Adrenal Pathology (5/16) Flashcards
Where are the adrenal glands?
In the retroperitoneal tissues at the upper poles of the kidney (4-6g)
What shape is the right adrenal?
Pyramidal, behind the right lobe of the liver
What shape is the left adrenal
Crescent shape, lies behind the omentum and stomach
Define Addison’s dis
Adrenal insufficiency: dec levels of glucocorticoid production which eventually affects production of mineralocorticoids and sex steroids
What is the pathology/cause of Addison’s dis
- Destruction of cortical cells-cortical atrophy
- Chronic inflamm cells (autoimm)
- Infectious agents (granulomatous inflammation in TB)
- Metastatic tumor from other sites
- Amyloid deposition
What are some clinical features of addison’s
- Fatigue, malaise, weakness, anorexia, vomiting, wt loss, hyperpigmentation, postural hypoT
- Infectious: fever, septic shock
What are some diseases of adrenal cortex hyperfxn?
Cushings (glucocorticoid xs) Conn's (aldosterone xs) Adrogenital syndrome (androgen xs)
What are some causes of cushings?
-Bilateral hyperplasia (80%) (pituitary ACTH sec adenoma, ectopic ACTH, primary, idiopathic)
- Adrenal cortical adenoma (10%)
- Adrenal cortical carcinoma (10%)
Most common cause of cushings in adults?
Hyperplasia
Most common cause of cushings in children?
Carcinoma
What are the 3 types of bilateral hyperplasia in cushings?
Simple diffuse (65%, females) Bilateral nodular (20%, females) Ectopic (15%, males)
What is adrenal cortical adenoma?
Benign neoplastic proliferation of adrenal cortical tissue
What is the gross pathology of adrenal cortical adenoma?
- Unilateral and solitary
- Well circumscribed
- Yellow tan
- <100g
What is the microscopic pathology of adrenal cortical adenoma?
- Tumor cells grow in mixture of growth patterns (nests, cords, solid)
- Usually cells have clear cytoplasm-resembling cells of zona fasciculata
- No mitosis or atypical cells
What is adrenal cortical carcinoma?
Malignant neoplasm arising from adrenal cortical cells
What is the gross path of adrenal cortical carcinoma?
- Large bulky tumor
- Fleshy cut surface with hemorrhage and necrosis
- > 100g
- Invasion
What is the micro path of adrenal cortical carcinoma?
- Invasion
- Necrosis
- Cellular pleomorphism
- Tumor capsule invasion
- Vascular invasion
- Distant metastases (lung and liver most common)
What causes hyperaldosteronism?
- Adenoma (65%)
- Bilateral hyperplasia (35%)
- Carcinoma (rare)
What is Conn’s syndrome
Aldosterone XS
What is the microscopic pathology of adrenal cortical adenoma causing Conn’s syndrome??
- Variety of cell types
- Most have cells resembling Zona Fasciculata with minority Zona Glomerulosa
What are the clinical features of Conn’s dis caused by adrenal cortical adenoma?
- Hyper T
- Muscle weakness, fatigue, polyuria
- Periodic paralysis
- Inc cardiac arrhythmias
What are some causes of adrogenital syndrome?
- Congenital adrenal hyperplasia
- Adrenal cortical adenoma (rare)
What are some clinical features of adrogenital syndrome?
- F: male hair pattern with facial hair
- M: gynecomastia, dec libido, feminized hair pattern and testicular atrophy
What is congenital adrenal hyperplasia?
Inherited disorder caused by def of enzymes req for biosynth of glucocort and mineralocort leading to androgen excess
