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Surgery > Fiser ABSITE Ch. 21 Adrenal > Flashcards

Fiser ABSITE Ch. 21 Adrenal Flashcards

1
Q

What inhibits prolactin secretions?

A

dopamine

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2
Q

What does the posterior pituitary produce?

A

ADH, Oxytocin

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3
Q

What nuclei in the hypothalamus produces ADH? and Oxytocin?

A

supraoptic, paraventricular

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4
Q

What does the anterior pituitary produce?

A

FSH, LH, ACTH, TSH, prolactin, GH

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5
Q

Nonfunctional tumors of the pituitary are almost always what type? what is the tx?

A

macroadenomas, transsphenoid resection

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6
Q

What rx might cause a response in TSH and FSH/LH secreting pituitary tumors?

A

bromocriptine (dopamine agonist)

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7
Q

What is the most common pituitary adenoma?

A

prolactinoma (mostly microadenomas)

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8
Q

Prolactinoma macroadenoma of the pituitary should be resected if hemorrhage, visual loss, CSF leak or if pt wants what?

A

pregnancy

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9
Q

Prolactinoma microadenoma of the pituitary should be resected if ____ unsafe or ineffective (is OK in pregnancy)

A

bromocriptine

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10
Q

Gigantism is a sx of acromegaly. Name 2 more.

A

HTN, DM

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11
Q

Name the acromegaly preoperative rx that inhibits the release of GH.

A

octreotide

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12
Q

How can acromegaly be life-threatening?

A

cardiac sx (valve dysfunction, cardiomyopathy)

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13
Q

Postpartum trouble lactating is usually the 1st sign of what syndrome?

A

Sheehan’s syndrome

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14
Q

Craniopharyngioma is a caclified cyst, remnants of what?

A

Rathke’s pouch

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15
Q

What syndrome occurs after bilateral adrenalectomy; increased CRH causes pituitary enlargement resulting in amenorrhea and visual problems?

A

Nelson’s syndrome

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16
Q

Why is there hyperpigmentation in Nelson’s syndrome?

A

bilateral adrenalectomy causes increased ACTH, beta-MSH (melanocyte-stimulating hormone) is a peptide byproduct of ACTH

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17
Q

What is the tx for Nelson’s syndrome?

A

steroids

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18
Q

What syndrome is caused by adrenal gland hemorrhage that occurs after meningococcal sepsis infection; can lead to adrenal insufficiency.

A

Waterhouse-Friderichsen syndrome

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19
Q

What is the arterial supply of the adrenal gland and what is their origin?

A

Superior adrenal - inferior phrenic artery; Middle adrenal – aorta; Inferior adrenal - renal artery

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20
Q

What is the venous drainage of the adrenal glands?

A

Left adrenal vein goes to left renal vein; Right adrenal vein goes to inferior vena cava

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21
Q

What percentage of abdominal CT scans show adrenal incidentalomas? what percentage are mets or primary adrenal tumors?

A

1-2%, 5%

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22
Q

When is surgery indicated for asymptomatic adrenal mass?

A

ominous characteristics (nonhomongenous), >4-6 cm, functioning, enlarging

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23
Q

How often to follow up for asymptomatic adrenal mass?

A

every 3 mos for first year and yearly after that

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24
Q

What is the most common mets to adrenal?

A

lung CA

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25
Q

What is the workup for asymptomatic adrenal mass with a cancer history?

A

bx

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26
Q

What are the 3 layers of the adrenal cortex and what do they produce?

A

GFR; Glomerulosa - aldosterone (salt); Fasciculata - glucocorticoids (sugar); Reticularis - androgens/estrogens (sex)

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27
Q

What is the innervation to the adrenal cortex? and the medulla?

A

none, splanchnic nerves

28
Q

What does 4 things does aldosterone affect in the kidney?

A

sodium resorption, secretion of potassium, hydrogen ions, and ammonia

29
Q

What does excess estrogens and androgens by adrenals almost always indicate?

A

CA

30
Q

What is the most common (90%) congenital adrenal hyperplasia?

A

21 hydroxylase deficiency

31
Q

In 21 hydroxylase deficiency what hormone is produced in excess and what is the effect on BP?

A

increased testosterone causes precocious puberty in males and virilization in females. Is salt wasting so causes hypotension

32
Q

What are the 2 treatments for 21 hydroxylase deficiency and 11 hydroxylase deficiency?

A

cortisol and genitoplasty

33
Q

List the 3 types of congenital adrenal hyperplasia and their sexual development and BP sx.

