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Pathology > Adrenal and Parathyroid Disease > Flashcards

Adrenal and Parathyroid Disease Flashcards

1
Q

3 layers of adrenal cortex and what they make

A

Glomerulosa –> mineralcorticoids

Fasicuculata –> Glucocorticoids

Reticularis –> Estrogen and Androgens

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2
Q

What does the adrenal medulla make

A

Epinephrine and norepinephrine

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3
Q

All effects of cushing syndrome are from?

A

Cortisol

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4
Q

High dose Dexamethasone only supresses what?

A

Cushing disease: Pituitary adenoma

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5
Q

Cushings symptoms

A

Truncal obesity, buffalo hump, flushed face, acne, immunosuppresion

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6
Q

Most common cause of Cushing’s syndrome

A

Iatrogenic: Steroid use

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7
Q

Adrenogentical syndrome comes from?

A

Hydroxylase deficiencies: Difficulty synthesizing cortisol causes more production of precursors, some shunted to make andgrogens

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8
Q

Hydroxylase def that is Na wasting? Na retaining?

A

Na wasting: 21-hydroxylase def

Na retaining: 11-B-hydroxylase def

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9
Q

All hyperaldosteronism diseases characterized by?

A

Hypertension and hypokalemia

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10
Q

What should you be weary of in a relatively healthy 20 year old with new onset HTN

A

Conn syndrome (Aldosterone secreting cortical adenoma)

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11
Q

Most common cause of hyperaldosteronism

A

Conn syndrome (aldosterone secreting tumor)

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12
Q

What will be high in Conn syndrome? What will be low?

A

Blood pressure will be high

Potassium will be low

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13
Q

Acute reponse to stress mediated by? Chronic?

A

Acute mediated by catecholamines

Chronic by corticosteroid hormones

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14
Q

Predominant manifestation of adrenal crisis?

A

Shock

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15
Q

Rare manifestation of primary acute adrenal insufficiency

A

Hypoglycemia

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16
Q

Prototype of acute adrenal insufficiency? Usually due to?

A

Waterhouse-Friderichsen syndrome: Overwhelming sepsis usually due to neisseria meningitidis

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17
Q

what is seen here?

A

Typical “bag of blood” apperance of the hemorrhagic adrenals

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18
Q

Waterhouse-Friderichsen syndrome symptoms

A

Overwhelming sepsis leading to shock, hemorrhagic obliteration of adrenals, DIC

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19
Q

What is seen here?

A

Waterhouse-Friderichsen syndrome

20
Q

Causes of acute adrenal insufficiency besides W-F syndrome

A

1) Sudden withdrawal of exogenous cortico-steroids
2) Sudden stress in pt with chronic adrenal insufficiency

21
Q

Manifestations of chronic adrenal insufficiency

A

Fatigue, malaise, anorexia, nausea, ab pain, weight loss, weakness, salt craving

22
Q

Addison’s disease is an example of? Causes?

A

Chronic adrenal insufficiency

Autoimmunity is most common cause is US

23
Q

Addison’s disease symptoms

A

Hypotension, hyperkalemia

Hyperpigmentation, weakness, low IQ

24
Q

Blood cortisol level after ACTH injection in Addison’s disease

A

None

25
Q

2 adrenal neoplasms seen in adrenal medulla

A

1) Pheochromocytoma
2) Neuroblastoma

26
Q

Vast majority of Adrenal cortical tumors?

A

Incidentalomas (non-functioning adenomas discovered on imaging)

27
Q

What is seen here?

A

Adrenal cortical tumor

28
Q

What is seen here?

A

Adrenal cortical adenoma (lipid rich)

29
Q

What is seen here?

A

Adrenal cortical carcinoma

30
Q

Factors that make adrenal cortical carcinoma malignant?

A

1) Size: greater than 5 cm
2) Function: >90% that are malignant secrete hormones

NOT histology, will look very non-malignant

31
Q

What is a catecholamine-secreting tumor of adrenal medulla? Symptoms and signs?

A

Pheochromocytoma

Symptoms: Episodic headache, sweating, tachycardia

Sign: HTN

32
Q

What is seen here?

A

Pheochromocytoma

33
Q

10% rules of pheochromocytomas

A

10% without HTN

10% extra adrenal

10% malignant

10% of sporadic ones are bilateral

25% are familial

34
Q

What is seen here? Features?

A

Pheochromocytoma

Abundant basophilic cytoplasm and composed of cells in clusters (“Zallballen”)

35
Q

Most common extracranial solid tumor of childhood?

A

Neuroblastoma

36
Q

What is seen here? Where is it most commonly found

A

Neuroblastoma

Most commonly found in adrenals and paraaortic ganglia

37
Q

Histopath of neuroblastomas

A

Can be undifferentiated or bening in appearance, admixed with more matural neural elements like ganglion cells

38
Q

Sites of paraganglia where neoplasms may form?

A

Brachiomeric

Intravagal

Aortico-sympathetic

39
Q

Most common malignancies in adrenals BY FAR?

A

Metastases,

Usually from Lung, Breast, and Kidney

40
Q

Characteristics of metastatic adrenal neoplasms

A

Bilateral and multifocal tumors are almost always metastatic

41
Q

Where do the superior parathyroid glands develop from? inferior?

A

Superior: Fourth branchial pouch

Inferior: Thrid branchial pouch

42
Q

Where are the parathyroid glands normally found

A

Posterior to thyroid and at the upper and lower poles

43
Q

Who gets primary hyperparathyroidism

A

Older African-American women

44
Q

What is seen here? Symptoms**

A

Parathyroid adenoma

Symptoms: Moans, Bones, Stones

45
Q

What is seen here?

A

Parathyroid hyperplasia (will have all 4 glands large)

46
Q

What is seen here?

A

Parathyroid adenoma

Pathology (10 decks)

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