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Genitourinary > Adrenal Glands > Flashcards

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
Q

Absence of change in size and appearance of a small adrenal lesion for _____ months is strong evidence of benignancy, except if there is hemorrhage

A

6 months

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26
Q

Evaluation of adrenal masses should included screening for

A

Cushing and Conn Syndrome

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27
Q

In chemical shift MR, benign adrenal lesion show decreased/increased signal on opposed phase

A

Decreased signal on OP

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28
Q

In chemical shift MR, malignant adrenal lesion show ______ signal on OP

A

No signal loss

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29
Q

In PET-CT, malignant adrenal lesion show what attenuation value

A

> 10

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30
Q

Percentage washout of how many would say an adrenal lesion is benign

A

Greater than 60% at early phase and 40 % at late phase

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31
Q

Adrenal biopsy should be avoided if there is high suspicion for

A

Pheochromocytoma

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32
Q

Caused by excessive amounts of hydrocortisone and corticosterone released by adrenal cortex

A

Cushing syndrome

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33
Q

Adrenal hyperplasia causing cushing syndrome is usually stimulated in 90% of cases by a _______

A

Pituitary microadenoma

34
Q

In 10% of cases of Cushing syndrome, ACTH is ectopic, usually from _____ malignancies

A

Lung

35
Q

Produced by elevated levels of aldosterone, that causes 1-2% of systemic hypertension

A

Conn syndrome

36
Q

Condition with increased serum and urine aldosterone level with decreased renin activity in plasma, persistent hypokalemia

A

Conn syndrome

37
Q

Adrenal adenomas are treated with ______ while hyperplasia is treated _____

A

Adenoma- surgical resection

Hyperplasia- medical management

38
Q

Adenomas producing Conn syndrome are usually what size

A

<2cm

39
Q

Used to confirm the site of excess aldosterone secretion and to differentiate adenoma from hyperplasia in problem cases

A

Adrenal venous sampling

40
Q

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

A

Androgenital syndrome

41
Q

Refers to primary adrenal insufficiency which occurs only after 90% of the adrenal cortex is destroyed

A

Addison disease

42
Q

Rare cathecolamine-secreting tumor that causes hypertension, headaches and tremors

A

Pheochromocytoma

43
Q

Rule of 10 in pheochromocytoma

A

10 % Bilateral, extra-adrenal, malignant, familial, incidental

44
Q

Pheochromocytoma is associated with what syndromes

A

MEN II, von-hippel-lindau syndrome and neurofibromatosis

45
Q

Most common adrenal tumor to haemorrhage spontaneously

A

Pheochromocytoma

46
Q

True or false, it is not safe to give contrast with high suspicion of pheochromocytoma

A

True

47
Q

Most tumors causing pheochromocytoma measures

A

More than 2 cm

48
Q

Adrenal tumor wherein calcification is rare, but usually “eggshell” in configuration when present

A

Pheochromocytoma

49
Q

Pattern of enhancement In adrenal tumors caused by pheochromocytoma

A

Enhances avidly and washout slowly

50
Q

Extra-adrenal sites for pheochromocytoma

A

Organ of Zuckerkandl, bladder, para-aortic sympathetic chain

51
Q

Organ of Zuckerkandl is found in the

A

Bifurcation of aorta

52
Q

In diffuse hyperplasia, the limbs of adrenal glands are longer than ____cm and exceed _____mm thickness

A

5 cm thickness

10 mm thickness

53
Q

Rare non-functioning benign tumors of adrenal gland

A

Adrenal myelolipomas

54
Q

Adrenal tumors that can enlarge up to 30 cm

A

Adrenal myelolipomas

55
Q

What size of the adrenal myelolipomas have a tendency to hemorrhage

A

> 5cm

56
Q

Definitive for diagnosis of adrenal myelolipomas

A

Fat saturation MR

57
Q

Unilateral adrenal hemorrhage is most common in children or adults?

A

Adults

58
Q

What side is more susceptible to hemorrhage

A

Right adrenal gland

59
Q

Most cases of adrenal hemorrhage are unilateral or bilateral

A

bilateral

60
Q

In children, adrenal haemorrhage may be associated with

A

child abuse

61
Q

most common causes of adrenal haemorrhage in adults

A

blunt trauma and infection

62
Q

On enhanced CT, adrenal haemorrhage is ____ compared with the liver and spleen

A

hypodense

63
Q

adrenal calcifications in both children and adults most commonly result from

A

hemorrhage

64
Q

Diffuse adrenal calcification can be seen in _____ and _____ associated with Addison disease

A

TB and histoplasmosis

65
Q

Adrenal tumors that calcify include _____ in children

A

neuroblastoma and ganglioneuroma

66
Q

In adults, calcification can be seen in

A

adrenal carcinoma, pheochromocytoma and ganglioneuroma

67
Q

Most common calcified adrenal masses in adults

A

adrenal pseudocysts secondary to previous hemorrhage

68
Q

Rare disease in adults that is an autosomal recessive lipid disorder associated with enlarged calcified adrenal glands, hepatomegaly and splenomegaly

A

Wolman disease

69
Q

Adrenal cysts are more common in men or women?

A

women

70
Q

Uncomplicated or benign cyst have walls measuring ____ with or without calcification, internal water density, size less than ___ to ___ cm and show no enhancement

A

<3mm walls, size <5-6 cm

71
Q

produces parasitic cysts in adrenal glands

A

echinococcus

72
Q

cysts that are multilocular with septal calcification

A

endothelial cysts

73
Q

Adrenal cyst characteristics that should be surgically removed

A

> 6 cm, have thick walls or solid components, show enhancement on CT and MR, inhomogeneous, have debris on utz

74
Q

Rare benign tumor of medulla or paravertebral sympathetic chain. They are usually homogeneous, often very large (>20 cm) mass with mild heterogeneous enhancement

A

Ganglioneuroma

75
Q

uncommon but lethal tumor, occurring with a frequency of 1-2 per million people. Mostly large (>6cm) and invasive at presentation

A

adrenal carcinoma

76
Q

Typical CT appearance of adrenal carcinoma

A

large mass with areas of central necrosis and haemorrhage, heterogeneous enhancement

77
Q

size of adrenal tutors for surgical resection

A

> 4-5 cm

78
Q

Common metastatic sites from adrenal carcinoma

A

liver, lymph nodes, tumor thrombus in renal vein or IVC

79
Q

useful MR sequence to detect tumor thrombus

A

gradient echo imaging

80
Q

Refers to coexistence of histologically distinct neoplasms that exist separately in the same region

A

collision tumor

Genitourinary (5 decks)

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