Chapter 16 Adrenal Glands power point Flashcards
Triangular glands located anteromedially and superior to the kidneys Adrenal glands consist of two endocrine glands: cortex and medulla
Adrenal glands
Outer portion; secretes steroids that help to regulate electrolyte metabolism, carbohydrate metabolism, and sex hormones
Cortex
produces epinephrine and noreinephrine
Medulla core;
Mineralocoricoids Glucocorticoids Sex Hormones
Physiology of cortex Steroids fall into 3 main categories
regulate electrolyte metabolism. Aldosterone is the primary steroid Regulates mineral ions in the body fluids which affect the water content of tissue Decreased steroid level leads to an increased secretion of sodium and chloride ions, and water into the urine. This leads to lowered pH in the blood causing acidosis.
Mineralocoricoids
Caused by excessive secretion of aldosterone due to adenoma of the glomerulosa cells or less common adrenal hyperplasia or adrenal carcinoma. Clinical signs and symptoms include Muscle weakness HTN Abnormal EKG
Conn’s sydrome (aldosteronism)
play an important role in the metabolism of carbohydrates Cortisone and hydrocortisone are the primary ones. These help diminish the allergic response to inflammatory diseases of the body eg. Rheumatoid arthritis and rheumatic fever
Glucocorticoids
Excessive secretion of cortisol normally from an adenoma or carcinoma of the adrenal gland or a pituitary tumor Clinical symptoms include truncal obesity with pencil thin extremities “moon face” Psychisatric disturbances
Cushing’s syndrome
Androgen-male sex hormone Estrogen-female sex hormone Secretes both in minute amounts regardless of gender. Controlled by the adrenocorticotropic hormone (ACTH) from the pituitary gland Hypofunction is termed Addison’s disease
Sex Hormones
Primary causes of decresed cortex are autoimmune disease, TB, inflammatory process, primary neoplasm or mets. Secondary causes of decreased cortex is a dysfunction and decrease in the production of ACTH by the pituitary gland Clinical symptoms are tissue edema, fatigue, muscle and bone weakness, hyperpigmentation of the skin Treatment is steroid therapy- good prognosis
Addison’ disease (adrenocortical insufficiency)
Increased secretion of sex hormones Symptoms vary depending on age and gender Newborns may have ambiguous genitalia Female adults, deepening of voice, decreased uterine size, decreased breast tissue, more muscularity
Adrenogenital syndrome (adrenal virilism)
Bilateral adrenal hemorrhage that is complicated by adrenocortical insuffiency Caused by a severe bacterial meningococcal infection or Strep B Happens very rapidly, suddenly, and severe (fulminant) Can be deadly if not treated
Waterhouse-Friderichsen syndrome
Uncommon Incidental F > M Vary in size, unilocular or multilocular
Adrenal cysts
Rare Caused by severe trauma or infection Bilateral hemorrhage may cause adrenal insufficiency
Adrenal hemorrhage Adults
Caused by stressful delivery, asphyxia, and septicemia Adrenals are very vascular Clinical symptoms include anemia, abdominal mass, and hyperbilirubinemia
Adrenal hemorrhage Neonates
may appear similar to adrenal neuroblastoma Follow up can differentiate the two Hemmorrhage will decrease in size, where the tumor would increase
Adrenal hemmorhage Sonographically
Ultrasound can detect 90% of tumors first detected y CT Ultrasoud is useful for characterizing the mass as solid or cystic Evaluating the position and patency of IVC and draining veins Evaluate tumor invasion into adjacent structures Can be used to f/u tumors not surgically removed
Adrenal tumors
Benign nonfunctioning is the most common primary adrenal tumor Normally < 2.5 cm Increased incidence in older patients with diabetes and/or HTN
Adrenal adenoma
Well defined, round mass Incidental finding May become very large, compressing adjacent organs
Adrenal adenoma By ultrasound appears
Myelolipomas Hemangiomas Teratomas Lipomas Fibromas Typically not seen y ultrasound, more frequently imaged on CT or MRI
Other rare nonfunctional adrenal tumors
