Chapter 16 Adrenal Glands power point

Question 1

Triangular glands located anteromedially and superior to the kidneys Adrenal glands consist of two endocrine glands: cortex and medulla

Answer 1

Adrenal glands

Question 2

Outer portion; secretes steroids that help to regulate electrolyte metabolism, carbohydrate metabolism, and sex hormones

Answer 2

Cortex

Question 3

produces epinephrine and noreinephrine

Answer 3

Medulla core;

Question 4

Mineralocoricoids Glucocorticoids Sex Hormones

Answer 4

Physiology of cortex Steroids fall into 3 main categories

Question 5

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.

Answer 5

Mineralocoricoids

Question 6

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

Answer 6

Conn’s sydrome (aldosteronism)

Question 7

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

Answer 7

Glucocorticoids

Question 8

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

Answer 8

Cushing’s syndrome

Question 9

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

Answer 9

Sex Hormones

Question 10

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

Answer 10

Addison’ disease (adrenocortical insufficiency)

Question 11

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

Answer 11

Adrenogenital syndrome (adrenal virilism)

Question 12

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

Answer 12

Waterhouse-Friderichsen syndrome

Question 13

Uncommon Incidental F > M Vary in size, unilocular or multilocular

Answer 13

Adrenal cysts

Question 14

Rare Caused by severe trauma or infection Bilateral hemorrhage may cause adrenal insufficiency

Answer 14

Adrenal hemorrhage Adults

Question 15

Caused by stressful delivery, asphyxia, and septicemia Adrenals are very vascular Clinical symptoms include anemia, abdominal mass, and hyperbilirubinemia

Answer 15

Adrenal hemorrhage Neonates

Question 16

may appear similar to adrenal neuroblastoma Follow up can differentiate the two Hemmorrhage will decrease in size, where the tumor would increase

Answer 16

Adrenal hemmorhage Sonographically

Question 17

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

Answer 17

Adrenal tumors

Question 18

Benign nonfunctioning is the most common primary adrenal tumor Normally < 2.5 cm Increased incidence in older patients with diabetes and/or HTN

Answer 18

Adrenal adenoma

Question 19

Well defined, round mass Incidental finding May become very large, compressing adjacent organs

Answer 19

Adrenal adenoma By ultrasound appears

Question 20

Myelolipomas Hemangiomas Teratomas Lipomas Fibromas Typically not seen y ultrasound, more frequently imaged on CT or MRI

Answer 20

Other rare nonfunctional adrenal tumors

Question 21

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

Answer 21

Malignant adrenal tumors

Question 22

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

Answer 22

Metastasis

Question 23

Pheochromocytoma Neuroblastoma

Answer 23

Medulla tumors

Question 24

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

Answer 24

Pheochromocytoma

Question 25

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

Answer 25

Neuroblastoma

Question 26

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

Answer 26

Neuroblastoma Pathology

Question 27

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

Answer 27

Neuroblastoma Sonographic findings

Question 28

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

Answer 28

Adrenal Vascular Supply

Question 29

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

Answer 29

RETROPERITONEAL FAThelps to determine origin of mass

Question 30

Primary retorperitoneal tumors originate independently within the retroperitoneal space Lymphoma Leiomysarcomas , Fibrosarcomas and rhabdomyosarcomas Teratomas

Answer 30

PRIMARY RETROPERITONEAL TUMORS

Question 31

most common PRT, nodes > 2cm, 90% accuracy of diagnosing

Answer 31

lymphoma

Question 32

2nd most common, muscle origin. undergo nercrosis and cystic degeneration. They have a complex pattern

Answer 32

Leiomysarcomas

Question 33

are invasive tumors with infiltration into muscles and adjoining soft tissue

Answer 33

Fibrosarcomas and rhabdomyosarcomas

Question 34

contain bones, cartilage, teeth, and soft tissue. Most often seen in children usually located by upper pole left kidney

Answer 34

Teratomas

Question 35

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

Answer 35

Lymph nodes

Question 36

> .70 more suggestive of malignant lymph node

Answer 36

Lymph nodes Resistive index

Question 37

usually occur from previously resected tumors Ascites along the retroperitoneal tumor usually indicates seeding or invasion of the peritoneal surface.

Answer 37

Secondary retroperitoneal tumors

Question 38

Urinoma Hemorrhage Abscess-

Answer 38

RETROPERITONEAL FLUID COLLECTIONS

Question 39

walled off collection of extravasated urine that develops spontaneously after trauma, surgery, or urinary obstruction

Answer 39

Urinoma

Question 40

secondary to trauma, vasculitits, bleeding diathesis(abnormal blood clotting disorder), or bleeding neoplasm, or dissecting aneurysm

Answer 40

Hemorrhage

Question 41

may result from surgery, trauma, perforation of bowel or duodenum

Answer 41

Abscess

Question 42

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

Answer 42

RETROPERITONEAL FIBROISIS(ORMOND’S DISEASE)