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ENRP Exam 2 > Adrenal Gland Pathology Dr. Singh > Flashcards

Adrenal Gland Pathology Dr. Singh Flashcards

1
Q

Cortex of adrenal gland has wha layers ad secretes what

A
  1. Zona Glomerulosa (Aldosterone) salt outer
  2. Zone Fasciculata (Cortisol) sweet middle
  3. Zona Reticularis (androgens) sex inner
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2
Q

Medulla of adrenal gland has wha layers ad secretes what

A

Chromaffin Cells = NE and Epi (catacholamines)

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3
Q

Adrenal hypercortisolism ACTH dependent + independent

A
  1. ACTH dependent = secondary cause, primary AP adenoma or ectopic
  2. ACTH independent = primary adrenal tumor or problem secreting too much Cortisol
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4
Q

ACTH dependent Cushing syndrome cause what to happen to the adrenal glands

A

Bilateral Cortical Hyperplasia

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5
Q

Primary hyperadrenalism ACTH independent causes what to happen to the gland

A

Cortical adenoma , yellow round mass

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6
Q

Giving high dose dexamethasone will suppress cortisol when and when will it not

A
  1. Will suppress it : AP microadenoma (cushings disease)

2. Will not suppress it : Adrenal primary tumor or hyperplasia, + Ectopic ACTH (corticotropin)

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7
Q

Conn’s Syndrome :

  1. From what
  2. SX
  3. Most common cause + 2 other causes
A
  1. High Aldosterone
  2. = HTN (severe over 160/100, refractory, young age)**
    = Adrenal mass
    = hypokalemia + HypoMg (not always seen)
  3. Idiopathic : glomerular cells secrete too much aldosterone (others : high ACTH driven, adenoma)
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8
Q

Secondary Hyperaldosteronism :

1. Caused by what and causes what

A
  1. Anything activating renin-angiotensin - aldosterone system
    (Diuretics, low renal perfusion, arterial hypovolemia, Pregnancy, Renin secreting tumors)
    Low renal perfusion (like sclerosis = makes BV through renal capsules low) = makes body think you’re Hypovolemic
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9
Q

Hyperaldosteonism with low renin and high aldosterone what do you do

A
  1. Adrenal CT for any adrenal tumors (usually see in young pts 20-30yo)
  2. Tx HTN with aldosterone specific antagonists : Spironolactone (histology will show spironolactone bodies if pt was on this)
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10
Q

Adrenal Virilization

1. what makes this happen

A
  1. high ACTH increases androgens
  2. Primary Adrenal Reticularis tumor adenoma or CARCINOMA ** more commonly
  3. Congenital Adrenal Hyperplasia (CAH)
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11
Q

Congenital Adrenal Hyperplasia

  1. Is caused by what
  2. Causes what to happen worst thing that can happen
A
  1. AR X 21-Hydroxylase ( Xaldosterone + Xcortisol + HIGH Adrongens)

Low cortisol will never block ACTH from being secreted
2. Salt wasting syndrome

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12
Q

21-Hydroxylase deficiency causes what and what does that cause and what syndrome is this from

A

Congenital Adrenal Hyperplasia = Salt wasting syndrome

  1. no cortisol + No mineralocorticoids (most severe form)
  2. HYPONATRIEMIA , hypokalemia, hypotension
  3. Virulizaion in females (Cliteromegaly + fused labia)
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13
Q

Simple Virulization syndrome is what

A

Partial loss of 21-Hydroxylase ( NO salt wasting syndrome)

= just virulization

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14
Q

Nonclassic / Late onset adrenal virilism is what

A

Partial loss of 21-Hydroxylase
= precocious puberty
= acne + hirsutism during puberty

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15
Q

Congenital adrenal hyperplasia is dx how

A

Measure 17-Hydroxyprogesterone levels OR give 17-Hydroxyprogesterone and see if cortisol increases
(17-Hydroxyprogesterone + 21-Hydroxylase ——-> Cortisol)

+ HEEL STICKS IN INFANTS ARE USED NOW

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16
Q

CAH tx

A

GLUCOCORTICOIDS (cortisol) and minerocorticoids as necessary

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17
Q

Primary Acute Adrenocortical insufficiency

  1. what happens and
  2. Can happen from
A
  1. Low cortisol released from cortical cells (cortical atrophy)
  2. Rapid withdrawal from steroids
    Massive adrenal hemorrhage (Waterhouse’s Friderichsen syndrome)
    Stress, infections, trauma, burns
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18
Q

What does an adrenal crisis looks like **

A

ACUTE ABD pain + FEVER + HYPOTENSION (not solved with fluids) = low glucose, K+ , Na+

= GIVE STEROID REPLACEMENT

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19
Q

Waterhouse Friderichen syndrome is usually seen when

A

Sepsis form Neisseria Meningitis (whippes out adrenal glans)

20
Q

Primary Chronic Adrenocortical Insufficiency :

  1. Is what
  2. SX
A
  1. ADDISONS disease (low chronic cortisol)

2. Malaise, fatigue, WL, Joint pain, HYPERPIGMENTATION

21
Q

Addison dz hyperpigmentation comes from

A

Elevated ACTH (as seen in Nelson’s syndrome also when you remove adrenal glands) = increases MSH (melanocyte stimulating syndrome)

