Adrenal Glands Flashcards
What space is are the adreal glands and kidneys located in?
perirenal space
The right adrenal gland is shaped like a ______ or ________.
triangle or pyramid
Where is the right adrenal gland located on the upper pole of the right kidney?
located superior, anterior, and on the medial aspect of the upper pole of the right kidney
Portions of the right adrenal gland extend _____ to the iVC
posterior
The crus of of the diaphragm lies _____ and _____ to the right adrenal gland.
medial and posterior
The left adrenal gland is shaped like a _______.
crescent
Where is the left adrenal gland located on the uper pole of the let kidney
anteriormedial to the upper pole
The Ao and crus of the diaphragm are located _____ to the left adrenal gland and the tail of the pancreas is located ______ to the left adrenal gland
medial
anterior
Adrenal anatomy
Adrenal Cortex
- produces steroid hormones (aldosterone, cortisol, androgens) these ACH are regulated by the adrenocorticotropic hormones of the anterior pituitary gland- these glands function together to regulate production……a dec in adrenal cortical function inc ACTH which stimulates the cortex, or an inc in ACH leads to drop in ACTH secretions, whihc leads to drop in activity of adrenal cortex
- peripherary of the gland
Adrenal Medulla
- produces catecholamines (epinephrine/arenaline, norepinephrine)
- inside/center of gland
_____ of the adrenal gland and anterior pituitary gland may overproduce or underproduce ACTH and ACH
tumors
Sonographic appearance of an adrenal gland
adrenal cortex is hypoechoic and typically less echogenic than the suroudinging retroperitoneal fat
adrenal medulla is seen as an echogenic linera structure within
A singe vein drains each adrenal gland, what are they and what do they drain into?
right - right suprarenal vein drains into IVC
left - left suprarenal vein drains into the left renal vein
What 3 arteries supply each adrenal gland
suprarenal branch of inferior phrenic art
suprarenal branch of aorta
suprarenal branch of renal artery
T/F - TSonographic appearance of adrenal masses does not allow differenetiation between adenoma, carcinoma, pheochromocytoma and metastases.
T
Most adrenal adenomas are ______ but can be ______.
nonhyperfunctioning
hyperfunctioning
What syndromes are the result adrenal hyperfunctioning?
Cushing’s Syndrome (hypercortisolism)
Conn Syndrome (primary aldosteronism)
Hirsutism (abundance of hair growth)
cushing’s is assoc with
steroids
inc ACTH from a pituitary adenoma
primary adrenal adenoma
ectopic ACTH (oat cell ca, small cell lung ca)
Conn’s is assoc with
adrenal adenomas
bilateral idiopathic adrenal hyperplasia
ectopic secretion of aldosterone
aldosterone-producing adrenocortical carcinoma
hirtuism is assoc with
congenital adrenal hyperplasia cushing's pituitary tumor adrenocortical carcinoma ovarian tumor (arrhenoblastoma) PCOS idiopathic
adrenal cortical carcinoma
rare tumor poor prognosis majority present with Cushing's many present with MET involvement differentiation from benign adenoma is difficult - tumor removal/Bx based on size (>3cm)
Adrenal cortical carcinomas tend to invade the _____ _____ and ____ _____ _____.
renal veins and IVC
Pehocromocytoma originate from where
adrenal medulla
but
may occur in ectopic locations such as along the paraaortic sympathetic nerve chain
Are pehocromocytomas malignanat or benign?
majority are benign
What do pheocromocytoma tumors secrete?
catecholamines (nor/epi- neprhine)
What are pehocromocytomas assoc with?
multiple endocrine neoplasi (MEN)
Von Hippel-Lindau disease
neurofibromatosis type 1
_________ is a malignant tumor arising from the sympathetic nervous system.
Neuroblastoma
Where do neuroblastomas commonly occur?
in the adrenal medulla but can occur in the neck, chest, pelvis
-vs Wilm’s Tumors, which orginate from and invades the kidney
How does adrenal neuroblastoma present?
palpable abdominal mass with increased blood and urine catecholamines
-majority present with metastatic disease
Can neuroblastomas be diagnosed prenatally?
Yes, typically during the 3rd trimester
Most common adrenal mass of infancy/early (between 2m and 2yrs) childhood?
neuroblastomas
Sonograohic appearance of adrenal neuroblastoma
solid mass
displaces ipsilateral kidney inferiorly into plevis
Benign, non-functioning adrenal mass that contains fat and bone?
myelolipomas
What artifact is associated with myelolipomas?
propagation speed artifact
Sonographically, myelolipomas are seen as _______ masses in the adrenal bed.
hyperechoic
MC cell type found in adrenal lymphoma metastases from malignant tumors?
Non-Hodgkin disease
- usually assoc with other sites of disease, most usually the retroperitoneal lymph nodes and ipsilateral kidney
- adrenal involvment in widespread non-Hodgkin’s lymphoma occurs in 4% of cases and may be diffuse, resembling hyperplasia or mass-like
Is adrenal lymphoma bilateral or unilateral?
frequently bilateral
When it comes to metastases, in order, what is the most common site (liver, bone, adrenal glands, lung)
Lung
Liver
bone
Adrenals
Most common primary cancer that metastasizes to the adrenal glands?
lung ca
Differentiation from a unilateral adrenal mass, benign adenoma vs a metastatic lesions, is diffiuclt wuth a primary cancer. What may be needed to make this distinction?
biospy
MC adrenal mass in a newborn/neonate?
adrenal hemorrhage
Why are the adrenals vulnerable to birth trauma?
large size of neonatal adrenals and their high degree of the vascularity
Sonographic appearance of an adrenal hemorrhage?
varies with blood coagulation…..
normally evolution - hematoma ends with a pseudocyst formation
if a mass is seen adjacent to the adrenal, mos likely a hemorrhage in a newborn
What is the Dx in a newborn with an abdominal mass and decreasing hematocrit?
adrenal hemorrhage
