Adrenals Glands path Flashcards
Adrenal cortex is divided into what layers?
What does each layer produce?
- Zona Glomerulosa: mineralocorticoids (aldosterone)
- Zona Fasciculata: Glucocorticoids (Cortisol)
- Zona Reticularis: Adrenal androgens and estrogens
What cells are in the adrenal medulla and what do they make and secrete
Chromaffin cells: catecholamines, mainly epinephrine
Excess of cortisol is called what
Cushing syndrome
What are the syndromes called that are caused from excessive androgens
-Adrenogenital or virilizing syndromes
What is the most common cause of Cushing syndrome
-Exogenous: Glucocorticoids (“steroids”)
What are the Endogenous causes of Cushing syndrome that are ACTH dependent?
- -Cushing disease: pituitary adenoma
- Ectopic coricotropin syndrome (ACTH)
What are the Endogenous causes of Cushing syndrome that are ACTH independent?
- Adrenal adenoma or carcinoma
- Macronodular hyperplasia
- Primary pigmented nodular adrenal disease
- McCune-Albright syndrome
What makes up 70% of endogenous hypercortisolism?
ACTH-secreting pituitary adenoma
What is the epidemiology of an ACTH secreting pituitary adenoma
- W>M (4x)
- most frequent in young adults
- Majority are Microadenomas
Ectopic ACTH secretion by a nonpituitary tumor is most often due to what
small cell carcinoma of the lung
Sometimes a neuroendocrine neoplasm produces ectopic corticotrophin releasing hormone (CRH) . . leading to what
-ACTH secretion and hypercortisolism
What is the most common causes of ACTH independent Cushing syndrome
Primary Adrenal neoplasms
- Adenoma (10%)
- Carcinoma (5%): produce the most profound hypercortisolism
in a primary adrenal neoplasm producing hypercortisolism, what happens to ACTH levels
go down
Explain the cortical atrophy associated with administration of exogenous glucocorticoids
-suppression of ACTH –> lack of stimulationg of Zona Fasciculata and reticularis
Describe Diffuse hyperplasia of adrenals in Cushing syndrome
- both glands enlarged
- Endogenous hypercortisolism
- ACTH-dependent
- Cortex can be variably nodular
What are the two types of adrenal gland hyperplasia?
- Macronodular
- micronodular
Describe macronodular hyperplasia of adrenal glands
- Endogenous hypercortisolsim
- Adrenals almost entirely replaced by prominent nodules of varying sizes (less than or equal to 3 cm)
- Areas b/t macroscopic nodules also demonstrate evidence of microscopic nodularity
Describe micronodular hyperplasia of adrenal glands
- endogenous hyperplasia
- Composed of 1 to 3 mm darkly pigmented (brown to black) micronodules, with atrophic intervening areas
- pigment is thought to be lipfuscin
Generalities for Primary adrenocortical neoplasms
- Can be functional (Cushing syndrome) or non-Functional
- Morphologically indistinct
- in functional tumors: adjacent adrenal cortex and the contralateral adrenal gland are atrophic
Age and gender for Primary adrenocorical neoplasms
women aged 30-50
Describe a primary adrenocortical adenoma
- benign
- Yellow tumors surrounded by thin or well developed capsules
- most weigh < 30gms
- microscopically see cells that look like normal fasciculata
Describe a primary adrenocortical carcinoma
- malignant
- Larger than the adenomas (usually > 200-300 gms)
- UNencapsulated
What are the early manifestations of a Cushing syndrome
- HTN
- weigh gain
Later more characteristic features of a primary Cushing syndrome
- Central pattern of fat deposition (truncal obesity)
- Moon facies
- Fat in the posterior neck and back (buffalo hump)