22
Q

Addisons in 1800 and developing countries and Addisons now and in US and all other countries

A

TB

No is Autoimmune

23
Q

Primary Chronic Adrenocortical Insufficiency : WHAT DO I DO NOW

A

ADDISONS DZ :

You need to figure out if it is Autoimmune Polyendocrine TYPE 1 or Autoimmune Polyendocrine TYPE 2

24
Q

Autoimmune Polyendocrine TYPE 1 of Addisons

A
  1. AIRE mutation
  2. Adrenalitis, Parathyroiditis,
  3. Hypogonadism
  4. Pernicious anemia
  5. Mucocutaneous candidiasis chronic
  6. .Ectodermal dystrophy
    ==== APECED (Autoimmune Polyendocrine candidiasis Ectodermal dystrophy)
25
Q

Autoimmune Polyendocrine TYPE 2 of Addisons

A
  1. Adrenalitis
  2. Thyroiditis
  3. T1D
26
Q

Ectodermal dystrophy

A

Malformed fingernails + malformed teeth some missing

27
Q

Adrenal insufficiency DX

A

Random free cortisol test + ACTH stimulation test (should increase cortisol)
= tx give cortisol (can cause Cushings )

28
Q

Adrenal metastasis can cause

A

Adrenal insufficiency from tx

29
Q

Autoimmune adrenalitis

A

Dark blue nuclei = infiltrating lymphocytes

30
Q

Adrenal carcinoma vs adenoma

A

Carcioma = get really big and invade (compress adjacent structures)+ more likely to VIRILIZE
Adenoma = stay small and round and dont invade
= both are incidental xray findings

31
Q

Adrenal medulla is controlled by

A

Sympathetic Neves

32
Q

Phenochromocytoma is what + Sx + rule to 10

A
  1. Hypersecreting NE + Epi
  2. profound HTN, cyclical, HA, insomnia
  3. 10% extraderenal (paraganglioma), 10% bilateral, 10% kids, 10% malignant, 10% no HTN
    ++++ 25% Familial**
33
Q

Adrenal medualla tumor like phenochromocytoma look like

A

Brown

34
Q

Phenochromocytoma TRIAD

A
  1. Palpitations
  2. HA
  3. Diaphoresis
    = HTN (chronic or paroxysmal)
35
Q

Phenochromocytoma chronic complications

A

Cardiomyopathy

36
Q

Phenochromocytoma histology + DX

A
  1. Zellballen = ball of cells

2. Urine + plasma elevated metanephrines

37
Q

Myelolipoma is what

  1. Consists of
  2. Presents with
A

Benign tumor

  1. BM + Fat
  2. Hemorrhage (into itself) = pain inretroperitnium
38
Q

Adrenal incidentaloma is what and what do I do

A
  1. Incidentally finding adrenal tumor on imaging
  2. Get it out of its bigger then 4cm + level of cortisol, aldosterone, metanephines + looks at of CT shows (if there is cysts , fat (myelolipoma) you dont have to do anything) if it’s malignant looking or functionally increases Hs then remove it
39
Q

MEN syndromes are what and types

A

Familial syndromes that give you Endocrine tumors of multiple sites (aggressive, recurrent, bilateral multiple)

  1. MEN 1 = Pituitary adenoma, Pancreas, parathyroid adenoma
  2. MEN 2A = Parathyroid adenoma, Phenochromocytoma, medullary thyroid carcinoma
  3. MEN 2B = Mucosal neuromas, Marfanoid body habitus + Phenochromocytoma, medullary thyroid carcinoma
40
Q

MEN 1 (Multiple Endocrine Neoplasia)

  1. Mutation
  2. What you get
  3. Another thing you can get that is associated
A
  1. Menin lost tumor suppression
  2. Primary hyperparathyroidism, Pancreatic Endocrine Tumor, Pituitary adenoma (Lactotroph + Somatotroph) 3 Ps
  3. Gastrinomas (Duodenal)
41
Q

MEN 2A

  1. Mutation
  2. What you get
A
  1. Gained oncogene RET

2. Phenochromocytoma + Medullary Thyroid carcinoma + Parathyroid hyperplasia

42
Q

MEN 2B :

  1. Mutation
  2. What happens
A
  1. Gain of oncogene RET
  2. Medullary thyroid carcinoma + Phenochromocytoma + Mucosal neuromas (tongue)
  3. You also see Marfan syndrome characteristics
43
Q

Medullary Thyroid carcinoma means what and what do you need to do

A

Very deadly , need to remove thyroid by age 10yo (medically C-cell hyperplasia is precursor to see) = will lead to Medually Thyroid Carcinoma

44
Q

Familial Medullary Thyroid carcinoma

A

RET oncogene and in familial

45
Q

Pineal Gland

  1. Tissue it has + secretes what
  2. 3 tumors it has
A
  1. Photoreceptor with neuro tissue ( Melatonin)

2. Germ cell tumor (can happen any place midline) , Pineocytoma, Pineoblastoma

ENRP Exam 2 (8 decks)

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