Adrenal pathology

Question 1

Describe the anatomy of adrenal glands

Answer 1

2 endocrine organs that are retroperitoneal, superomedial to kidneys

Question 2

The 3 layers of the cortex are of _____ origin

Answer 2

mesoderm

Question 3

Characteristic appearance of cushing

Answer 3

moon facies with flushing and acne, buffalo hump, truncal obesity and so forth

Question 4

What are the 3 forms of endogenous forms of Cushing syndrome?

Answer 4

1. More ACTH–> more cortisol
2. Tumor or nodular hyperplasia
3. Lung cancer secreting a lot of ACTH

Question 5

Hyperaldosteronism is most commonly due to what?

Answer 5

an aldosterone secreting cortical adenoma (Conn Syndrome)

Question 6

All hyperaldosteronisms are characterized clinically by ____.

Answer 6

hypertension and hypokalemia

Question 7

Describe what happens in adrenogenital syndrome

Answer 7

21-Hydroxylase or 11-beta-hydroxylase deficiency impairs the synthesis of both cortisol and aldosterone. The resultant decrease in feedback inhibition causes increased secretion of adrenocorticotropic hormone, resulting ultimately in adrenal hyperplasia and increased synthesis of testosterone.

Question 8

What is the prototype of acute adrenal insufficiency

Answer 8

Waterhouse-Friderichsen Syndrome

Question 9

Descibe presentation/causes of Waterhouse-Friderichsen Syndrome

Answer 9

Overwhelming sepsis in adults, typically by N. meningitidis, leading to disseminated intravascular coagulopathy, hypotension, shock, and acute adrenal insufficiency
Other causal bacteria include Staphylococcus, pneumococcus, or Haemophilus
In newborns may be due to perinatal trauma/hypotension

Question 10

What are causes of acute adrenal insufficiency other than Waterhouse-Friderichsen

Answer 10

Sudden withdrawal of exogenous corticosteroids, patients with chronic adrenal ins. with sudden stress

Question 11

What is the key to survival in Waterhouse-Friderichsen

Answer 11

earliest possible clinical diagnosis with aggressive management

Question 12

What happens to the skin and buccal mucosa in primary hypoadrenocorticism

Answer 12

hyperpigmented due to increased ACTH and MSH. Also look at freckles, nipples, palmar creases, old scars

Question 13

Lab studies with chronic adrenal insufficiency

Answer 13

hyponatremia, hyperkalemia, metabolic acidosis, hypoglycemia, low serum cortisol. low urinary 17-OH steroids and failure to respond to various stimulation tests by increasing cortisol output

Question 14

T or F It is common for these pt to die suddenly and unexpectedly before anyone thinks of adrenocortical insufficiency

Answer 14

T

Question 15

What are primary adrenal neoplasms in the cortex? medulla?

Answer 15

Cortex: adrenal cortical adenoma, carcinoma
Medulla: neuroblastoma, pheochromocytoma

Question 16

Size of adrenal cortical adenomas

Answer 16

2.5 cm diameter

Question 17

How does adrenal cortical adenoma look on histo?

Answer 17

typical adrenal cortical tissue with cells arranged in ribbons and cords

Question 18

Describe the difference in functioning and non-functional adrenal cortical adenoma

Answer 18

Functional: adjacent and opposite gland is atrophic

non-functional: adjacent and opposite gland is normal

Question 19

Describe adrenal cortical carcinoma

Answer 19

Uncommon neoplasm, seen in kids or adults, more likely to be functioning, tumors greater than 5 cm diameter or 50 grams are more likely to be malignant. May be histologically bland or very aggressive.

Question 20

____ is the most common tumor of childhood.

Answer 20

Neuroblastoma

Question 21

Neuroblastoma may occur anywhere in the sympathetic nervous system but where is most common?

Answer 21

adrenals and paraaortic ganglia

Question 22

What is pheochromocytoma rule of 10%

Answer 22

10% familial, bilateral, malignant, in children, extra adrenal,

Question 23

T or F. Pheochromocytoma is a surgically correctable cause of HTN

Answer 23

T

Question 24

Adrenals are a common site of metastasis from ____.

Answer 24

lung, breast, many others

Question 25

T or F. Multifocal and/or bilateral tumors are almost certainly metastatic.

Answer 25

T