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Uroradiology > adrenal gland > Flashcards

adrenal gland Flashcards

1
Q

What are the 3 main categories of adrenal disease?

A

Hyperfunctioning, Adrenal insufficiency, normal functionE

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2
Q

What is cushings syndrome? What are the two types? What is the diagnostics test?

A

excess glucocorticoid
Exogenous - large doses of steroid
Endogenous - overproduction of cortisol by adrenal cortex

urniary 17-hydroxycorticosteroid level

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3
Q

What is the majority cause of cushings syndrome? What are the types?

A

Excess ACTH

ACTH dependent - bilateral adrenal hyperplasia

ACTH independent - adenoma, carcinoma, PPNAD, AIMAH

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4
Q

What are the causes of excess ACTH in ACTH dependent cushings?

A

Pituitary, oat cell tumor, bronchial adenoma, ovary, pancreas, thymus, thyroid

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5
Q

Truncal obesity, hirsutism, abdominal striae, and muscle atrophy suggest what syndrome?

A

Cushings

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6
Q

How do you distinguish macronodular hyperplasia from pituitary adenoma versus a cortisol producing adenoma

A

Size of contralateral adrenal gland - will be atrophic in cortisol secreting adenoma and enlarged in pituitary adenoma

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7
Q

What is conns syndrome? What are the types?

A

Primary aldosteronism

Adrenal hyperplasia - idiopathic hyperaldosteronism (more common), primary adrenal hyperplasia
Adrenal tumor

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8
Q

What are the two types of primary aldosteronism hyperplasia subtype? What are the differences in treatment?

A

Idiopathic hyperaldosteronism - medically

Primary adrenal hyperplasia - surgical if unilateral, otherwise medical

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9
Q

Hypokalemia, hypertension, increased aldosterone, low renin

A

Conn syndrome

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10
Q

What is the pathophysiology of conns syndrome?

A

ALdosterone causes sodium retention which leads to increased plasma volume and hypertension. Potassium is exchanged for sodium in the distal tubule, thus causing hypokalemia

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11
Q

How is primary vs secondary hyperaldosteronism determined?

A

Serum renin levels - will be elevated in secondary and low in primary

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12
Q

What is the most common form of CAH? What are the symptoms?

A

deficiency of 21-hydroxylase

excess androgen effect

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13
Q

What are the two types of adrenal insufficiency?

A

Primary - tissue destruction of adrenal glands

Secondary - inadequate stimulation

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14
Q

What are 5 causes of primary adrenal insufficiency

A 
Idiopathic
Granulomatous disease
Metastasis - rarely, because so much cortex (>90%) must be destroyed
Lymphoma
Hemorrhage
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15
Q

What is a distinguishing characteristic of primary vs secondary adrenal insufficiency?

A

Primary will have destruction of all producing cells and have decreased cortisol, androgen, and aldosterone.

Secondary will have normal aldosterone production

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16
Q

How much of the adrenal gland has to be destroyed before addisons occurs?

A

90%

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17
Q

why do addisons patients get hyperpigmentation?

A

Because of decreased cortisol production, there will be increased ACTH production which is on the same gene as melanocyte stimulating hormones

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18
Q

What is the radiographic appearance of addisons?

A

Depends on the cause

Granulomatous disease will be calcified with bilateral enlargement with maintanance of shape

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19
Q

Which tumors are larger - conns or cushings

A

Cushings

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20
Q

Which has larger adrenal glands - exogenous or endogenous?

A

Exogenous

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21
Q

When is venous sampling helpful?

A

in determining masculinizing/feminizing tumors

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22
Q

What are pheochromocytomas composed of? What is the name for an extra-adrenal pheochromocytoma?

A

Chromaffin cells

Paragangliomas

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23
Q

What is MEN2A and MEN2B

A

2A - PMP, medullary thyroid, pheo, parathyroid

2B - Medullary, pheo, marfan, neuromas

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24
Q

What, aside from MEN, are the associations with pheochromocytoma? What is carney’s triad?

A

NF1, VHL

gastric leiomyosarcoma, pulmonary chondroma, extra adrenal pheochromocytoma

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25
Q

Where are most pheos located? What is the difference in location between sporadic and MEN associated pheos?

A

90% in medulla

Sporadic - up to 25% outside adrenal, normal medulla

MEN - multicentric and intraadrenal, hyperplastic medulla

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26
Q

T or F: extraadrenal pheos are more likely to be malignant

A

True

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27
Q

What is administered prior to removal of pheo?

A

alpha (phenoxybenzamine) and beta blockers (propranolol)

28
Q

How do pheos enhance? how do they appear on T1/T2?

A

heterogeneously

hypo T1
hyper T2

29
Q

What are the NM scans used for pheochromocytoma?

A

I131-MIBG or Indium 111 pentetreotide (octreotide) scan

PET scans are also useful and can detect tumors that fail to concentrate MIBG

30
Q

Where is the most common site for a neuroblastoma?

A

Adrenal gland

31
Q

What age range for neuroblastomas?

32
Q

What are neuroblastomas? What is the malignant and benign maturation tumor?

