Pathology: Adrenal Glands Flashcards
The healthy adrenal gland is approximately how big ?
2.5-3 cm
What are the two main subdivisions of the Adrenal Gland ?
Cortex
Medulla
What are the three layers of the Cortex ?
Zona Glomerulosa
Zona Fasciculata
Zona Reticulata
What does the Zona Glomerulosa produce ?
Mineralocorticoids (Aldosterone)
What does the Zona Fasciculata produce ?
Glucocorticoids
What does the Zona Reticulata produce ?
Sex hormones
What is Cushing Disease ?
Excess ACTH production in the anterior pituitary that will lead to increased cortisol production
Is Cushing Disease a primary or secondary endocrine dysfunction ?
Secondary
What is Cushing Syndrome ?
Anything that can lead to increased glucocorticoid levels (Cushing Syndrome is Hypercotrisolism and can be exogenous or endogenous.)
( In fact, the Syndrome includes Cushing Disease, which only involves hypercortisolism caused by pituitary hyper production of ACTH)
Who are affected more by Cushing Disease: Men or Women ?
Women
Cushing Disease is caused by adenoma of the pituitary gland leading to increased release of ACTH. Are they micro or macro adenomas ?
Microadenoma.
What is seen in the Adrenal glands of those with Cushing Disease (pituitary ACTH secreting micro adenoma) ?
Varying degrees of Nodular cortical hyperplasia.
What percent of Cushing SYNDROME patients have a ACTH secreting tumor that is NOT found within the adrenal gland ? (ectopic secretion)
10%
Where is the main site of Non-renal ACTH secreting tumor ? (ectopic secretion)
Lung (Small Cell Carcinoma of the Lung)
Other ectopic sites include: Carcinoids, medullary carcinomas of the thyroid, and islet cell tumors
Leads to bilateral cortical hyperplasia of the adrenals
Who is most likely to have an ectopic ACTH producing tumo ?
MEN ! (40-50 yo)
What is the morphological ‘change’ called in the pituitary which produces homogeneous and paler cells in the course of Cushing Syndrome ?
“Crooke Hyaline Change”
What are the two classification of ‘endogenous’ causes of Cushing syndrome ?
ACTH Dependent (Production of Corticosteroids is reliant on ACTH, typically caused by an ACTH secreting adenoma of the pituitary)
ACTH Independent (Tumor of the adrenals which produces Corticosteroids w/o need for ACTH stimulation)
Endogenous: occurs within the axis of the Hypothalamus/Pituitary/Adrenals. (anything outside of this is considered exogenous: drugs, ectopic tumors etc.)
What is the MOST COMMON cause of Cushing Syndrome ?
According to Pathoma and the Cleveland Clinic, it is Exongenous Corticosteroid Drug use. (iatrogenic)
Is Primary pigmented nodular adrenocortical disease malignant ? How can you tell
No, just looks nasty with lipofuscin rich granules
you can tell because most malignancies have a ‘desmoplastic’ look, meaning they have an outer ring that looks blue/ purple due to NEW collagen being placed down to wall off tumor
How large do adrenal glands get in Cushing Syndrome (secondary causes) ?
Usually up to 10-12 g (have been shown to get up to 30 but very unlikely)
What does the adrenal cortex often look like when examined in a patient with cushing syndrome ?
Diffusely thickened and variably nodular
How does the zona reticularis look with Cushing Syndrome ?
LIPID POOR
Cushings often shows compact eosinophilic cells surrounded by an outer zone of what kind of cells ?
vacuolated lipid rich cells
Primary adrenocortical adenomas
are more prevalent in which demographic ?
More common in women in their 30s to 50s
What color are primary adrenocortical adenomas ?
yellow
Do primary adrenocortical adenomas have a capsule ?
Yes !! Differentiate between them and carcinoma
How much Do primary adrenocortical adenomas weigh ?
Less than 30 g
primary adrenocortical adenomas resemble cells from which cortex ‘zone’ ?
Zone Fasciculata
Do adrenocortical carcinomas have a capsule ?
Nope !
How much do adrenocortical carcinomas weigh ?
200-300 g!!
Where does the weight gain seen in Cushings distribute ?
Trunk , Back (buffalo hump) and Face (moon facies)
Are patients with Cushings hypo or hypertensive ?
Hyper
Primary Hyperaldosteronism is considered Conn Syndrome when ….
It involves a primary adenoma that secretes Aldosterone
What is the Most common manifestation of Primary Hyperaldosteronism ?
HTN