Adrenal Gland Pathology

Question 1

how much do adrenal glands weigh

Answer 1

4-5 grams each

Question 2

where do the adrenal glands sit

Answer 2

superior and medial to upper pole of kidneys (embedded in perineal fat)

Question 3

what are the adrenal glands composed of

Answer 3

outer cortex and inner medulla

Question 4

what 3 zones are is the adrenal cortex split up into

Answer 4

zona glomerulosa, zona fasciculata and zona reticularis

Question 5

what is produced and secreted in the zona glomerulosa

Answer 5

mineralocorticoids and aldosterone

Question 6

what is produced and secreted in the zona fasciculata

Answer 6

glucocorticoids and cortisol

Question 7

what is produced in the zona reticularis

Answer 7

sex steroids and glucocorticoids

Question 8

where is the adrenal medulla

Answer 8

central core of adrenal (extension of nervous system)

Question 9

what innervates the adrenal medulla

Answer 9

pre-synaptic fibres from sympathetic nervous system

Question 10

what do neuroendocrine (chromaffin) cells secrete

Answer 10

catecholamines

Question 11

what causes adrenocortical hyperfunction

Answer 11

hyperplasia, adenoma, carcinoma

Question 12

what causes adrenocortical hypofunction

Answer 12

acute: Waterhouse-Friderichsen syndrome
chronic: Addison’s disease

Question 13

what is the sequence of events leading to congenital adrenocortical hyperplasia

Answer 13

group of autosomal recessive disorders, deficiency/lack of enzyme required for steroid biosynthesis, altered biosynthesis leads to increased androgen production (masculinisation or precocious puberty), reduced cortisol stimulated ACTH release and cortical hyperplasia (10-15X normal. weight)

Question 14

what can cause acquired adrenocortical hyperplasia

Answer 14

endogenous ACTH production (pituitary adenoma (cushings disease) or ectopic ACTH secretion (paraneoplastic syndrome from small cell lung cancer)), bilateral adrenal enlargement (up to 30g), diffuse or nodular (diffuse-ACTH driven and nodular-usually ACTH independent)

Question 15

who gets adrenocortical tumours

Answer 15

usually adults

Question 16

what syndrome is associated with younger patients with adrenocortical tumours

Answer 16

Li-Fraumeni syndrome (germline mutation of p53 gene)

one feature of this syndrome is an association with adrenocortical tumours

Question 17

how does an adrenocorical tumour present

Answer 17

incidental, hormonal effects if functional, mass lesion (has to be quite big-can undergo central necrosis), carcinomas with necrosis can cause fever (fever with no known cause is. sign of malignancy)

Question 18

are adrenocortical adenomas benign or malignant

Answer 18

benign

Question 19

how are adrenocortical adenomas usually found

Answer 19

incidentally

Question 20

what is characteristic of adrenocortical adenomas

Answer 20

well circumscribed, encapsulated lesions, well differentiated, small nuclei, rare, mitoses, yellow

Question 21

how big are adrenocortical adenomas

Answer 21

2-3cm (won’t present as mass lesion)

Question 22

what cells are adrenocortical adenomas composed of

Answer 22

cells resembling adrenocortical cells

Question 23

are adrenocortical adenomas usually functional or non-functional

Answer 23

non-functional (cause no problems)

Question 24

are adrenocortical carcinomas common or rare

Answer 24

rare

Question 25

are adrenocortical tumours usually functional or non-functional

Answer 25

functional (virtualising tumours usually malignant)

Question 26

are adrenocortical adenomas or carcinomas more likely to be function

Answer 26

adrenocortical carcinomas

Question 27

what is associated with the spread of adrenocortical carcinomas

Answer 27

local invasions (retroperitoneum, kidney), metastasis (vascular: liver, lung and bone (usually first sign of metastatic disease)), peritoneum and pleura and regional lymph nodes (tends to be vascular over lymphatic though)

Question 28

what is the 5 year survival rate and mortality of adrenocarcinomas

Answer 28

20-35% at 5 years, 50% dead in 2 years (could be due to arising in relatively silent site, by the time it is found not a lot that can be done)

Question 29

what is the only criteria to distinguish between benign and malignant tumours

Answer 29

metastasis

Question 30

what are some features to suggest carcinoma over adenoma

Answer 30

large size (>50g often >20cm in max dimension), haemorrhage and necrosis, frequent mitoses, atypical mitoses, lack of clear cells, capsular or. vascular invasion

Question 31

what causes primary. hyperaldosteronism

Answer 31

Conn's syndrome, usually 60% associated with diffuse or nodular hyperplasia of both adrenal glands, adenoma, rarely carcinoma, glucocorticoid remediable

Question 32

what causes secondary hyperaldisteronism

Answer 32

increased renin, decreased renal perfusion, hypovolaemia, pregnancy

Question 33

what causes hypercortisolism

Answer 33

cushings,