Functional Adrenal Tumors

Question 1

WHat are the major types of Functional Adrenal tumors?

Answer 1

Adrenal Cancers 
Cushing Sundrome 
PheoCC
Aldosteronoma
Incidentaloma

Question 2

What are the traits of Adrenal Cancer?

Answer 2

Hormonally active: Hirsuitism, Acne, hypokalemia, HTN, fatigue
Not Hormonally active: Vague, abd pain or fulness

Question 3

What are the concerning CT findings in Adrenal Cancer?

Answer 3

Irregular shape
Large size
Calcification in tumor
Unilateral 
High Attenuation values(density)
Invasion of local structures

Question 4

WHat are the labs you want to get in Adrenal Cancer?

Answer 4

Cortisol(cush)
Meta/Catechol(pheo)
Andro/Estro(virilization)

Question 5

What is the Tx of Adrenal CA?

Answer 5

Surgical if curative
Palliative if advanced
Tx of Metabolic Synd

Question 6

What are the surgical approaches to Adrenal Tumors?

Question 7

What other organs can be affected by an adrenal CA?

Answer 7

Liver
Pancreas
Spleen/Diaphragm
Colon

Question 8

WHat are the common causes of Cushing Syndrome

Answer 8

Long term steroid use (99%)
Pituitary overproduction of ACTH (Cush Dis)
Benign or malignant adrenal lesions
Rarely Tumors

Question 9

How is Cushing Disease Diagnosed?

Answer 9

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

Question 10

How are the Pituitary and Adrenals Imaged?

Answer 10

Pit: MRI
Adrenals: CT

Question 11

What is the Tx of Cushing Synd?

Answer 11

Adrenal Souce? Surgery

Question 12

What are the symptoms of Pheo?

Answer 12

Sweating
Headaches
 Tachycardia
Nervous attacks
Hyperthyroid 
Relatives have it.

Question 13

What are the other names for Pheo?

Answer 13

anywhere else: Paraganglioma

Branch of iliac arteries: Organ of Zuckerland

Question 14

What are the associated conditions of Pheochromocytoma?

Answer 14

VonRecklinghausen’s Neurofibromatosis
Von Hippel Lindau Disease
Tuberous Sclerosis
Men-2a and 2b synd

Question 15

What is the lab used for Pheo?

Answer 15

Serum followed by 24hr urine metanephrine

Question 16

WHat is the pre-op prep for Pheo?

Answer 16

Alpha Blockade before Beta blockade
Phenoxybenzamine
Volume if needed in Orthostatic Hypotension
2 weeks before

Question 17

What is the operative strategy in Pheo?

Answer 17

Laparascopic
Adrenal vein control
Limit manip until vein controlled
Systemic exploration of abdomen

Question 18

What do you do if you see a Pheo during another surgery?

Answer 18

Finish original surgery as fast as possible
Do prep
Do second surgery

Question 19

WHat are rhe signs of Primary Aldosteronism?

Answer 19

Drug resistant HTN
Hypokalemia
-Spon
-diuretic induced
Most are normokalemic

Question 20

What are the symptoms of 1^ Hyperaldosteronism?

Answer 20

Muscle Weakness
Polydypsia
Polyuria
Nocturia
Muscle Cramps
Headache

Question 21

What is the 3 teir approach to diagnosing 1^ aldosteronism?

Answer 21

Screen
Confirmation
Determine subtype
-Ald producing AD -Surgical
-Bilat idio. HyperAld - Medical

Question 22

WHat is the screening test for 1^ Hyp Ald?

Answer 22

Ald to Renin Ratio

Question 23

What is the confirmatory test for 1^ hyperaldosteronism?

Answer 23

24hr urine aldosterone (Hi Na Diet)

Saline suppression test

Question 24

What is bilateral Adrenal Vein Sampling?

Answer 24

Thread catheter into adrenal veins and compare aldosterone on each side

Question 25

WHat is the drug used for bilateral Idiopathic HyperAld?

Answer 25

Spironolactone (Aldosterone Antagonist

Question 26

What is an “Incedetaloma”

Answer 26

An incidental finding on normal 
imaging
Functional?
Malignant potential?
Metastasis from another site?

Question 27

WHat are the lab tests to diagnose:
Hypercortisolism
Hyperaldosteronism
Pheo

Answer 27

Dexameth supression
Aldosterone
Serum metanephrines
(NEVER BIOPSY an adrenal mass til you know if it’s a pheo!)