Adrenal Cortex (path)

Question 1

Normal adrenal glands?

Answer 1

paired and located above upper pole of kidney

normal net +/- 4 gms

Question 2

Right vs left adrenal gland

Answer 2

right triangular

left semilunar

Question 3

Adrenal Cortex?

Answer 3

Zona glomerulosa- mineralcorticoids
Zona fasciculata- glucocorticoids
Zona reticularis- sex steroids (estrogen and androgen)

Question 4

Adrenal medulla?

Answer 4

Chromaffin cells- catecholamines

Question 5

Hypercortisolism (Cushing Syndrome)?

Answer 5

caused by increased amount of glucocorticoid
most commonly exogenous
Primary hypothalamic- pituitary dieases associated with increase secretion of ACTH
Hypersecretion of cortisol by adrenal adenoma
secretion of ectopic ACTH by a nonendocrine neoplasm

Question 6

Pituitary Hypersecretion?

Answer 6

most common in young adults
most associated with ACTH-producing pituitary adenoma
adrenals are bilateral hyperplastic

Question 7

Clin features of Hypercortisolism/ Cushing syndrome

Answer 7

Muscle weakness, thin extremities
moon facies, buffalo hump, truncal obesity
abdominal striae
hypertension
osteoporosis
immune suppression

Question 8

Primary adrenal neoplasms?

Answer 8

they are a small number 10-15% of endogenous Cushing Syndrome
adneomas and carcinomas are equally common in adults

Question 9

Ectopic secretion?

Answer 9

about 10% of endogenous Cushing syndrome
most common in men 40-50s

small cell carcinoma of lung, carcinoid tumors of bronchus or pancreas, meduallary ca of thyroid, islet cell tumor of the pancreas

Question 10

Hyperaldosteronism?

Answer 10

chronic excess aldosterone secretion
cause Na retention and K secretion
results in suppression of the renin angiotensis system and decrease levels of plasms renin activity

Question 11

Cause of Hyperaldosteronism?

Answer 11

aldosterone producing neoplasm or by adrenocortical hyperpolasia

Question 12

Conn syndrome?

Answer 12

solitary adenoma as the cause of Hyperaldosteronism, usually the case

Question 13

Conn syndrome/ Hyperaldosteronism presents?

Answer 13

hypertension, hypokalemia, high serum aldosterone and low serum renin levels, aldosterone secreting adenoma (Conn’s syndrome)

Question 14

Secondary Hyperaldosteronism?

Answer 14

response to activation of the renin-angiotensin system

high aldosterone, high renin

Question 15

Primary Hyperaldosteronism?

Answer 15

Hypertension, hypokalemia (weakness, parathesias, visual disturbance, tetany), sodium retention incresae extracellular fluid volume, hypertension is in part secondary to sodium retention

Question 16

Cause secondary Hyperaldosteronism?

Answer 16

decreased renal perfusion
arterial hypovolemia
pregnancy

Question 17

Adrogenital syndromes?

Answer 17

primary gonadal or adrenal disorders may cause

virilzation in girls, precocious puberty in boys, all are autosomal recessive disorders

Question 18

Waterhouse-Friderchesen Syndrome?

Answer 18

Uncommon but catastrophic syndrome
more often in children
not as many infections so not as common today

Question 19

primary chronic adrenal insufficiency?

Answer 19

Addison disease
uncommon
autoimmune most common cause
infectious disease can cause (TB, fungi)
metastatic cause

Question 20

Clincal symptoms of Addison’s disease?

Answer 20

weakness, fatigue, anroexia, hypotension, nausea/vomit, cutaneous hyperpigmentation
lab- high ACTH, hyperkalemia, hyponatremia, volume depletion

Question 21

Secondary adrenocortical insufficency?

Answer 21

may be caused by any disorder of the hypothalamus or pituitary associated with decreased production of ACTH
distinguished from primary by abscence of hyperpigmentation, normal level of aldosterone

Question 22

Adrenocortical neoplasms
Adenoma?
carcinoma?

Answer 22

poorly encapsulated

highly malignant, usually large at time of diagnosis, mets to lung

Question 23

Cortical carcinoma

Answer 23

displaces kidney downward, functional neoplasm usually, secrete corticosteroids or sex steroids, poor prognosis

Question 24

Adrenal medulla?

Answer 24

structure/ function different from cortex
neural crest cells- chromaffin cells
catecholamines
neuroendocrine cells similar to chromaffin cells are widely spread in extra adrenal systen and form the paraganlion system
most medullary disorders are neoplams

Question 25

Pheochromocytoma?

Answer 25

associated with catecholamine production and hypertension
adrenal medulla
usually sporadically, some are familial

Question 26

Rule of 10s

Answer 26

10% occur in children
10% are bilateral
10% occur outside the adrenal gland
10% are malignant
10% are familial (MEN II and MEN III)

Question 27

Patient present with pheochromocytoma?

Answer 27

Episodic hypertension