Adrenal Gland Pathology (Handorf)

Question 1

What are the layers of the adrenal gl and what do they male

Answer 1

z. glomerulosa = mineralcorticoids - SALT
z. fasciuculata = glucocorticoids - SUGAR
reticulariz = estrogens and androgens - SEX

Question 2

What determines the shape of the adrenals

Answer 2

configuration od surrounding organs

Question 3

What shape would the adrenals be if a kidney was congenitally absent?

Answer 3

spherical

Question 4

pituitary adenoma induced hypercorticalism

Answer 4

cushing’s disease

Question 5

Distinguish cushing’s dz from cushing’s syndrome

Answer 5

syndrome is a state of ↑cortisol due to any cause

diseases is due to a pituitary adenoma that secretes ACTH

Question 6

hypertension + hypokalemia

Answer 6

conn syndrome = excess aldosterone

Question 7

conn syndrome can be caused by a aldosterone secreting…

Answer 7

cortical adrenal adenoma

Question 8

precocious puberty in males

Answer 8

adrenogenital syndrome

Question 9

pathophys of adrenogenital syndrome

Answer 9

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

Question 10

septic shock + DIC + adrenal hemorrhage =

Answer 10

Waterhouse-Friederichsen Syndrome

= acute adrenal insufficiency

Question 11

what bug is most assc with Waterhouse-Friederichsen Syndrome

Answer 11

N. meningitis

Question 12

etiologies of acute adrenal insufficiency

Answer 12

1. Waterhouse-Friederichsen Syndrome
2. sudden withdrawal of exogenous corticosteroids
3. sudden stress + underlying chronic renal insufficiency

Question 13

What is notable of H &E in a pt that suffered from Waterhouse-Friederichsen Syndrome

Answer 13

hemorrhages!! red everywhere!

Question 14

widespread ecchymosis

Answer 14

DIC

Question 15

Treatment for Waterhouse-Friederichsen Syndrome

Answer 15

abx and replacement of the hormones lost when the adrenals were wiped out—vasopressors

Question 16

hyper-pigmentation 
hypotension (<110/70)
nausea
weight loss
appear emotional

Answer 16

chronic adrenal insufficiency disease… aka addisons

Question 17

chronic adrenal insufficiency disease…

Answer 17

addisons

**primary or secondary

Question 18

notale electrolytes in acute adrenal insufficiency

Answer 18

hyperkalemia and hyponatremia

Question 19

why do pts with addison’s have hyperpigmentation?

Answer 19

↑ATCH = ↑MSH (melanocyte stimulating hormone)

Question 20

most common etiology of chronic adrenal insufficiency disease

Answer 20

US = autoimmune and hemachromatosis 
under-developed = TB

Question 21

notable labs in addisons

Answer 21

hyperkalemia, hyponatremia, metabolic acidosis, hypoglycemia

Question 22

treatment for addisons

Answer 22

hormone replacement therapy (catecholamines)

Question 23

causes of secondary chronic adrenal insufficiency disease

Answer 23

• hypothalamic pituitary disease
• neoplasm
• infection
• hypothalamic-pituitary suppression (long term steroid use, steroid producing neoplasms)

Question 24

What are the primary adrenal neoplasms of the cortex?

medulla?

Answer 24

cortex:

• adrenal cortical ademoma
• adrenal cortical carcinoma

medulla:

• neuoblastoma
• pheochromocytoma

Question 25

color or cortical neoplasms

Answer 25

yellow

Question 26

gross appearence of medullary neoplasms

Answer 26

redish with YELLOW RING

Question 27

grossly how can you tell if an adrenal cortical adenoma is functional? non-functional?

Answer 27

functional = the adjacent/oppostie gland is atrophic non-functional = the adjacent/oppostie gland is hyperplastic

Question 28

most adrenal cortical carcinomas are (functional or non-functional)

Answer 28

functional... >90%

Question 29

what are clues to tell you that an adrenal cortical carcinoma is malignant?

Answer 29

> 5 cm in diameter if there are mets... they don't really invade so thats not helpful

Question 30

characteristic histo of adrenal cortical carcinomas

Answer 30

bland, anaplastic, no mitoses

Question 31

most common extracranial solid tumor of childhood

Answer 31

neuroblastoma

Question 32

Where can neuoblastomas arise? What are the most common sites?

Answer 32

anywhere in the sympathetic nercous system or the brian adrenals (medullary) and paraaotric ganglia

Question 33

neuroblastomas are (indolent, aggressive)

Answer 33

aggressive, they are rapidly dividing

Question 34

treatment for neurobalstoma

Answer 34

surger + chemo

Question 35

episodic HTN, palpitations

Answer 35

pheochromocytoma

Question 36

Where can pheochromocytomas arise?

Answer 36

paraganglionic system

Question 37

3 families of paraganglionic system (outside of the adrenals)

Answer 37

branchiometric, intravagal, aorticosympathetic

Question 38

adrenals are common sites of metastasis from

Answer 38

lung and breast

Question 39

___ and/or ___ tumors are almost certainly metastatic

Answer 39

multifocal and/or bilateral

Question 40

T or F: mets are the commonest malignant neoplasm in adrenals

Answer 40

true