Malignant and functional adrenal gland tumors Flashcards
what are the major functional adrenal tumors?
adrenal cancers cushing syndrome pheochromocytoma aldosteronoma incidentaloma
what makes adrenal cancer different from the other adrenal syndromes in terms of presentation?
different hormonal syndromes combined with each other
what are concerning CT findings for adrenal cancer?
- irregular shape
- large size
- intralesional calcification
- unilateral location
- high CT attenuation values
- invasion into vessels
what lab studies are done for suspected adrenal cancer?
- cortisol
- metanephrines / catecholamines
- serum androgens / estrogens
what are the treatment options for adrenal cancer?
- surgery
- palliative
- treat metabolic syndromes
adrenal tumors can be approached laparoscopically if less than what size?
6 cm
what is the potassium level in cushing syndrome?
hypokalemia
diagnosis of cushings syndrome
- check cortisol - if positive then check ACTH
- low ACTH means adrenal gland source (independent)
- ACTH normal / high - ectopic or pituitary source (dependent)
adrenal tumor
cortisol
ACTH
dexamethasone test
- high cortisol
- low ACTH
- no suppression with low dose or high dose dexamethasone
treatment for adrenal cancer
surgery
pheochromocytoma: clinical features
- hypertension
- orthostatic hypotension
what are some associated conditions of pheochromocytoma?
- von recklinghausen neurofibromatosis
- von hippel lindau disease
- tuberous sclerosis
- MEN 2A and 2B syndrome
what is the best imaging modality for pheochromocytoma?
CT
what is the preoperative preparation for pheochromocytoma?
- alpha blockade first
- phenoxybenzamine
- possibly beta blockade
definition: primary hyperaldosteronism
failure to suppress aldosterone secretion by intravascular volume expansion is the fundamental basis for establishing the diagnosis
definition: conn syndrome
elevated BP due to an identifiable cause (renal disease, medication, renal artery stenosis, pheochromocytoma)
what is the potassium level in primary hyperaldosteronism?
hypokalemia
majority of patients are normokalemic
conn syndrome: clinical features
- muscle weakness
- polydipsia
- polyuria
- nocturia
- muscle cramps
- headache
what is the three tier diagnosis strategy for primary hyperaldosteronism?
- initial screening
- confirmation of diagnosis
- determination of subtype of primary hyperaldosteronism
what is the treatment for aldosterone producing adenoma?
surgery
what is the treatment for bilateral idiopathic hyperaldosteronism?
medical therapy - aldosterone antagonists
what is the screening test for primary aldosteronism? what are the confirmatory tests?
aldosterone-to-renin ratio
- 24 hr urine aldosterone
- saline suppression test (give salt, then aldosterone is still high and renin is low post-test)
what does renal vein sampling do? when is it warranted?
compared aldosterone levels to determine laterality of adrenal lesion
use when CT scan findings are equivocal or if both glands are abnormal
what is the treatment for primary hyperaldosteronism?
- APA (aldosterone producing adenoma) - surgery
- IHA (idiopathic hyperaldosteronism) - subtotal adrenectomy (poor results)
- medical treatment (RECOMMENDED) - spironolactone (aldosterone receptor antagonist)
what is an adrenal incidentaloma? what questions should be asked upon finding one?
unsuspected adrenal mass on imaging
- is it functional?
- malignant potential?
- does pt have a primary cancer and could it be metastatic?
what should you always check for prior to needle biopsy for a adrenal incidentaloma?
pheochromocytoma
