adrenal tumors

Question 1

is adrenal cancer more often hormonally active or not hormonally active?

Answer 1

60% hormonally active

Question 2

hirsutism, acne, hypokalemia, HTN, fatigue, cancer

Answer 2

hormonally active adrenal cancer

Question 3

tx for adrenal cancer

Answer 3

surgery if smaller

Question 4

how to do surgery on tumors under 6 cm?

Answer 4

laparoscopically

Question 5

most common cause of cushing syndrome

Answer 5

long term steroid use

Question 6

2nd most common cause of cushing syndrome

Answer 6

pituitary overproducing ACTH

Question 7

1st step of dx’ing cushings

Answer 7

check cortisol via urine or blood

Question 8

if positive cortisol test, next step in dx of cushings?

Answer 8

check ACTH

Question 9

if high cortisol, and ACTH is low, then cause of cushings?

Answer 9

adrenal

Question 10

if high cortisol, and ACTH is high or normal, then cause of cushings?

Answer 10

ectopic or pituitary source

Question 11

best method of imaging adrenals

Answer 11

CT scan

Question 12

tx of cushings with adrenal source

Answer 12

surgery + steroids in perioperative period

Question 13

necessary to dx and tx____before any other surgery

Answer 13

pheochromocytoma

Question 14

sweating, HA, tachycardia, nervous attackes, hyperthryoid patients

Answer 14

pheochromocytoma

Question 15

10% rule used for?

Answer 15

pheochromocytoma

Question 16

10% ___lateral, 10%___(malignant or benign); 10% ___in/outside adrenal; 10% _____(multiple/single); 10%____(familial/sporadic)

Answer 16

10% bilateral; 
10% malignant;
10% extra-adrenal;
10% multiple;
10% familial;
10% children

Question 17

T or F: clinical sx of pheochromocytoma correlate with size of it

Answer 17

FALSE

Question 18

assc’d conditions with pheochromocytoma (4)

Answer 18

1. NF
2. von hippel lindau disease
3. tuberous sclerosis
4. Men 2a & 2b

Question 19

to dx pheochromocytoma, can run a plasma _______, or a urine _____

Answer 19

plasma metanephrine; urine catacholamines/metanephrines

Question 20

best imaging modality for pheochromocytoma

Answer 20

CT

Question 21

pre-op prep for pheochromocytoma: give ____, followed by _____ if persistent tachycardia

Answer 21

1. alpha blocker - phenyoxybenzamine

2. beta blocker

Question 22

in pheochromocytoma, what must you control early?

Answer 22

adrenal vein

Question 23

failure to suppress aldosterone secretion by intravascular volume expansion

Answer 23

primary hyperaldosteronism

Question 24

what is one of the more more common causes of secondary HTN?

Answer 24

Conn’s syndrome

Question 25

Primary aldosteronism is AKA?

Answer 25

conn’s syndrome

Question 26

what to consider when someone has drug resistance HTN?

Answer 26

conn’s syndrome

Question 27

how to tx aldosterone producing adenoma (APA)

Answer 27

surgery

Question 28

how to tx bilateral idiopathic hyperaldosteronism

Answer 28

spironolactone (aldosterone antagonists)

Question 29

screening test for primary hyperaldosteronism

Answer 29

aldosterone: renin ratio

Question 30

confirmatory tests for primary hyperaldosteronism (2)

Answer 30

1. 24 hr urine aldosterone

2. saline suppression test

Question 31

best way to look for primary hyperaldosteronism

Answer 31

CT

Question 32

adrenal incidentaloma is most commonly due to?

Answer 32

nonfxnl (nothing)

Question 33

how to check for hypercortisolism?

Answer 33

dexamethasone suppression test

Question 34

how to test for hyperaldosteronism

Answer 34

aldosterone

Question 35

how to check pheochromocytoma

Answer 35

serum metanphrines or urine

Question 36

adrenal incidentaloma f/u recommendations: f/u CT at _____, again at _____ then stop if asymptomatic

Answer 36

3-6 mon; 1 year