adrenal mass

Question 1

Glomerulosa producing
fasciculata producing
reticularis producing
medulla

Answer 1

aldo
cortisol
androgens
catecholamines

Question 2

how often are incidentalomas present in people over 50

Answer 2

3% of the time

Question 3

If timor is >6cm then more likely

Answer 3

a malignancy 25% chance

Question 4

80 % of incidentalomas are

Answer 4

<2 cm

Question 5

In order what proportion of adrenal masses are functional?

Answer 5

1- cushing’s 9%
2- pheos 4%
3 - primary hyperaldo 1.5%

Question 6

If adrenal tumour is secreting hormones then

Answer 6

stabilize and go to Sx

Question 7

If adrenal tumour is not secreting hormones

Answer 7

check if tumor is >4 cm

- surgery unless it’s a met

Question 8

Would you biopsy an adrenal mass?

Answer 8

NEVER until RO pheo

Question 9

classic pheochromocytoma triad

Answer 9

Pain
Palpitation
Perspiration
(50% of patients)

Question 10

how do you diagnose a pheo

Answer 10

• measure catecholamines

metanephrines and creatinine

Question 11

Screenig for hyperaldo

Answer 11

Ratio of aldo to renin is high

Question 12

a primary adrenal carcinoma can produce

Answer 12

High levels of androgens so perform DHEAS

Question 13

Screening for adrenal hormone excess

Answer 13

1- creatinine, catechol, metane
2- Dex suppression test
3- aldo/renin ratio

Question 14

Causes of unsuppressed cortisol if ACTH is high

Answer 14

• Pituitary ACTH, ectopic ACTH, ectopic CRH

-

Question 15

Causes of unsuppressed cortisol if ACTH is low

Answer 15

Adrenal related

Question 16

Cortisol levels if suspecting CUshing’s

Answer 16

Normally 3x ULN

And High dose DST - will not suppress cortisol

Question 17

Tumors of adrenal cortex

Answer 17

• hyperplasias
• adenomas
• carcinomas

Question 18

Tumors of adrenal medulla

Answer 18

pheos

- medullary hyperplasias

Question 19

If suspecting cortical hyperplasia often bilaterial

Answer 19

• ACTH producing pituitary adenoma
• exogenous acth
• CRH producing tuor

Question 20

How will contralateral adrenal gland look like if adrenal cortical adenoma suspected?

Answer 20

• will be atrophic –> addisonian crisis

Question 21

Most common situation for increased mineralocorticoids

Answer 21

• adrenal cortical adenoma is most common

-

Question 22

what would aldo-producing adenomas look like

Answer 22

lots of lipids - very yellow

Question 23

Virilism or feminization think of

Answer 23

adrenal cortical carcinoma - may be present only with increased aldo or glue

Question 24

Adrenal cortical carcinomas are often

Answer 24

LARGE
necrosis, invasive
NON-functioning or clinically functioning

Question 25

Adrenal medullary hyperplasia often associated with

Answer 25

MEN2A MEN2B syndromes

Question 26

Pheochromocytoma often

Answer 26

30% related to familial syndromes

Question 27

Adenomas are most common with

Answer 27

Cushing’s and Conn’s syndromes