Defense & Barriers 2: Adrenal Tumors

Question 1

2 categories for adrenal masses (generally)

Answer 1

1. ADRENOCORTICAL ADENOMAS/CARCINOMAS can either be FUNCTIONAL or NON-FUNCTIONAL
2. PHEOCHROMOCYTOMA is often FUNCTIONAL & MALIGNANT

Question 2

which diagnostic test is the most SENSITIVE for METASTATIC INVASION of CORTICAL ADRENAL TUMORS? what is more sensitive than?

Answer 2

CT, more sensitive than US!

Question 3

why do we take THORACIC rads for adrenal tumors?

Answer 3

to ensure NO PULMONARY METASTASIS

Question 4

we usually have to make a decision about adrenal tumors WITHOUT performing ____…
risk?
accuracy?

Answer 4

CYTOLOGY/HISTOLOGY

risk?
–> FNA can cause CATECHOLAMINE RELEASE in PHEOCHROMOCYTOMA, LETHAL potentially

accuracy?
if it CAN be done, VERY ACCURATE AT DIFFERENTIATING PHEOCHROMOCYTOMA vs. ADRENOCORTICAL TUMOR

Question 5

adrenal tumors in CATS…
commonality?
most AT in cats are ____ & can make what 4 hormones?
what kind of tumor is MOST PREVALENT?
treatment options? (3)

Answer 5

commonality? = RARE!

Most AT in cats are FUNCTIONAL
1. Aldosterone
2. Cortisol
3. Progesterone
4. Estradiol

what KIND of tumor?
–> CORTICAL tumors > pheochromocytomas

treatment?
1. RECOMMEND ADRENALECTOMY
2. MIS APPROACH for ADRENALECTOMY is NOT INDICATED (much more difficult)
3. SPIRONOLACTONE good option if NO SURGERY and cat has PRIMARY HYPERALDOSTERONISM

Question 6

if a DOG DOES NOT get ADRENAL TUMOR SX, what is the MEDIAN SURVIVAL TIME?

Answer 6

~12 months

Question 7

BILATERAL adrenalectomy is ____, but indicated when there’s ____ ____

Answer 7

UNCOMMON, BILATERAL MALIGNANCY

Question 8

in ADRENAL TUMORS IN DOGS, their RESPONSE TO CHEMOTHERAPY IS…

Answer 8

POOR

Question 9

4 reasons we’d perform STEREOTACTIC RADIATION THERAPY on a DOG WITH ADRENAL TUMOR?

Answer 9

1, highly invasive tumor
2. non-resectable tumor
3. metastatic disease
4. if owners decline surgery

Question 10

ADRENALECTOMY…
the tumor should be WHAT 2 things? (include 3 subsets for second)
2 approaches?
most common complication?

Answer 10

tumor should be…
1. FUNCTIONAL = not necessarily a trait of malignancy, but making something!
2. MALIGNANT
–> Mass size equal to or GREATER than 2 cm in ANY DIMENSION
–> Vascular or soft tissue INVASION as evidenced by US or CT (better on CT)
–> Evidence of METASTASIS based on additional mass lesions

2 approaches?
1. OPEN approach
–> Approach via VENTRAL MIDLINE = MOST COMMON

Advantages
–> Can see everything in abdomen
–> Exposure of bilateral adrenals

Disadvantages
–> ADRENAL GLANDS ARE DORSAL/RETROPERITONEAL
–> Need retraction of liver/kidney/CVC

MIS (minimally invasive surgical) APPROACH, but has CONTRAINDICATIONS….
–> VASCULAR INVASION = BAD IDEA!
–> LARGE adrenal tumors (>5 cm)
–> SPONTANEOUS HEMORRHAGE

most common complication?
= CAPSULAR RUPTURE

Question 11

what are INCIDENTALOMAS?
can consider WHAT treatment?

Answer 11

= NON-FUNCTIONAL ADRENAL TUMORS WITHOUT EVIDENCE OF MALIGNANCY

Can consider surgical excision

Question 12

PRE-, PERI-, and POST-OP management of PHEOCHROMOCYTOMAS (2)

Answer 12

1. Can have EPISODIC/SEVERE CHANGE SIN HR, RHYTHM, BP so needs COMPETENT ANESTHETIC EXAM
2. Can use ATENOLOL for the DAY FOR SURGERY for TACHYARRHYTHMIAS but only if PHENOXYBENZAMINE (decrease BP) IS ALSO USED

Question 13

PRE-, PERI-, and POST-OP management of CORTISOL-SECRETING TUMORS (4)

Answer 13

1. Should do TREATMENT OF HYPERTENSION PRE-OP (dogs = labetalol or phentoamine, cats = hydralazine)
2. Can do RENAL PANEL and ACTH STIM 1 DAY POST-OP
3. Assess risk of AKI & if they need CORTISOL SUPPLEMENTATION
4. PRE-TREATMENT WITH TRILOSTANE HAS NO EVIDENCE THAT SUPPORTS BENEFIT, and has potential SIDE EFFECTS

Question 14

when is VITAMIN A used in adrenal tumor surgery?

Answer 14

can be used due to IMPAIRED WOUND HEALING from TOO MANY GCCs from TUMOR

Question 15

does TUMOR TYPE affect PROGNOSIS of patients with ADRENAL TUMORS?

Answer 15

TUMOR TYPE DOESN’T AFFECT PROGNOSIS, but pheochromocytomas more likely to metastasize, so greater risk of srugery