Adrenal Cortex (path) Flashcards

8/5

1
Q

Normal adrenal glands?

A

paired and located above upper pole of kidney

normal net +/- 4 gms

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2
Q

Right vs left adrenal gland

A

right triangular

left semilunar

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3
Q

Adrenal Cortex?

A

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

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4
Q

Adrenal medulla?

A

Chromaffin cells- catecholamines

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5
Q

Hypercortisolism (Cushing Syndrome)?

A

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

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6
Q

Pituitary Hypersecretion?

A

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

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7
Q

Clin features of Hypercortisolism/ Cushing syndrome

A
Muscle weakness, thin extremities
moon facies, buffalo hump, truncal obesity
abdominal striae
hypertension
osteoporosis
immune suppression
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8
Q

Primary adrenal neoplasms?

A

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

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9
Q

Ectopic secretion?

A

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

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10
Q

Hyperaldosteronism?

A

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

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11
Q

Cause of Hyperaldosteronism?

A

aldosterone producing neoplasm or by adrenocortical hyperpolasia

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12
Q

Conn syndrome?

A

solitary adenoma as the cause of Hyperaldosteronism, usually the case

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13
Q

Conn syndrome/ Hyperaldosteronism presents?

A

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

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14
Q

Secondary Hyperaldosteronism?

A

response to activation of the renin-angiotensin system

high aldosterone, high renin

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15
Q

Primary Hyperaldosteronism?

A

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

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16
Q

Cause secondary Hyperaldosteronism?

A

decreased renal perfusion
arterial hypovolemia
pregnancy

17
Q

Adrogenital syndromes?

A

primary gonadal or adrenal disorders may cause

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

18
Q

Waterhouse-Friderchesen Syndrome?

A

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

19
Q

primary chronic adrenal insufficiency?

A
Addison disease
uncommon
autoimmune most common cause
infectious disease can cause (TB, fungi)
metastatic cause
20
Q

Clincal symptoms of Addison’s disease?

A

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

21
Q

Secondary adrenocortical insufficency?

A

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

22
Q

Adrenocortical neoplasms
Adenoma?
carcinoma?

A

poorly encapsulated

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

23
Q

Cortical carcinoma

A

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

24
Q

Adrenal medulla?

A

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

25
Pheochromocytoma?
associated with catecholamine production and hypertension adrenal medulla usually sporadically, some are familial
26
Rule of 10s
``` 10% occur in children 10% are bilateral 10% occur outside the adrenal gland 10% are malignant 10% are familial (MEN II and MEN III) ```
27
Patient present with pheochromocytoma?
Episodic hypertension