Adrenal and Parathyroid Disease

Question 1

3 layers of adrenal cortex and what they make

Answer 1

Glomerulosa –> mineralcorticoids

Fasicuculata –> Glucocorticoids

Reticularis –> Estrogen and Androgens

Question 2

What does the adrenal medulla make

Answer 2

Epinephrine and norepinephrine

Question 3

All effects of cushing syndrome are from?

Answer 3

Cortisol

Question 4

High dose Dexamethasone only supresses what?

Answer 4

Cushing disease: Pituitary adenoma

Question 5

Cushings symptoms

Answer 5

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

Question 6

Most common cause of Cushing’s syndrome

Answer 6

Iatrogenic: Steroid use

Question 7

Adrenogentical syndrome comes from?

Answer 7

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

Question 8

Hydroxylase def that is Na wasting? Na retaining?

Answer 8

Na wasting: 21-hydroxylase def

Na retaining: 11-B-hydroxylase def

Question 9

All hyperaldosteronism diseases characterized by?

Answer 9

Hypertension and hypokalemia

Question 10

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

Answer 10

Conn syndrome (Aldosterone secreting cortical adenoma)

Question 11

Most common cause of hyperaldosteronism

Answer 11

Conn syndrome (aldosterone secreting tumor)

Question 12

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

Answer 12

Blood pressure will be high

Potassium will be low

Question 13

Acute reponse to stress mediated by? Chronic?

Answer 13

Acute mediated by catecholamines

Chronic by corticosteroid hormones

Question 14

Predominant manifestation of adrenal crisis?

Answer 14

Shock

Question 15

Rare manifestation of primary acute adrenal insufficiency

Answer 15

Hypoglycemia

Question 16

Prototype of acute adrenal insufficiency? Usually due to?

Answer 16

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

Question 17

what is seen here?

Answer 17

Typical “bag of blood” apperance of the hemorrhagic adrenals

Question 18

Waterhouse-Friderichsen syndrome symptoms

Answer 18

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

Question 19

What is seen here?

Answer 19

Waterhouse-Friderichsen syndrome

Question 20

Causes of acute adrenal insufficiency besides W-F syndrome

Answer 20

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

Question 21

Manifestations of chronic adrenal insufficiency

Answer 21

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

Question 22

Addison’s disease is an example of? Causes?

Answer 22

Chronic adrenal insufficiency

Autoimmunity is most common cause is US

Question 23

Addison’s disease symptoms

Answer 23

Hypotension, hyperkalemia

Hyperpigmentation, weakness, low IQ

Question 24

Blood cortisol level after ACTH injection in Addison’s disease

Answer 24

None

Question 25

2 adrenal neoplasms seen in adrenal medulla

Answer 25

1) Pheochromocytoma 2) Neuroblastoma

Question 26

Vast majority of Adrenal cortical tumors?

Answer 26

Incidentalomas (non-functioning adenomas discovered on imaging)

Question 27

What is seen here?

Answer 27

Adrenal cortical tumor

Question 28

What is seen here?

Answer 28

Adrenal cortical adenoma (lipid rich)

Question 29

What is seen here?

Answer 29

Adrenal cortical carcinoma

Question 30

Factors that make adrenal cortical carcinoma malignant?

Answer 30

1) Size: greater than 5 cm 2) Function: \>90% that are malignant secrete hormones _NOT_ histology, will look very non-malignant

Question 31

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

Answer 31

Pheochromocytoma Symptoms: Episodic headache, sweating, tachycardia Sign: HTN

Question 32

What is seen here?

Answer 32

Pheochromocytoma

Question 33

10% rules of pheochromocytomas

Answer 33

10% without HTN 10% extra adrenal 10% malignant 10% of sporadic ones are bilateral **_25%_** are familial

Question 34

What is seen here? Features?

Answer 34

Pheochromocytoma Abundant basophilic cytoplasm and composed of cells in clusters ("Zallballen")

Question 35

Most common extracranial solid tumor of childhood?

Answer 35

Neuroblastoma

Question 36

What is seen here? Where is it most commonly found

Answer 36

Neuroblastoma Most commonly found in adrenals and paraaortic ganglia

Question 37

Histopath of neuroblastomas

Answer 37

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

Question 38

Sites of paraganglia where neoplasms may form?

Answer 38

Brachiomeric Intravagal Aortico-sympathetic

Question 39

Most common malignancies in adrenals BY FAR?

Answer 39

Metastases, Usually from Lung, Breast, and Kidney

Question 40

Characteristics of metastatic adrenal neoplasms

Answer 40

Bilateral and multifocal tumors are almost always metastatic

Question 41

Where do the superior parathyroid glands develop from? inferior?

Answer 41

Superior: Fourth branchial pouch Inferior: Thrid branchial pouch

Question 42

Where are the parathyroid glands normally found

Answer 42

Posterior to thyroid and at the upper and lower poles

Question 43

Who gets primary hyperparathyroidism

Answer 43

Older African-American women

Question 44

What is seen here? Symptoms\*\*

Answer 44

Parathyroid adenoma Symptoms: Moans, Bones, Stones

Question 45

What is seen here?

Answer 45

Parathyroid hyperplasia (will have all 4 glands large)

Question 46

What is seen here?

Answer 46

Parathyroid adenoma