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SURGERY > ENDO BLOCK (ADRENAL) > Flashcards

ENDO BLOCK (ADRENAL) Flashcards

1
Q

Hormone produces in Zona Glomerulosa

A

Aldosterone

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2
Q

Hormone produces in Adrenal Medulla

A

Chromaffin cells: Epinephrine, Norepi

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3
Q

Hormones produced in Zona FAsciculata

A
  • Glucocorticoids

- Adrenal adrogens

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4
Q

Common precursor of all steroid hormones derived from the adrenal cortex

A

Cholesterol

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5
Q

Increase NA reabsorption and K and H excretion as well as regulated by renin-angiotensin system

A

Aldosterone

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6
Q

Adrenal Hormones

A
  • Mineralocorticoids
  • Adrenal Androgen (sex steroids)
  • CAtecholamines
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7
Q

Examples of Mineralocorticoids

A
  • Aldosterone
  • 11-deoxycorticosterone (DOC)
  • Cortisol
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8
Q

Major adrenal glucocorticoid

A

Cortisol

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9
Q

Examples of Catecholamines

A
  • Epinephrine
  • Norepinephrine
  • Dopamine
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10
Q

Examples of Adrenal androgen

A
  • Dehydroepiandrosterone (DHEA) / Dehydroepiandrosterone sulfate (DHEAS)
  • Androstenedione
  • testosterone and estrogen
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11
Q

There is autonomous aldosterone secretion which leads to suppresion of renin secretion. Solitary functioning adrenal adenoma (70%), idiopathic bilateral hyperplasia (30%), associated w/ hypokalemia

A

Primary Hyperaldosteronism

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12
Q

Typically presents with hypertension: long standing, moderate to severe, may be difficult to control despite multiple drug therapy, headaches, polydisia, polyuria, nocturia, muscle weakness and fatigue (hypokalemia)

A

Primary Hyperaldosteronism

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13
Q

Must be suspected in any hypertensive patient who present with hypokalemia.

Lab Studies: spontaneous hypokalemia (K<3.2mmol/L)
hypokalemia on diuretic therapy (K<3mmol/L)
Radiologic Studies: CT scan with 0.5cm cuts
MRI scans
scintigraphy with 121I-6B-iodomethyl noriodocholesterol (NP-59)

A

Hyperaldosteronism

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14
Q

Treatment:

CT Scan/ MRI -> Bilaterally abnormal or normal adrenals -> (1)Selective venous catheterization for aldosterone and cortisol, (2) NP-59 scan -> Unilateral increased aldosterone =?

A

Adrenalectomy

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15
Q

Treatment

CT Scan/ MRI -> Bilaterally abnormal or normal adrenals -> (1)Selective venous catheterization for aldosterone and cortisol, (2) NP-59 scan -> Bilateral hyperfunction or failure to localize =?

A

Medical management

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16
Q

Treatment

CT Scan/ MRI -> Unilateral adrenal tumor (0.5-2cm in diameter) =?

A

Adrenalectomy

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17
Q

Treatment for Primary Hyperaldosteronism

A
  • Preoperative control of hypertension and adequate potassium supplementation (keep K>3.5mmol/L)
  • generally treated with spironolactone, amiloride, nifedipine or captopril
  • unilateral tumors producing aldosterone are best managed by
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18
Q

Percentage of success in Adrenalectomy in treating Primary Hyperaldosteronism
Hypokalemia= ?
Correcting hypertension= ?

A

Hypokalemia= 90%

Correcting hypertension= 70%

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19
Q

Complex of symptoms and signs resulting from hypersecretion of cortisol regardless of etiology.

Leads to peculiar fat deposition, amenorrhea, impotence, hirsutism, purple striae, hypertension, diabetes

A

Cushing’s Sydrome

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20
Q

Refers to a pituitary tumor, usually an adenoma, w/c leads to bilateral adrenal hyperplasia and hypercortisolism

A

Cushing’s Disease

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21
Q

Features of Cushing’s Syndrome

A
  • Weight gain (buffalo humps, supraclavicular fat pads)
  • hirsutism, plethora, purple striae, ecchymosis
  • hypertension
  • fatigue, osteopenia
  • emotional lability, psychosis, depression
  • diabetic, hyperlipidemia
  • polyuria, renal stones
  • impotence, decreased libido, menstrual irregularities
22
Q

There is progressive truncal obesity which is the most common sign and symptoms.

A

Cushing’s Syndrome

23
Q

Radiologic studies used to diagnose Cushing’s Syndrome

A

CT SCAN/ MRI (identify adrenal tumor 95% sensitivity)

24
Q
  • elevated glucocoticoid levels that are not suppressible by exogenous hormone adminstration
  • loss of diurnal variation
  • overnight low-dose dexamethasone suppression test (N: <3ug/dl)
  • plasma ACTH levels (N: 10-100 pg/ml)
A

Cushing’s Syndrome

25
Q

Treatment of Cushing’s Syndrome

  • Laparoscopic adrenalectomy= ?
  • Open adrenalectomy= ?
  • Transphenoidal excision of pituitary adenoma= ?
  • Pituitary irradiation=?
A
  • Laparoscopic adrenalectomy= px with adrenal adenomas
  • Open adrenalectomy= px w/ large tumor (>6cm) / suspected to be adrenocortical
    cancers
  • Transphenoidal excision of pituitary adenoma= Cushing’s DIsease
  • Pituitary irradiation= persistent/ recurrent disease after surgery
26
Q