A

21 hydroxylase deficiency causes precocious puberty in males virilization in females. It is salt wasting so it causes hypotension; 17 hydroxylase deficience causes ambiguous genitalia in males at birth and is salt saving; 11 Hydroxylase deficiency precocious puberty in males, virilization in females. Salt saving so it causes hypertension; 21 hypotensive boy, 17 hypertensive girl, 11 hypertensive boy

34
Q

What is the name of the syndrome with hyperaldosteronism?

A

Conn’s syndrome

35
Q

What are the two types of Conn’s syndrome and their primary marker?

A

Primary disease has low renin (adenoma); Secondary disease has high renin (CHF, RAS, liver failure, diuretics, Bartter’s syndrome - renin secreting tumor)

36
Q

What is more common primary or secondary Conn’s syndrome?

A

secondary

37
Q

What is the #1 and #2 causes of primary hyperaldosteronism?

A

adenoma, hyperplasia

38
Q

Localizing studies in hyperaldosteronesim include Localizing studies - MRI, and ___ (shows hyperfunctioning adrenal tissue; differentiates adenoma from hyperplasia; 90% accurate); ___ if others nondiagnostic

A

NP-59 scintigraphy; adrenal venous sampling

39
Q

In the tx of hyperaldosteronism, hyperplasia is seldom cured (↑ morbidity with bilateral resection) Try medical therapy first with hyperplasia using ___, calcium channel blockers, and potassium. If bilateral resection is performed (usually done for refractory hypokalemia), patient will need ___ postoperatively

A

spironolactone, fludrocortisone

40
Q

What is the number one cause of hypocortisolism?

A

withdrawal of exogenous steroids

41
Q

What is the number one cause of hypercortisolism?

A

iatrogenic

42
Q

In the diagnosis of hypercortisolism what is done first (most sensitive test)? What is done 2nd?

A

24 hour urine cortisol, low dose overnight dexamethasone suppression test

43
Q

What is the dx if low-dose overnight dexamethasone suppression test results in low urinary cortisol?

A

Cushing’s disease (pituitary adenoma)

44
Q

What is the #1 non-iatrogenic cause of Cushing’s syndrome?

A

Cushing’s disease (pituitary adenoma)

45
Q

What is the #2 noniatrogenic cause of Cushing’s syndrome? what is its most common cause?

A

Ectopic ACTH, small cell lung CA

46
Q

Cortisol is not suppressed with either the low-dose or high-dose dexamethasone suppression test, what is the most likely diagnosis?

A

ectopic ACTH

47
Q

With ectopic ACTH resection of the primary tumor is the tx. What are two alternatives if resection is not possible?

A

medical suppression or bilateral adrenalectomy

48
Q

Name the drug used for adrenocortical cancer with metastatic disease that is an adrenal-lytic

A

Op-DDD (mitotane)

49
Q

What is the origin of the adrenal medulla?

A

ectoderm neural crest cells

50
Q

Catecholamine production starts with tyrosine. What are the next 4?

A

dopa -> dopamine -> norepinephrine -> epinephrine

51
Q

What is the rate limiting step in the production of catecholamines and what is the enzyme?

A

tyrosine to dopa, tyrosine hydroxylase

52
Q

PNMT is the enzyme only found in the adrenal medulla. What does it doe?

A

converts norepinephrine to epinephrine

53
Q

What is the only type of pheochromocytomas that will produce epinephrine?

A

adrenal

54
Q

What is the most notable location for extra-adrenal neural crest tissue?

A

organ of Zuckerkandl

55
Q

What are the 5 things in the 10% rule for pheochromocytoma?

A

malignant, bilateral, in children, familial, extra-adrenal

56
Q

What type(s) of MEN syndrome are associated with pheo?

A

MEN IIA and IIB

57
Q

Which side are most pheos on?

A

right

58
Q

Extra-adrenal pheos are more likely what?

A

malignant

59
Q

What type of scan is useful in finding the location of a pheo?

A

MIBG (noepinephrine analogue)

60
Q

Why don’t you use venography with pheo dx?

A

can cause hypertensive crisis

61
Q

How do you control pressure in a pheo pt preoperatively?

A

alpha blocker (phenoxybenzamine) before beta blocker to prevent a hypertensive crisis from unopposed alpha blockade

62
Q

What drug is used in the tx of pheo, inhibits tyrosine hydroxylase causing decreased synthesis of catecholamines?

A

metyrosine

63
Q

What is an important step in the resection of a pheo?

A

ligate veins before manipulating tumor

64
Q

Name 4 extra adrenal sites for pheo.

A

vertebral bodies, opposite adrenal gland, bladder, aortic bifurcation

65
Q

Name the rare benign, asymptomatic tumor of neural crest origin in the adrenal medulla or sympathetic chain.

A

Ganglioneuroma

Surgery (33 decks)

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