Functional Adrenal Tumors Flashcards
WHat are the major types of Functional Adrenal tumors?
Adrenal Cancers Cushing Sundrome PheoCC Aldosteronoma Incidentaloma
What are the traits of Adrenal Cancer?
Hormonally active: Hirsuitism, Acne, hypokalemia, HTN, fatigue
Not Hormonally active: Vague, abd pain or fulness
What are the concerning CT findings in Adrenal Cancer?
Irregular shape Large size Calcification in tumor Unilateral High Attenuation values(density) Invasion of local structures
WHat are the labs you want to get in Adrenal Cancer?
Cortisol(cush)
Meta/Catechol(pheo)
Andro/Estro(virilization)
What is the Tx of Adrenal CA?
Surgical if curative
Palliative if advanced
Tx of Metabolic Synd
What are the surgical approaches to Adrenal Tumors?
What other organs can be affected by an adrenal CA?
Liver
Pancreas
Spleen/Diaphragm
Colon
WHat are the common causes of Cushing Syndrome
Long term steroid use (99%)
Pituitary overproduction of ACTH (Cush Dis)
Benign or malignant adrenal lesions
Rarely Tumors
How is Cushing Disease Diagnosed?
Check cortisol (urine or blood) Check ACTH ACTH low?(ind-adrenal) ACTH norm/high? (dep-ect or pit) High Dose Dexamethasone supression test! Pit => cort supressed Ect => no supression
How are the Pituitary and Adrenals Imaged?
Pit: MRI
Adrenals: CT
What is the Tx of Cushing Synd?
Adrenal Souce? Surgery
What are the symptoms of Pheo?
Sweating Headaches Tachycardia Nervous attacks Hyperthyroid Relatives have it.
What are the other names for Pheo?
anywhere else: Paraganglioma
Branch of iliac arteries: Organ of Zuckerland
What are the associated conditions of Pheochromocytoma?
VonRecklinghausen’s Neurofibromatosis
Von Hippel Lindau Disease
Tuberous Sclerosis
Men-2a and 2b synd
What is the lab used for Pheo?
Serum followed by 24hr urine metanephrine
WHat is the pre-op prep for Pheo?
Alpha Blockade before Beta blockade
Phenoxybenzamine
Volume if needed in Orthostatic Hypotension
2 weeks before
What is the operative strategy in Pheo?
Laparascopic
Adrenal vein control
Limit manip until vein controlled
Systemic exploration of abdomen
What do you do if you see a Pheo during another surgery?
Finish original surgery as fast as possible
Do prep
Do second surgery
WHat are rhe signs of Primary Aldosteronism?
Drug resistant HTN Hypokalemia -Spon -diuretic induced Most are normokalemic
What are the symptoms of 1^ Hyperaldosteronism?
Muscle Weakness Polydypsia Polyuria Nocturia Muscle Cramps Headache
What is the 3 teir approach to diagnosing 1^ aldosteronism?
Screen Confirmation Determine subtype -Ald producing AD -Surgical -Bilat idio. HyperAld - Medical
WHat is the screening test for 1^ Hyp Ald?
Ald to Renin Ratio
What is the confirmatory test for 1^ hyperaldosteronism?
24hr urine aldosterone (Hi Na Diet)
Saline suppression test
What is bilateral Adrenal Vein Sampling?
Thread catheter into adrenal veins and compare aldosterone on each side