Path of Adrenals

Question 1

What is charicteristic of Adenal Cortical ADenoma?

Answer 1

Well circumscribed, yello-orange lesion (high in lipids)
Benign, solitary, well circumscribed
+/- 1 cm with hemmorhage or calcification
Inhibits ACTH production

Question 2

What is seen on microscopic of Adrenal cortical adenoma?

Answer 2

Vacuolated bc of intracytoplasmic lipid
Mild nuclear pleomorphism
No mitotic activity or necrosis

Question 3

What is charicteristic of adrenal cortical CA?

Answer 3

HIGHLY Malignant
Lesions Yellow on cut surface, contains hemmorhage, cystic change, and necrosis
Invade vascular channels, mets to LN and viscera, esp LUNG

Question 4

What are the microscopic traits of anaplastic cells?

Answer 4

1) Pleomorphic cells(diff. stages)
2) Abn nuclear morphology(vary in chromatin content, etc)
3) Mitoses
4) Loss of polarity

Question 5

How can we differentiate Adrenal Cortical AD from CA?

Answer 5

Metastasis***
Large size
Necrosis
Mitotic figures
Vascular invasion***

Question 6

What are the charicteristics of Adrenal Cortical Hyperplasia?

Answer 6

Adrenal Cortex is yellow, thickened, and multinodular (hypertrophy and hyperplasia)

Question 7

What are the 3 clinical hyperadrenal syndromes?

Answer 7

Cushing syndrome (+Cortisol)
Hyperaldosteronism
Adrenogenital syndromes

Question 8

What are the 4 different causes of Cushing Syndrome?

Answer 8

Pituitary CS (tumor in ant pit, Ad Hyp)
Adrenal CS (tumor in adrenal or nodular hyperplasia)
Parneoplastic CS (ACTH prod tumor, lung? Ad Hyp)
Iatrogenic CS (exogenous steroid use, Ad Atrophy)

Question 9

What are the 3 morphologies of Hypercortisolism?

Answer 9

Cortical Hyperplasia
Cortical Adenoma
Cortical Carcinoma

Question 10

What is the Clinical appearance of Hypercortisolism?

Answer 10

Central Obesity
Moon Facies (cant see ears from front, no nose from side)
HTN
Neuropsych Abn
Menstrual Abn
Cutaneous Striae

Question 11

WHat are the charicteristics of Aldosterone-secreting adenoma?

Answer 11

Conn syndrome
Cut surface is yellow/orange
solitary, small, encapsulated lesion

Question 12

What is the clinical course of Hyperaldosteronism?

Answer 12

HTN
Hypokalemia
High Ald
low blood renin

Question 13

What are the different patterns of Adrenocortical Insufficiency?

Answer 13

1^ acute ACI (adrenal crisis)
1^ chronic ACI (Addison’s disease)
2^ ACI

Question 14

What is Waterhouse-Friederichsen syndrome?

Answer 14

Overwhelming septicemic infections caused by Neisseria meningitidis
Massive adrenal hemmorhage w/adrenal insufficency
In children

Question 15

What are the charicteristics of Addison Disease?

Answer 15

Adults who suffer 90% destruction of Adrenal Gland

Question 16

What is the morphology of Addison disease?

Answer 16

Autoimmune Adrenitis 
-small glands
-lipid DEPLETION
-variable LYMPHOCYTIC infiltrate in cortex
SPARES the Adrenal Medulla

Question 17

What is the clinical course of addison disease?

Answer 17

HIGH POTASSIUM!
LOW SODIUM!
Fatigue
Anorexia
Nausea
Cutaneous Hyperpigmant
Hypotension
Elevated ACTH

Question 18

What is the 5x 10% rule in Pheochromocytoma?

Answer 18

5X 10%
10% Malignant
10% Afunctional
10% Bilateral
10% Extra adrenal 
10% Familial

Question 19

What are the charicteristics of a pheochromocytoma?

Answer 19

Variable size
Cut surface is pale gray or brown, hemmorhage, necrosis, cystic change
Highly vascular
Dichromate Fixitave (Zenker) from oxidation of catecholamines
Neuroendocrine markers

Question 20

What is the morphology of Pheochromocytoma?

Answer 20

mature polygonal to spindle shaped medullary-type cells basophilic cytoplasmic gran, trabeculae or small nests

Cellular and nuclear pleomorphism
Can only say malignant if it mets

Question 21

WHat are the clinical features of Pheochromocytoma?

Answer 21

Htn
Tachycrdia
Headache
Apprehension (feel like they're going to die)
Sweaty

Question 22

What is mutated gene in Neuroblastoma?

Answer 22

N-MYC Oncogene

Question 23

What are the clinical features of Neuroblastoma?

Answer 23

Palp abdominal mass
Diastolic HTN
Mets to skin and bones
Inc Vanillylmandelic Acid
metanephrines and Homovanillic acid
BLUBERRY MUFFIN BABY