Hyperfunctional malignant tumors more common in females. May be the cause of Cushing’s, Conn’s, and adrenogenital sydromes Hyperfunctional tumors smaller in size than nonfunctional malignant tumors
Malignant adrenal tumors
4th most common site after 1. lung 2. liver 3. bones Most come from the lung (33%), breast (30%) followed by melanoma, gastric, colon, kidney, and thyroid Bilateral involement in more than half of cases
Metastasis
Pheochromocytoma Neuroblastoma
Medulla tumors
rare tumor arising from the adrenal medulla. Occurs in adults between age 40-60. Usually benign, but can be malignant. Hypertension occurs due to secretion of epinephrine and norepinephrine
Pheochromocytoma
50% arise from the adrenal medulla, and tumors have been found in the neck, mediastinum, retrperitoneum, and pelvis Clinical symptoms, depend on location of tumor. If adrenal- enlarged abdomen,HTN,diarrhea,bone pain if metastasized
Neuroblastoma
2nd most common abdominal tumor in childhood Arises in the sympathetic chain ganglia and adrenal medulla Normally seen between 2 months to 2 years common in children
Neuroblastoma Pathology
Echogenic Internal calcifications Adjacent kidney is displaced downward Doppler evaluation will show increase in flow Spreads quickly and widely, look for liver mets, masses around aorta, celiac and sma. Also spreads into spinal canal in young infants Wilm’s tumor is encapsulated and does not spread as in neuroblastoma
Neuroblastoma Sonographic findings
3 arteries supply each adrenal glad; the suprarenal branch of the inferior phrenic, the suprarenal branch of the aorta, and the suprarenal branch of the renal artery A single vein from the hilum of each gland drains into the IVC on the right The left drains into the left renal vein
Adrenal Vascular Supply
Lesions in the liver or Morison’s pouch displace the echoes posterior and inferior Renal and adrenal lesions cause anterior displacement Extrahepatic masses shift the IVC anteromedially
RETROPERITONEAL FAThelps to determine origin of mass
Primary retorperitoneal tumors originate independently within the retroperitoneal space Lymphoma Leiomysarcomas , Fibrosarcomas and rhabdomyosarcomas Teratomas
PRIMARY RETROPERITONEAL TUMORS
most common PRT, nodes > 2cm, 90% accuracy of diagnosing
lymphoma
2nd most common, muscle origin. undergo nercrosis and cystic degeneration. They have a complex pattern
Leiomysarcomas
are invasive tumors with infiltration into muscles and adjoining soft tissue
Fibrosarcomas and rhabdomyosarcomas
contain bones, cartilage, teeth, and soft tissue. Most often seen in children usually located by upper pole left kidney
Teratomas
Located throughout the abdomen. Normally are not visualized unless they are enlarged Numerous periaortic nodes, if enlarged, may displace celiac and SMA vessels Can be single, multiple or appear as a bulky type mass When they invade the mesentery, they become layered looking and often referred to as the Sandwich sign
Lymph nodes
> .70 more suggestive of malignant lymph node
Lymph nodes Resistive index
usually occur from previously resected tumors Ascites along the retroperitoneal tumor usually indicates seeding or invasion of the peritoneal surface.
Secondary retroperitoneal tumors
Urinoma Hemorrhage Abscess-
RETROPERITONEAL FLUID COLLECTIONS
walled off collection of extravasated urine that develops spontaneously after trauma, surgery, or urinary obstruction
Urinoma
secondary to trauma, vasculitits, bleeding diathesis(abnormal blood clotting disorder), or bleeding neoplasm, or dissecting aneurysm
Hemorrhage
may result from surgery, trauma, perforation of bowel or duodenum
Abscess
Has an unknown cause. It may be associated with a malignant process Fibrosis may encase and obstruct the ureters and vena cava which results in hydronephrosis Clinical signs are flank pain, back pain, weight loss, and nausea and vomiting Sonography shows a discrete mass of abnormal tissue anterior and lateral to the great vessels, may mimic lymphoma
RETROPERITONEAL FIBROISIS(ORMOND’S DISEASE)
