Adrenal disease Flashcards
signs that mass may be adrenal carcinoma vs. benign
- look at char. on CT
- large is worse esp over 6cm
- growing?
- hyperfunction?
4 types of adrenal hyper
- pheo- epi
- cushings - gluco
- hyperaldosteronism - mineralocorticoids
- sex hormoes
2 times to go to surgery
- secreting hormones
2. Large and with features of malignancy
when to biopsy mass
NEVER before ruling our pheo
- can dump epi
- if ruled out, can biopsy
classic triad of pheo
Pain (headache)
Perspiratiokn
Palpitations
how to test for pheo
24hr urine
- metanepherines, catecholamine
- creatiinien - to make sure you get a good measure
what to test for cuchings
- make sure it’s not exogenous
2. dexamethasone supression test
presentation of hyperaldosteron
hypertensions +/- hypokalemia
what is seen on test for hyperaldo
high aldo and low renin
3 possible causes for unsupressed cortisol
- high ACTH (pit, ectopic ACTH or CRH)
- ACTH indep. ( adernal cort.)
- exogenous - glucocort drug
3 steps for adrenal cushings
- diagnose (urine cortisol and supression test)
- look for cause of cushings
- imagining (CT/MRI)
role of pathol in adrenal (3)
- define lesion
- do patho findings explain clinical findings
- prognostics
basic classification of adrenal lesion in adults
Cortex - adrenal cortical hyperplasia - AC adenoma - AC carcinoma Medulla - Adrenal meduallary hyperplasia - pheo
gross patho of a adrenal cortical hypoerplasia
- usually bilateral
- diffusely enlarged gland
- can show nodularity
what is functional approach
for each hormonal syndrome there is a different group of pathological entities
3 pathos in high glucocorticoids
- adrenal cortical hyperplasia
- AC adenoma
- AC carcinoma
*** what will the contralateral adrenal gland look like in a patient with a cortisol secreting AC adenoma
will be atrophic
what is the sig. of this
if miss the diagnosis and remove can go into insifficiency crisis
how can path. help prevent this
look at the thickness of the non-lesional cortex
what is most common causes of increased mineralocort
- adrenal cortical hyperplasia - rare
- AC adenoma - common
- AC carcinoma - V. rare
what is most common cause of virilization
almost always AC carcinoma
feat. of AC carcinoma
- large >4cm
- weight
- histo features
- can be funct. or not
2 cause of excess catecholamines
- adrenal medullary hypoerplasia
2. pheo
def. pheochromocytoma
- 30% familial
- often benign
- can be malig
