Adrenal Flashcards
normal appearance of adrenals
Lie above the kidneys in an anteromedial position
Form a cap or inverted V over the kidneys
Most easily seen until about 1 month of age
Rt gland seen better than Lt
Have a V or Y configuration
adrenal gland is large in neonate due to
presence of fetal zone in the cortex, that involutes after birth
Three factors that make adrenals easy to visualize in neonates:
Proportionally larger than adult glands (1/3 vs 1/13 of kidney size)
Scarcity of perirenal fat allows better image resolution than the abundance of fatty tissue in the adult
Closer to the skin surface, which permits the use of higher frequency transducers
sono appearance of adrenal
echogenic medulla surrounded by the hypoechoic cortex
challenges of the adrenals
Small size in older children
Obesity
Overlying bowel gas
It is common to scan the adrenals in multiple planes in order to visualize it in its entirety
Adrenal Gland Functions
Two endocrine glands in one organ
Important hormone secretion function
Essential to life
two catecholamines made by medulla
Epinephrine (adrenalin)(80%)
Norepinephrine (noradrenalin)
hormones from the adrenals do what
hormones accelerate heart rate, increase blood pressure, accelerate respiratory rate, increase blood sugar levels, etc.
3 adrenal tumors
Neuroblastoma
Adrenocortical carcinoma
Pheochromocytoma
can sonography differentiate tumor types
no
characteristics of Ganglioneurblastoma and ganglioneuroma
incidental finding on routine exams or chest x-rays
moderately malignant to completely benign
might be an asymptomatic mass
Neuroblastoma clinical presentation (8)
Palpable mass Other symptoms Fever Weight loss Irritability Hypertention Abdo distention Spreads rapidly to other organs
prognosis is better for who
better in neonates and young infants vs. older children
where can adrenal tumours arise from
These tumours can arise from sympathetic ganglia in abdomen, pelvis, chest, neck.
neuroblastoma sono (6)
Echogenic mass Poorly defined borders Calcifications with PAS Areas of necrosis (hypoechoic) Displaced kidney Mets – often at presentation
Adrenocortical Carcinoma symptoms (5)
Virilizing symtoms Abdo mass Deepened voice Hypertention Seizures
Adrenocortical Carcinoma sono (5)
Echogenic Complex/heterogenous - from necrosis and hemorrhage May have Thick echogenic capsule Calcifications.
Pheochromocytoma originates in
medulla
clinical presentation of pheochromocytoma
(4)
↑ BP
Headache
Palpitations
Diaphoresis
pheochromocytoma sono (5)
Solid Mixed – solid and cystic Cystic Large lesions have hemorrhage and necrosis Almost always – sharply encapsulated
adrenal haemorrhage causes (3)
Prematurity
Neonatal sepsis or hypoxia
Birth trauma
clinical presentation of adrenal hemorrhage (5)
Palpable mass Anemia Jaundice (resorption of excess Hb) ↓ BP Scrotal discoloration in boys.
adrenal hemorrhage sono appearance (4)
Echogenic mass
Anechoic if liquefies
Follow up scans to see change and establish Dx
In a few weeks or months Ca2+ appear
adrenal cyst sono appearance (6)
Anechoic Well-defined walls Enhancement Displace the kidney inferiorly Can contain debris Must be distinguished from renal cysts, hydronephrosis, splenic and pancreatic cysts.
adrenal abscess difficult to differentiate from
hemmorhage
Congenital Adrenal Hyperplasia (CAH) caused by
condition caused by an enzyme deficiency in the adrenal cortex and accumulation of androgenic precursors
clinical signs of Congenital Adrenal Hyperplasia (CAH) (3)
Virilism in newborn females
Premature masculinization in males
advanced somatic development in both sexes
Congenital Adrenal Hyperplasia (CAH) sono (4)
Increased adrenal size
Enlargement involves mostly the cortex
Preserved sonographic appearance
Cerebriform appearance
Measurements suggestive of CAH:
Length > 20mm, Width > 4mm
renal agenesis sign
Lying-flat adrenal”
renal agenesis causes
Renal agenesis
Potter syndrome
Ectopic kidney
renal agenesis the gland is
flat and elongated but other wise normal
