Adrenal Tumors

Question 1

Types of incidental adrenal masses (3) with percentages

Answer 1

1. nonfunctioning adenoma (80%)
2. Functioning adenoma (10%)
3. Malignancy (10%)

Question 2

Adrenal adenoma

1. CT findings benign (2)
2. Size and risk of malignancy
3. Remove at what size

Answer 2

1. Hounsfield < 18 or washout > 60% at 15 minutes
   may be functional still
2. <4 cm 2%; 4-6cm 6%; >6 cm 25%
3. Remove at 5 cm

Question 3

Adrenal Malignancy

1. Most are what?
2. If primary adrenal, functional or no?

Answer 3

1. Most are metastatic

2. Adrenal cortical Ca, functional

Question 4

Conn’s Syndrome

1. What is it?
2. Signs/symptoms (3)
3. Differential Dx (2)
4. Labs (5)

Answer 4

1. Primary hyperaldosteronism
2. refractory HTN, muscle weakness, hypokalemia on diuretics
3. functioning adenoma vs bilateral adrenal hyperplasia
4. hypoK, hyperNa, alkalosis, low renin, high aldo

Question 5

Aldosterone

1. effect on ions (3)
2. where does it function

Answer 5

1. hypokalemia and alkalosis, hypernatremia

2. Distal renal tubule

Question 6

Secondary hyperaldosteronism (2)

Answer 6

1. reninoma

2. renovascular HTN

Question 7

Conn Syndrome

1. Screening test (2 parts)
2. Confirmatory test
3. Prior to surgery

Answer 7

1. (serum) Aldosterone to renin ratio > 20:1; serum K
2. (urine) Urine aldosterone excretion x3 days +/- sodium loading
3. Adrenal venous sampling to lateralize

Question 8

Conn Syndrome Treatment

1. Functional adenoma, what to do prior
2. Bilateral adrenal hyperplasia , mech

Answer 8

1. Adrenalectomy, start K sparing diuretics prior

2. Non surgical. Spironolactone or eplerenone, aldo antagonists

Question 9

Pheochromocytoma

1. what do they secrete, from where
2. Location if extra-adrenal
3. Symptoms
4. What can induce (4)

Answer 9

1. catecholamines, adrenal medulla
2. organ of zuckerkandle (aorta bifurcation vs IMA), paraganglioma
3. HA, tachycardia, sweating, palpitations, HTN, n/v, chest pain
4. tyramine (beer, cheese, wine), cigarettes, anaesthesia (propofol), cocaine

Question 10

Pheochromocytoma in pregnancy

1. Early pregnancy
2. Late pregnancy
3. Do not do ____

Answer 10

1. terminate pregnancy and remove tumor
2. C section with resection of tumor at same time
3. DO NOT allow vaginal delivery

Question 11

Pheochromocytoma

1. Histologic pattern/stain (2)
2. labs (2)

Answer 11

1. zellballen pattern and Chromogranin A

2. elevated catecholamines/metanephrines, hyperglycemia