Adrenal - Tumours Flashcards

1
Q

Adrenocortical tumours may occur in children and young adults in association with which genetic condition?

A

Li-Fraumeni syndrome

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2
Q

What is the only definite criteria for malignancy in adrenocortical tumours?

A

Metastases

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3
Q

What is the commonest solid organ malignancy in those aged < 5 years?

A

Neuroblastoma

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4
Q

What is the median age of onset of a neuroblastoma?

A

20 months

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5
Q

How does a neuroblastoma most commonly present?

A

Abdominal swelling

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6
Q

How should neuroblastomas be treated?

A

Surgical excision and chemotherapy

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7
Q

Where are phaeochromocytomas most likely to be located?

A

The adrenal medulla

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8
Q

What do phaeochromocytomas produce?

A

Catecholamines

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9
Q

Extra-adrenal phaeochromocytomas are most likely to be found where?

A

At the aortic bifurcation

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10
Q

Describe the 10% rule associated with phaechromocytoma?

A

10% malignant, 10% extra-adrenal, 10% bilateral, 10% familial

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11
Q

What would make you suspicious that a phaeochromocytoma was related to a genetic condition?

A

If it occurred in a young individual and/or was bilateral

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12
Q

10% of phaeochromocytomas are related to a hereditary syndrome. What may these be?

A

MEN2A, MEN2B, Von-Hippel-Lindau syndrome, neurofibromatosis

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13
Q

What is the classic triad of phaeochromocytoma?

A

Episodic headache, sweating and tachycardia

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14
Q

Describe the hypertension which occurs with a phaeochromocytoma?

A

Often labile (comes on with stress, exercise, palpation of the tumour…) and may be postural

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15
Q

What happens to the WCC in those with a phaeochromocytoma?

A

Raised

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16
Q

What is the diagnostic investigation of choice for a phaeochromocytoma?

A

Plasma and 3x free urinary metanephrines

17
Q

What investigations can be used to identify the location of a phaeochromocytoma?

A

Abdominal CT/MRI or MIBG chromaffin-seeking isotope scan

18
Q

How is a phaeochromocytoma treated definitively?

A

Surgical excision

19
Q

What treatment must be given before surgery for a phaeochromocytoma?

A

Alpha blocker (e.g. phenoxybenzamine) followed by beta blocker (e.g. propranolol)

20
Q

Why must alpha blockers be given before beta blockers in the treatment of a phaeochromocytoma?

A

Beta blockers alone can worsen hypertension