EXAM #2: PATHOLOGY OF THE ADRENAL GLAND Flashcards
What are the two primary adrenal cortical neoplasms?
1) Cortical adenoma
2) Cortical carcinoma
What are the gross characteristics that are pathognomonic cortical adenoma?
“well circumscribed (benign), yellow-orange lesions”
*Can be in cortex only, or protrude into the medulla/subcapsular region
How is a cortical adenoma differentiated from adrenal hyperplasia?
Solitary, circumscribed nodule
How can you tell the difference between a functional and non-functional cortical adenoma?
Fucntional= normal adjacent tissue thickness
Nonfunctional= atrophy of adjacent tissue
Describe the histologic appearance of a cortical adenoma.
Vacoulated with mild nuclear pleomorphism
Describe the gross appearance of a cortical carcinoma.
- Yellow on cut surface
- Usually large with areas of hemorrhage, cystic change, and necrosis
*Note that this is NOT different from adenoma
Where do adrenal carcinomas commonly metastasize?
1) Lung
2) Lymh nodes
What characteristics differentiate a cortical adenoma from a cortical carcinoma?
1) Metastasis
2) Large size
3) Necrosis
4) Mitotic figures
5) Vascular invasion
Describe the gross appearance of adrenal hyperplasia.
Yellow, thickened, and multinodular
*Note that being mutlinodular vs. singular differentiates from cortical adenoma
What is the basic cause of Cushing’s Syndrome?
Elevated glucocorticoid levels (cortisol)
What are the four etiologies of Cushing’s Diseases/ Syndrome?
1) Cushing Disease (an anterior pituitary tumor oversecreting ACTH)
2) Paraneoplasic Syndrome esp. small cell carcinoma making ACTH
3) Adrenal (tumor or hyperplasia) secreting cortisol
4) Iatrogenic (exogenous cortisol use)
What are the classic clinical manifestations of Cushing’s Syndrome?
1) Central obesity
2) Moon facies
- Unable to see ears from inspection from the front
3) HTN
4) Neuropsychiatric abnormalities
5) Menstrual abnormalities
6) Cutaneous striae
*Also, osteoporosis
Generally, what causes primary hyperaldosteronism?
- Increased aldosterone production from the adrenal gland
- Usually, an adrenal neoplasm or adrenal hyperplasia
What is Conn Syndrome?
This is a solitary aldosterone producing adenoma
*Sometimes called an APA (Aldosterone Producing Adenoma)
Describe the gross appearance of the tumor seen in Conn Syndrome.
- Singular
- Small
- Encapsulated
What are the clinical manifestations of hyperaldosteronism?
1) Hypertension
- Elevated Aldosterone causing Na+ and water reabsorption in the principal cells of the collecting duct
2) Hyperkalemia
What are the three major etiologies of adrenocortical insufficiency?
1) Primary acute adrenocortical insufficiency
2) Primary chronic adrenocrtical insufficiency (Addison Disease)
3) Secondary adrenocortical insufficiency
What is Waterhouse-Friderichsen Syndrome?
Adrenal insufficiency secondary to massive adrenal hemorrhage
- Associated with N. meningitidis infection
- Esp. in children
What is Addison Disease?
Chronic autoimmune destruction of the adrenal cortex
How much of the adrenal gland must be destroyed in Addison Disease for there to be symptoms?
90%
Describe the morphology of the adrenal gland in Addison Disease.
1) Small glands
2) Lipid depletion of the adrenal cortex
3) Variable lymphocytic infiltrate in the adrenal cortex
*Note that the adrenal medulla is SPARED
What are the clinical manifestations of Addison Disease?
1) Fatigue
2) Anorexia
3) Nausea
4) Cutaneous hyperpigmentation
5) Hypotension
What are the labs associated with Addison Disease?
1) Elevated ATCH
2) Hyperkalemia
3) Hyponatremia
What is secondary adrenal insufficiency?
Disorder of the hypothalamus or pituitary associated with decreased ACTH production
How does secondary adrenal insufficiency appear morphologically?
Atrophy of the adrenal gland WITH SPARING OF:
1) Zona glomerulosa
2) Adrenal medulla
What are the 5x 10% rules in pheochromocytoma?
1) 10% malignant
2) 10% afunctional
3) 10% bilateral
4) 10% extraadrenal
5) 10% familial
Describe the morphological appearance of a pheochromocytoma.
- Pale gray-brown
- Associated with hemorrhage, necrosis, cystic change
- Highly vascular
What are the clinical manifestations of a pheochromocytoma?
1) Abrupt HTN
2) Tachycardia
3) Palpitations
4) Headache, sweating, tremor
5) Apprehension
How is a pheochromocytoma diagnosed?
Measurement of urinary and serum catecholamine metabolites
What scan is used to diagnose a pheochromocytoma?
MIBG scan
Adrenal medulla tumors include neuroblastoma and pheochromocytoma. What patient population is a neuroblastoma associated with?
Kids
What oncogene are neuroblastomas associated with?
N-myc
How are neuroblastomas described histologically?
- Small blue cells
- Rosette structure
What are the clinical manifestations of a neuroblastoma?
1) Abdominal mass
2) Diastolic HTN
3) “Blueberry muffin baby”– mets to skin
