Pathology

Question 1

cortex hyperfunction causes

Answer 1

hyperplasia
adenoma
carcinoma

Question 2

cortex hypofunction causes

Answer 2

acute (Waterhouse-Friderichsen)

chronic (Addison’s)

Question 3

two causes of adrenocortical hyperplasia

Answer 3

• congenital (AR disorder with deficiency of enzymes, leading to increased androgen production)
• acquired e.g. endogenous (pituitary adenoma- Cushing’s disease), ectopic ACTH, bilateral adrenal enlargement and diffuse or nodular.

Question 4

adrenocortical tumours

Answer 4

usually adults

if young consider Li-Fraumeni syndrome

Question 5

two conditions a functional adrenocortical tumour can cause

Answer 5

1. primary hyperaldosteronism (Conn’s syndrome)

2. Cushing’s

Question 6

describe causes of Conn’s syndrome

Answer 6

diffuse or nodular hyperplasia
usually adenoma
do not suppress ACTH so no atrophy

Question 7

describe causes of Cushing’s around the adrenal gland

Answer 7

exogenous or endogenous (ACTH dependent gives rise to adrenal hyperplasia and independent gives rise to atrophy)

Question 8

causes of adrenocortical hypo function acute

Answer 8

rapid withdrawal of steroid treatment and insufficiency due to stress
haemorrhage in new-born
anti-coagulation
DIC
Waterhouse-Friderchsen

Question 9

chronic causes of adrenocortical hypofunction

Answer 9

Addisons causes include AI adrenalitis, infections (TB, histoplasmosis and HIV e.g. MAI), tumours, amyloid, sarcoidosis and haemochromatosis

Question 10

what innervates the medulla?

Answer 10

pre-sympathetic fibres

Question 11

two types of medullary tumours

Answer 11

neuroblastoma: primitive appearing cell with maturation towards ganglion cells
phaeochromocytoma secretes catecholamines