Pathology of the Adrenal II

Question 1

adrenal crisis

Answer 1

primary acute adrenocortical insufficiency

Question 2

addison disease

Answer 2

primary chronic adrenocortical insufficiency

Question 3

secondary adrenocortical insufficiency

Answer 3

low pituitary function

Question 4

rapid withdrawal of steroids

Answer 4

primary acute adrenocortical insufficiency can occur

Question 5

massive adrenal hemorrhage

Answer 5

damages the adrenal cortex causing primary acute adrenocortical insufficiency

newborns - following prolonged and difficult delivery with considerable trauma and hypoxia

Question 6

patients on anticoagulant therapy

Answer 6

primary acute adrenocortical insufficiency

Question 7

waterhouse friederichsen syndrome

Answer 7

complication of disseminated bacterial infection

leads to primary acute adrenocortical insufficiency

massive bilateral adrenal hemorrhage

Question 8

infection, hypotension, widespread purpura

Answer 8

disseminated intravascular coagulation

can lead to waterhouse friederichsen syndrome

Question 9

common infection with waterhouse friedrichsen

Answer 9

neisseria meningitidis

psendomonas
pneumococci
h. flu
staphylococci

Question 10

addison disease

Answer 10

primary chronic adrenocortical insufficiency

autoimmune adrenalitis

Question 11

autoimmune polyendocrine syndrome

Answer 11

type 1 and type 2

main cuases of autoimmune adrenalitis

Question 12

infection with addison

Answer 12

tuberculosis and fungi

primary chronic adrenocortical insufficiency

Question 13

metastatic neoplasms

Answer 13

may involve adrenals
-lead to addison disease

majority lung and breast**

Question 14

tuberculous and fungal disease of adrenal

Answer 14

granolomatous inflammation

Question 15

priamry autoimmune adrenalitis

Answer 15

irregularly shrunken glands

difficult to identify in suprarenal adipose tissue

Question 16

metastatic carcinoma to adrenal

Answer 16

enlarged and obscured architecture

Question 17

progressive weakness and fatigability

Answer 17

initial manifestations of addisons

doesn’t come to attention until glucocorticoids and mineralocorticoids are significantly decreased

Question 18

anorexia, nausea, vomiting, weight loss, diarrhea

Answer 18

seen in addisons

Question 19

hyperpigmentation

Answer 19

seen in addisons

-sun exposed areas and pressure points

Question 20

cause of hyperpigmentation in addisons

Answer 20

elevated POMC from anterior pituitary

is precursor of both ACTh and MSH

Question 21

hyperkalemia, hpyonatremia, volume depletion, hypotension

Answer 21

seen in addisons

potassium retention and sodium loss with decreased mineralocorticoids

Question 22

waterhouse friedrichsen

Answer 22

acute adrenocortical insufficiency

Question 23

addison

Answer 23

chronic adrenocortical insufficiency

Question 24

APS1 mutation

Answer 24

AIRE

autoimmune attack against multiple endocrine organs and auto Abs against IL-17

Question 25

secondary adrenocortical insufficiency

Answer 25

hypothalamus and pituitary dysfunction reduced ACTH NO hyperpigmentation** -no elevation of MSH

Question 26

no hyponatremia or hyperkalemia

Answer 26

in secondary adrenocortical insufficiency -because near-normal aldosterone synthesis just no cortisol and androgen output

Question 27

secondary hypoadrenalism morph

Answer 27

decreased in size and still yellow color

Question 28

adrenocortical neoplasms

Answer 28

adults - adenomas and carcinomas equally children - more carcinomas

Question 29

TP53 mutation

Answer 29

li fraumeni syndrome familial cancer syndromes with adrenocortical carcinomas

Question 30

epigenetic imprinting disorder

Answer 30

beckwith wiedemann syndrome familial cancer syndromes with adrenocortical carcinomas

Question 31

virilizing neoplasm of adrenal

Answer 31

carcinoma

Question 32

hyperaldosteronism and cushing causing adrenal neoplasm

Answer 32

functional adenoma

Question 33

bilateral adrenal enlargement

Answer 33

mets until proven otherwise

Question 34

functionality of adrenocortical neoplasms

Answer 34

determined by clinical evaluation and measure of hormones and hormone metabolites

Question 35

majority of adrenocortical adenomas

Answer 35

incidentalomas

Question 36

adrenocortical carcinoma

Answer 36

associated with virilism large and invasive lesions

Question 37

lung cancer

Answer 37

mets to adrenals

Question 38

metastasis to adrenal

Answer 38

more common than primary adrenocortical carcinoma

Question 39

53yo M, feels bad, weight loss, smoker, bronchogenic lung cancer

Answer 39

b/l mets to adrenals

Question 40

adrenal incidentaloma

Answer 40

incidental finding in asymptomatic patient majority - of no clinical importance - nonsecreting cortical adenomas

Question 41

needle biopsy of adrenal

Answer 41

NO - lots of blood supply

Question 42

chromaffin cells

Answer 42

in adrenal medulla

Question 43

adrenal medulla products

Answer 43

catecholamines - NE and E

Question 44

paraganglion system

Answer 44

neuroendocrie cells dispersed in extra-adrenal system of clusters and nodules bronchiomeric intravagal aorticosympathetic

Question 45

pheochromocytoma

Answer 45

neoplasm of chromaffin cells adrenal medulla noeplasm

Question 46

neuroblastoma

Answer 46

neuronal neoplasm - in children

Question 47

53yo intermittent HA, sweating, tremors, HTN, metanephrines on urine

Answer 47

pheochromocytoma

Question 48

surgically correctable HTN

Answer 48

pheochromcytoma also - renal artery stenosis

Question 49

rule of 10s**

Answer 49

for pheochromocytoma 10% extra-adrenal - paraganglionomas 10% bilateral 10% biologically malignant 10% not associated with HTN

Question 50

HTN with pheochromocytoma

Answer 50

2/3 have paroxysmal episodes

Question 51

mutations for pheochromocytoma

Answer 51

``` RET NF1 VHL SDHD SDHC SCHB ```

Question 52

adrenal colors**

Answer 52

yellow - cortex | red - medulla

Question 53

zellballen

Answer 53

in pheochromocytoma

Question 54

paroxysmal HTN in pheochromocytoma

Answer 54

precipitated by stress, exercise, postural changes, palpation in region of tumor

Question 55

catecholamine cardiomyopathy

Answer 55

cardiac complications with pheochromocytoma myocardial instability and ventricular arrhythmias

Question 56

diagnosis of pheochromcytoma

Answer 56

increased urinary catecholamines, VMA, and metanephrines**

Question 57

tx of pheochromocytoma

Answer 57

benign tumors - surgical excision adrenergic block agents to prevent HTN crisis