Adrenals (105-107 12th ed)

Question 1

Where are adrenal rests located?

Answer 1

Adrenal rests are found in proximity to the celiac axis and along the
path of gonadal descent. In patients with congenital adrenal
hyperplasia, adrenal rests along the spermatic cord may become
quite large.

Question 2

Differentiate the 2 adrenal glands with regards to shape

Answer 2

Right: triangular
left: crescent

Question 3

What are the predictors of perisistent hypertension following adrenalectomy?

Answer 3

The predictors of persistent hypertension following adrenalectomy
for primary aldosteronism include (1) age older than 50 years, (2)
the requirement for more than two antihypertensive agents
preoperatively, (3) a first-degree relative with hypertension, (4)
prolonged duration of hypertension prior to adrenalectomy, and (5)
renal insufficiency.

Question 4

What stain is the best indicator of adrenal malignancy

Answer 4

Ki-67

Question 5

Elevated chromogrannin is confirmatory for

Answer 5

pheochromoyctoma

Question 6

Most frequent cause of adrenal insufficiency in the US vs developing countries?

Answer 6

US: autoimmune adrenalitis
developing: TB

Question 7

criteria to distinguish benign from malignant adrenal mass

Answer 7

The Weiss criteria distinguish benign from malignant adrenal tumors.
The presence of three or more of the Weiss criteria is associated with
malignancy. When oncocytic features are present, the criteria should
be used with caution

Question 8

Preferred imaging for pheochromocytoma

Answer 8

Positron emission tomography (PET) scan is the preferred imaging
modality for pheochromocytoma

Question 9

What is Nelson syndrome?

Answer 9

Up to 30% of patients with Cushing disease who undergo bilateral
adrenalectomy may develop Nelson syndrome—progressive growth
of the pituitary adenoma causing increased intracranial pressure and
compression of the ocular chiasm.

Question 10

How do you repair a torn right adrenal vein?

Answer 10

The right adrenal vein enters the inferior vena cava in a posterior
lateral position. When torn, the vena cava must be rotated to gain
access to suture the defect.

Question 11

What organs commonly metastasize to the adrenal?

Answer 11

The most common sites from which metastases occur to the adrenal
are lung, breast, kidney, and melanoma.