Adrenal Gland Pathology (Handorf) Flashcards
What are the layers of the adrenal gl and what do they male
z. glomerulosa = mineralcorticoids - SALT
z. fasciuculata = glucocorticoids - SUGAR
reticulariz = estrogens and androgens - SEX
What determines the shape of the adrenals
configuration od surrounding organs
What shape would the adrenals be if a kidney was congenitally absent?
spherical
pituitary adenoma induced hypercorticalism
cushing’s disease
Distinguish cushing’s dz from cushing’s syndrome
syndrome is a state of ↑cortisol due to any cause
diseases is due to a pituitary adenoma that secretes ACTH
hypertension + hypokalemia
conn syndrome = excess aldosterone
conn syndrome can be caused by a aldosterone secreting…
cortical adrenal adenoma
precocious puberty in males
adrenogenital syndrome
pathophys of adrenogenital syndrome
21-hydroxylase or 11-beta-hydroxylase deficiency impairs the synthesis of cortisol and aldosterone, shunting precursors into androgen synthesis (no cortisol = no feedback inhibition to turn off pathway) → adrenal hyperplasia and increased testosterone
septic shock + DIC + adrenal hemorrhage =
Waterhouse-Friederichsen Syndrome
= acute adrenal insufficiency
what bug is most assc with Waterhouse-Friederichsen Syndrome
N. meningitis
etiologies of acute adrenal insufficiency
- Waterhouse-Friederichsen Syndrome
- sudden withdrawal of exogenous corticosteroids
- sudden stress + underlying chronic renal insufficiency
What is notable of H &E in a pt that suffered from Waterhouse-Friederichsen Syndrome
hemorrhages!! red everywhere!
widespread ecchymosis
DIC
Treatment for Waterhouse-Friederichsen Syndrome
abx and replacement of the hormones lost when the adrenals were wiped out—vasopressors
hyper-pigmentation hypotension (<110/70) nausea weight loss appear emotional
chronic adrenal insufficiency disease… aka addisons
chronic adrenal insufficiency disease…
addisons
**primary or secondary
notale electrolytes in acute adrenal insufficiency
hyperkalemia and hyponatremia
why do pts with addison’s have hyperpigmentation?
↑ATCH = ↑MSH (melanocyte stimulating hormone)
most common etiology of chronic adrenal insufficiency disease
US = autoimmune and hemachromatosis under-developed = TB
notable labs in addisons
hyperkalemia, hyponatremia, metabolic acidosis, hypoglycemia
treatment for addisons
hormone replacement therapy (catecholamines)
causes of secondary chronic adrenal insufficiency disease
- hypothalamic pituitary disease
- neoplasm
- infection
- hypothalamic-pituitary suppression (long term steroid use, steroid producing neoplasms)
What are the primary adrenal neoplasms of the cortex?
medulla?
cortex:
- adrenal cortical ademoma
- adrenal cortical carcinoma
medulla:
- neuoblastoma
- pheochromocytoma
color or cortical neoplasms
yellow
gross appearence of medullary neoplasms
redish with YELLOW RING
grossly how can you tell if an adrenal cortical adenoma is functional? non-functional?
functional = the adjacent/oppostie gland is atrophic
non-functional = the adjacent/oppostie gland is hyperplastic
most adrenal cortical carcinomas are (functional or non-functional)
functional… >90%
what are clues to tell you that an adrenal cortical carcinoma is malignant?
> 5 cm in diameter
if there are mets…
they don’t really invade so thats not helpful
characteristic histo of adrenal cortical carcinomas
bland, anaplastic, no mitoses
most common extracranial solid tumor of childhood
neuroblastoma
Where can neuoblastomas arise? What are the most common sites?
anywhere in the sympathetic nercous system or the brian
adrenals (medullary) and paraaotric ganglia
neuroblastomas are (indolent, aggressive)
aggressive, they are rapidly dividing
treatment for neurobalstoma
surger + chemo
episodic HTN, palpitations
pheochromocytoma
Where can pheochromocytomas arise?
paraganglionic system
3 families of paraganglionic system (outside of the adrenals)
branchiometric, intravagal, aorticosympathetic
adrenals are common sites of metastasis from
lung and breast
___ and/or ___ tumors are almost certainly metastatic
multifocal and/or bilateral
T or F: mets are the commonest malignant neoplasm in adrenals
true
