Pathoma: Adrenal Cortex and Adrenal Medulla Flashcards
True or false: those with Cushing’s develop hypotension.
False! They get hypertension because cortisol upregulates the expression of alpha-1 receptors.
Once again, how does Cushing’s lead to immunosuppression?
- Inhibits PLC A2, leading to decreased vasodilation
- Inhibits IL-2, leading to inhibited T cells
- Inhibits histamine release, inhibiting vasodilation
In which kind of Cushing’s will the adrenal glands become atrophic?
Exogenous (iatrogenic)
What is the most common cause of paraneoplastic Cushing’s?
Small cell carcinoma of the lung
How can you differentiate between ACTH-secreting pituitary adenoma and paraneoplastic ACTH?
Dexamethasone can suppress the pituitary adenoma ACTH but not paraneoplastic ACTH.
Primary hyperaldosteronism presents with low levels of ___________.
renin
In males, “hyper-virilization” presents as _______________.
precocious puberty
Three lab values and signs suggest 21-alpha hydroxylase deficiency: _______________.
hyponatremia, hyperkalemia, and hypotension
How do the adrenal glands appear in Waterhouse-Friederichsen syndrome?
As a “sack of blood” – totally necrotic
Which kind of cancer most often metastasizes to the adrenal glands?
Lung cancer
What is the classic description of pheochromocytoma specimens?
Brown tumor
What enzyme produces vanillylmandelic acid?
Monoamine oxidase (from epinephrine and norepinephrine)
Why is it necessary to give phenoxybenzamine to a patient before removal of pheochromocytoma?
Because squeezing the tumor can cause a surge of catecholamines that can be fatal
What is a common extra-adrenal site for pheochromocytoma?
The bladder wall; this will show up as changes in BP when urinating
What genetic syndromes other than MEN 2A and 2B can predispose someone to pheochromocytoma?
VHL and NF-1
