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Adrenal Glands Flashcards

1
Q

Imaging modality of choice for adrenal glands

A

MDCT

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2
Q

Secretes steroid hormones including cortisol, aldosterone, androgens and estrogens

A

Cortex

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3
Q

Produces cathecolamines

A

Medulla

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4
Q

Adrenal glands lie within the

A

Perirenal space

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5
Q

Right adrenal gland is located posterior to the

A

IVC, at the level where the IVC enters the liver

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6
Q

Right adrenal gland is between the

A

Right lobe of liver and right crus of diaphragm just above the upper pole of right kidney

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7
Q

Orientation of left adrenal gland to the upper pole of left kidney

A

Medial and anterior

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8
Q

Lefr adrenal gland orientation to the pancreas and splenic vessels

A

Posterior

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9
Q

Left adrenal gland orientation to lefr crus of diaphragm

A

Lateral

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10
Q

Length of each adrenal limb

A

4-5 mm

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11
Q

Thickness of each adrenal limb

A

5-7 mm

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12
Q

Appearance of normal adrenal gland on MR

A

T1W1 hypointense

T2W1 Isointense or slightly hypointense compared with the liver and hypointense compared with spleen

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13
Q

Used to demonstrate intracellular fat in benign adrenal adenomas by utilizing IP and OP gradient-recalled sequences

A

Chemical shift MR

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14
Q

Intracellular fat demonstrates loss of signal on OP or IP?

A

Out of phase

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15
Q

Used to demonstrate macroscopic fat seen in adrenal myolipomas

A

Fat saturation MR technique

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16
Q

Macroscopic fat shows _____ on fat saturation images compared to pulse sequences of the same technique without fat saturation

A

Loss of signal intensity

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17
Q

Size of benign adrenal nodules such as hyperfunctioning adrenal cortical adenomas

A

<4cm

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18
Q

In a patient with a known malignancy, the incidence of metastasis to the adrenal rises up to what percent

A

50%

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19
Q

Most common adrenal mass with increased incidence with age

A

Adrenal cortical adenomas

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20
Q

Adrenal adenomas are usually hyper or non-hyperfunctioning?