Adrenal adenomas or carcinomas that secret adrenal androgens leads to what _______ in sex steroids excess

A

Virilizing syndrome

27
Q

Women in this disorder develop hirsutism, amenorrhea, infertility, increased muscle mass, deepend voice, temporal baldness

A

Sex steroid excess

28
Q

Diagnostic test for Sex Steroid Excess

A

DHEA (measured in plasma and urine as 17-ketosteroids)

29
Q

Treatment for Sex Steroids Excess

A

Adrenalectomy

30
Q

Group of disorders that result from deficiencies or complete absence of enzymes involved in adrenal steroidogenesis

A

Congenital adreenal hyperplasia (CAH)

31
Q

Deficiency of this CAH is the most common that leads to virilization

A

21-hydroxylase (CYP21A2)

32
Q

Second most common CAH that leads to hypertension, virilization and hyperpigmentation

A

11B-hydroxylase deficiency

33
Q

The most severe form fo CAH, caused by cholesterol desmolase dificiency which result in fatal salt-wasting syndrome in female patients

A

Congenital adrenal lipoid hyperplasia

34
Q

Diagnostic test for CAH

A

karyotype analysis and measurement of plasma and urinary steroids

35
Q

Tx for CAH

A

-traditionally managed medically with Cortisol and mineralocorticoid replacement
- - recently, bilateral laparoscopic adrenalectomy has been proposed as an alternative treatment

36
Q

Rare tumors with prevalence rate from 0.3 - -.95% and often called the “10 percent tumor”: 10% bilateral, 10% malignant, 10% occur in pediatric px, 10% are extra-adrenal and 10% are familial. It also occurs in families with MEN2A and MEN2B

A

Pheochromocytomas

37
Q

Signs and symptoms of Pheochromocytomas

A
  • classic triad (headache, palpitations & diaphoresis)
  • non specific: anxiety, tremulousness, paresthesia, flushing, chest pain, shortness of breath, abdominal pain, nausea & vomiting
  • most common clinical sign is hypertension
38
Q

Biochemical studies used in pheochromocytomas

A
  • diagnosed by testing 24-hour urine samples for catecholamines and their metabolites
  • determining plasma metanerphrine levels
  • urinary metanerphines are 98% sensitive and 98% specific
39
Q

Radiologic studies for pheochromocytomas

A
  • CT scans w/out contrast
  • MRI scan (pregnant women)
  • 121I-radiolabeled MIBG_ localizing pheochromocytomas es. in ectopic positions
40
Q

Medical management is aimed chiefly at BP control and volume repletion preoperatively. Adrenalectomy is tx of choice usually performed via an open anterior approach to faciliate detection of bilateral tumor, extra-adrenal lesions or metastatic lesions

A

Treatment for Pheochromocytomas

41
Q

Tumor in this disorder tends to be multiple and bilateral

A

Hereditary pheochormocytoma

42
Q

Is rercommended in the absence of obvious lesions in the contralateral adrenal gland

A

Unilateral adrenalectomy

43
Q

Px with tumors in both adrenal gland, this surgery may preserve adrenocortical function and avoid the morbidity of bilateral total adrenalectomy

A

Cortical-sparing subtotal adrenalectomy

44
Q

DIsorder that 12-29% of pheochromocytomas are malignant and are associated w/ decreased survuval. There’s no definitive histologic criteria defining this and malignancy is diagnosed when there is evidence of invasion into the surrounding structures or distant metastasis

A

Malignant Pheochromocytoma

45
Q

In general, soft tissue lesions of malignant pheochromocytomas are treated with what if feasible

A

resection

46
Q

Can be used for unresectable lesions or symptomatic skeletal metastases

A

External-beam radiation

47
Q

MAybe useful in px with diffuse disease showing uptake on a diagnotic scan in Malignant Pheochromocytoma

A

Therapeutic 131I-MIBG Irradation

48
Q

Cause:
Primary Adrenal Insufficiency=
Secondary Adrenal INsufficiency=

A

Primary Adrenal Insufficiency= resulting from adrenal disease
Secondary Adrenal INsufficiency= due to deficiency of ACTH

49
Q

Treatment fo Adrenal Insufficiency

A
  • treatment must be inititiated based on clinical suspicion alone, even before test results are obtained or the patient is unlikely to survive
  • volume resuscitation with at least 2 to 3L of a 0.9% saline solution or 5% dextrose in saline solution
  • dexamethasone (4mg) should be administered IV
  • once patient has stabilized, infection should be sought, identified and treated
50
Q

Diagnostic Studies:

Characteristic lab findings:
Diagnosed by ACTH Srimulation test:
Peak cortisol levels:

A

Characteristic lab findings: hyponatremia, hyperkalemia, eosinophilia, mild azotemia and fasting or reactive hypoglycemia
Diagnosed by ACTH Srimulation test: ACTH (250μg) is infused IV and cortisol levels are measured at 0, 30 and 60 mins.
Peak cortisol levels: <20µg/dL suggest adrenal insufficiency

51
Q

Subtle symptoms: fatigue, salt craving, weight loss, nausea, vomiting and abdominal pain

A

Chronic Adrenal Insufficiency

52
Q

Suspected in stressed patients with any of relevant risk
and may mimic sepsis, M.I., or pulmonary embulos and presents with fever, weakness, confusion, N&V, lethargy abdominal pain or severe hypotension

A

Acute Adrenal Insufficiency

SURGERY (9 decks)

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