrome (high cortisol).
Test with overnight dexamethasone suppression test.
Usually you do NOT screen for excess aldosterone or androgen when you find an incidentaloma, because these are rare. However, what WOULD prompt you to screen for it?
Aldosterone: Hypertension, hypokalemia
Androgen: Feminization in men, Hirsutism in women
When you find an incidentaloma, what 2 tests do you run next?
- Overnight dexamethasone suppression test
2. Plasma metanephrines
What is the best screening test for primary hyperaldosteronism? What is considered a positive test?
- Screen with: Serum aldosterone:renin ratio (not imaging!! Because incidental adrenal lesions are common)
- Positive if: Ratio>20, esp if aldosterone>15
How good is CT at picking up adrenal adenomas?
93-100% sensitivity
What is the definition of primary and secondary adrenal insufficiency?
Primary: Low cortisol, high ATCH because problem is in the adrenals
Secondary: Low cortisol, low ACTH because problem is in the pituitary
Does exogenous use of steroids cause primary or secondary adrenal insufficiency?
Secondary (it makes the pituitary stop secreting ACTH)
How long do you have to be on exogenous steroids in order to get insufficiency if you stop them?
3 weeks
How should you treat adrenal insufficiency (low BP, orthostatic, low Na, high K) during stress?
IV “stress dose” (10x normal dose, usually ends up to be 100 mg daily) of hydrocortisone. No oral because nausea and vomiting often limit use. No fludrocortisone because at those high doses hydrocortisone covers both.
Which type of fluid do you give to correct hyponatremia and hypotension in adrenal insufficiency?
Just normal saline. No hypertonic saline necessary, because restoring volume will suppress ADH which should correct the hyponatremia.