A

Non-hyperfunctioning

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21
Q

Lipid-rich adenomas has fat accumulation of approximately how many percent

A

70%

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22
Q

Attenuation of adenomas range in

A

-20 to 30 HU

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23
Q

Benign adenomas are characterized on MDCT by _____ washout of contrast agent

A

Rapid washout

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24
Q

Most common primary tumors that metastasize to adrenal glands

A

Lung, breast, melanoma, gastrointestinal, thyroid and renal

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25
Absence of change in size and appearance of a small adrenal lesion for _____ months is strong evidence of benignancy, except if there is hemorrhage
6 months
26
Evaluation of adrenal masses should included screening for
Cushing and Conn Syndrome
27
In chemical shift MR, benign adrenal lesion show decreased/increased signal on opposed phase
Decreased signal on OP
28
In chemical shift MR, malignant adrenal lesion show ______ signal on OP
No signal loss
29
In PET-CT, malignant adrenal lesion show what attenuation value
>10
30
Percentage washout of how many would say an adrenal lesion is benign
Greater than 60% at early phase and 40 % at late phase
31
Adrenal biopsy should be avoided if there is high suspicion for
Pheochromocytoma
32
Caused by excessive amounts of hydrocortisone and corticosterone released by adrenal cortex
Cushing syndrome
33
Adrenal hyperplasia causing cushing syndrome is usually stimulated in 90% of cases by a _______
Pituitary microadenoma
34
In 10% of cases of Cushing syndrome, ACTH is ectopic, usually from _____ malignancies
Lung
35
Produced by elevated levels of aldosterone, that causes 1-2% of systemic hypertension
Conn syndrome
36
Condition with increased serum and urine aldosterone level with decreased renin activity in plasma, persistent hypokalemia
Conn syndrome
37
Adrenal adenomas are treated with ______ while hyperplasia is treated _____
Adenoma- surgical resection | Hyperplasia- medical management
38
Adenomas producing Conn syndrome are usually what size
<2cm
39
Used to confirm the site of excess aldosterone secretion and to differentiate adenoma from hyperplasia in problem cases
Adrenal venous sampling
40
Usually occurs in newborns and in infants who have enzyme deficiency (11B or 22-hydroxylase) leading to deficient production of cortisol and aldosterone and an excess of precursors especially androgens
Androgenital syndrome
41
Refers to primary adrenal insufficiency which occurs only after 90% of the adrenal cortex is destroyed
Addison disease
42
Rare cathecolamine-secreting tumor that causes hypertension, headaches and tremors
Pheochromocytoma
43
Rule of 10 in pheochromocytoma
10 % Bilateral, extra-adrenal, malignant, familial, incidental
44
Pheochromocytoma is associated with what syndromes
MEN II, von-hippel-lindau syndrome and neurofibromatosis
45
Most common adrenal tumor to haemorrhage spontaneously
Pheochromocytoma
46
True or false, it is not safe to give contrast with high suspicion of pheochromocytoma
True
47
Most tumors causing pheochromocytoma measures
More than 2 cm
48
Adrenal tumor wherein calcification is rare, but usually “eggshell” in configuration when present
Pheochromocytoma
49
Pattern of enhancement In adrenal tumors caused by pheochromocytoma
Enhances avidly and washout slowly
50
Extra-adrenal sites for pheochromocytoma
Organ of Zuckerkandl, bladder, para-aortic sympathetic chain
51
Organ of Zuckerkandl is found in the
Bifurcation of aorta
52
In diffuse hyperplasia, the limbs of adrenal glands are longer than ____cm and exceed _____mm thickness
5 cm thickness | 10 mm thickness
53
Rare non-functioning benign tumors of adrenal gland
Adrenal myelolipomas
54
Adrenal tumors that can enlarge up to 30 cm
Adrenal myelolipomas
55
What size of the adrenal myelolipomas have a tendency to hemorrhage
>5cm
56
Definitive for diagnosis of adrenal myelolipomas
Fat saturation MR
57
Unilateral adrenal hemorrhage is most common in children or adults?
Adults
58
What side is more susceptible to hemorrhage
Right adrenal gland
59
Most cases of adrenal hemorrhage are unilateral or bilateral
bilateral
60
In children, adrenal haemorrhage may be associated with
child abuse
61
most common causes of adrenal haemorrhage in adults
blunt trauma and infection
62
On enhanced CT, adrenal haemorrhage is ____ compared with the liver and spleen
hypodense
63
adrenal calcifications in both children and adults most commonly result from
hemorrhage
64
Diffuse adrenal calcification can be seen in _____ and _____ associated with Addison disease
TB and histoplasmosis
65
Adrenal tumors that calcify include _____ in children
neuroblastoma and ganglioneuroma
66
In adults, calcification can be seen in
adrenal carcinoma, pheochromocytoma and ganglioneuroma
67
Most common calcified adrenal masses in adults
adrenal pseudocysts secondary to previous hemorrhage
68
Rare disease in adults that is an autosomal recessive lipid disorder associated with enlarged calcified adrenal glands, hepatomegaly and splenomegaly
Wolman disease
69
Adrenal cysts are more common in men or women?
women
70
Uncomplicated or benign cyst have walls measuring ____ with or without calcification, internal water density, size less than ___ to ___ cm and show no enhancement
<3mm walls, size <5-6 cm
71
produces parasitic cysts in adrenal glands
echinococcus
72
cysts that are multilocular with septal calcification
endothelial cysts
73
Adrenal cyst characteristics that should be surgically removed
>6 cm, have thick walls or solid components, show enhancement on CT and MR, inhomogeneous, have debris on utz
74
Rare benign tumor of medulla or paravertebral sympathetic chain. They are usually homogeneous, often very large (>20 cm) mass with mild heterogeneous enhancement
Ganglioneuroma
75
uncommon but lethal tumor, occurring with a frequency of 1-2 per million people. Mostly large (>6cm) and invasive at presentation
adrenal carcinoma
76
Typical CT appearance of adrenal carcinoma
large mass with areas of central necrosis and haemorrhage, heterogeneous enhancement
77
size of adrenal tutors for surgical resection
>4-5 cm
78
Common metastatic sites from adrenal carcinoma
liver, lymph nodes, tumor thrombus in renal vein or IVC
79
useful MR sequence to detect tumor thrombus
gradient echo imaging
80
Refers to coexistence of histologically distinct neoplasms that exist separately in the same region
collision tumor

Genitourinary (5 decks)

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