PEDIATRIC Section 11: Adrenal Flashcards
The most common extra-cranial solid childhood malignancy.
Neuroblastomas
They typically occur in very young kids (you can be bom with this
95% of neuroblastoma occur before age?
10
WHere does Neuroblastoma occur?
abdomen more than the thorax
adrenal 35%
retroperitoneum 30%
posterior mediastinum 20%
neck 5%).
Neuroblastoma is stage 3 if?
it CROSSES the MILINE + Contralateral positive Nodes
Stage 4 neuroblastoma
< 1 y.o.
Distal mets
Skin - Liver - Bone MARROW
Excellent prognosis
Does Stage 4 neuroblastoma go to the cortex?
NOPE. It;s the marrow
Nuroblastoma Associations
- NF-1, Hirschsprungs, DiGeorge, Beckwith Wiedemann
- Most are sporadic
paraneoplastic syndrome associated with neuroblastoma.
Opsomyoclonus (dancing eyes, dancing feet)
common way for orbital neuroblastoma mets to present
“Racoon Eyes”
Describe neuroblastoma bone mets
Neuroblastoma bone mets are on the “lucent metaphyseal band DDx”
Sclerostic bone mets in Neuroblastoma are common?/uncommon?
UNCOMMON
What are eleveated in nueroblastoma
Urine chatecolamines
< 2y.o + Calcifications + Vessel encasement (doesn’t invade) + Poor marin + Bone mets
Neuroblastoma
Around 4y.o. (never 2 months + Calcify rarely (10%) + INVADES vessels (no encasement ) + Well circumscribed + No Bone mets (unless clear cell) + Prefers lungs
WIlms
Neonatal Adrenal Hemorrhage can occur in what setting?
birth trauma or stress.
Neonatal adrenal hemorrhage is associated with what hemorrhage?
Scrotal hemorrhage
the most common cause of an adrenal “mass” in a neonate
Adrenal hemorrhage
Whay does 70% of adrehnal hemorrhages occur on the right?
due to the compression of the right adrenal gland between the liver and right kidney
If the hemorrhage occurs on the left - think?
Why?
Think about renal vein thrombosis
left adrenal vein drains into the renal vein — where as the right one dumps into the IVC
Renal vein thrombosis (and overall adrenal hemorrhage) is more common in the infants of what?
Diabetic mothers
“Next Step” Adrenal mass of a neonate.
followup ultrasound imaging.
With follow up imaging you should see something like this (depending on the interval);
Time 0: Adrenal hemorrhage is a well-defined ~ inhomogeneous isoechoic mass, no doppler flow
Time 1: Liquefaction - mass becomes more complex, strands and bands - classically starts to get a hypo echoic / cystic center area.
Time 2: Size continues to decrease
Time 3: Calcifications occure (peripheral curvilinear)
Time 4: Normal adrenal gland and size + calcifications persist
21 alpha hydroxylase deficiency causes?
Congenital adrenal hyperplasia