A

Primitive tumors from sympathetic nervous system tissue

Benign - ganglioneuroma, greater degree of cellular maturation

Malignant - ganglioneuroblastoma, greater degree of cellular maturation with more mature ganglion cells mixed with neuroblasts

33
Q

What is the radiographic appearance of neuroblastoma?

A

US - heterogenous echogenicity with poorly defined margins

CT - can have calcification on unenhanced study. Large and heterogenous w/wo low density areas of necrosis or hemorrhage. CAN INVADE paraspinal musculature and foramen

MRI - hetergenous signal. T1 will be hypo to liver/kidney, T2 will be hyper to liver and iso to kidney

34
Q

Which tumors can invade paraspinal musculature and neural foramina

A

Neuroblastomas

35
Q

Which tumor has a “dumbbell” appearance? Why?

A

Neuroblastoma - tumor growth through the foramen with epidural expansion

36
Q

Distinguish posttherapy fibrosis from recurrent neuroblastoma?

A

Fibrosis is hypo on T2

Recurrence is hyper

37
Q

What are the NM scans useful for neuroblastomas?

A

Bone scans - due to high rate of bone mets

MIBG or Octreoscan

38
Q

What is the makeup of an adrenal adenoma

A

cords of clear cells separated by fibrovascular trabeculae

39
Q

What percentage of adenoma are lipid poor?

40
Q

How does an adrenal adenoma image on MRI? How is it different/similar to mets?

A

Low signal on T1 and T2

Low on T2 differentiates between mets (high T2, low T1)

41
Q

With regards to adrenal carcinoma, M or F get functional tumors more?

42
Q

What is the most common functional syndrome with adrenal carcinoma?

43
Q

What is the CT appearance of adrenal carcinoma?

A

Large mass with central hypoattenuation representing necrosis, calcification in 30%

44
Q

What are the important areas to check with adrenal carcinoma regarding extension/mets?

A

Hepatic or regional lymph node metastasis

Extension into left renal vein or IVC

45
Q

What is needed to confidently rule out hepatic mets in adrenal carcinoma

A

Fat plane separating tumor and adrenal gland

46
Q

What invasive method can be used to diagnose adrenal origin?

A

Selective arteriography of the renal, inferior phrenic, celiac, hepatic, or middle adrenal

47
Q

What is the vasculature to adrenal carcinoma?

A

HYPOvascular,

most vascularity is on the periphery which is supplied by the inferior phrenic artery

48
Q

What is the MR imaging of adrenal carcinoma?

A

heterogenous and hyperintense on T1 and T2

heterogenous enhancement

49
Q

What is a myelolipoma? How does it look on US?

A

benign tumor of mature adipose cells and hematopoietic tissue

Highly echogenic mass with propagation speed artifact (similar to comet tail)

50
Q

What is the main difference between adenoma and myelolipoma?

A

Adenoma - homogenous lowe density

Myelolipoma - heterogenous low density

51
Q

Which side is adrenal hemorrhage more common in? Why?

A

Right

The right adrenal vein enters the IVC directly, which in trauma with the increase in venous pressure, is directly transmitted back to the right adrenal vein

52
Q

What are the associated conditions with adrenal hemorrhage

A

septicemia, HTN, renal vein thrombosis, tumor, anticoagulation therapy, steroids

53
Q

What age is adrenal hemorrhage most common?

54
Q

What is the result of most adrenal hemorrhages?

A

Resorption

a small amount can persist as a pseudocyst

55
Q

What are the types of adrenal cyst? which is most common? M or F prediliction?

A

Female prediliction

Endothelial (most common), lymphangiomatous, epithelial, parasitic, pseudocysts (second most common)

56
Q

Which sex is hemangioma more prominent?

A

Female prediliction

Large mass with thick irregular wall and hypodense ceter

57
Q

What are CT findings suggesting mets over adenoma

A 
Size >3cm
poorly defined margins
invasion of adjacent structures
inhomogenous attenuation
thick, irregular, enhancing rim
58
Q

What is the nuclear medicine scan that is useful in adenoma vs mets

A

scintigraphy with NP59

59
Q

What is the difference in contrast enhancement between adenoma and mets?

A

Adenoma washout quicker!

60
Q

What is the equation to determine enhancement washout?

A

% enhancement washout = enhancement washout / enhancement

Enhancement washout = enhanced attenuation value - delayed contrast attenuation value

Enhancement = enhanced - unenhanced

61
Q

What is the equation to determine washout if no unenhanced is available

A

% relative washout = enhancement washout / enhanced attenuation value

62
Q

What are the cutoff percentages to diagnose adenoma?

A

Regular - if washout >60%, adenoma is confidently diagnosed

Relative - if washout >40%, adenoma confidently diagnosed

63
Q

What is the basis of comparison on in and out of phase imaging?

A

Paraspinal muscles

64
Q

What is the general cutoff on MRI in/out of phase imaging in terms of signal intensity loss?

65
Q

What is the most common complication in adrenal biopsy? What is the complication in an anterior approach to the left adrenal gland?

A

Pneumothorax

Pancreatitis

66
Q

Which lymphoma is more common in the adrenal glands?

67
Q

What is the appearance of lymphoma in the adrenal glands?

A

Homogenous soft tissue mass with enhancement

Uroradiology (11 decks)

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