Adrenals

Question 1

Preop tx of pheo

Answer 1

Alpha block 1st

Beta block 2nd

Question 2

Hyperaldosteronism

Answer 2

HTN + Hypokalemia

Autonomous adrenal secretion of aldosterone (mineralocorticoid)

Primary: adrenal neoplasm, suppressed renin. MC adenoma (Conn syndrome).

Secondary: elevated renin

Question 3

Critical step of R adrenalectomy

Answer 3

control & division of right adrenal vein (off the IVC)

Question 4

Pt w/ AMS and lactic acidosis following adrenalectomy for pheo

Answer 4

cyanide toxicity d/t nitro drip intra-op

tx: hydroxycobolamin, sodium thiosulfate, sodium nitrite

Question 5

Malignant pheo

Answer 5

Tumor implants distant from primary lesion in non-neuroectodermal tissue

MC sites: skeleton, LNs, liver, lung, kidney

No reliable histopath criteria to determine malignancy

Question 6

Congenital adrenal hyperplasia

Answer 6

MC enzyme deficiency: 21-hydroxylase (90%)

results in over-expression of 17-hydroxyprogesterone –> excess androgens. low Na and high K