peds- adrenal glands Flashcards
Normal apperance of the adrenal gland?
- Lie above the kidneys in an anteromedial position
- Form a cap or inverted V over the kidneys
- Most easily seen until about 1mo of age
- Rt gland seen better than Lt
- Have a V or Y configuration
what is the Neonatal period?
large adrenal gland due to the presence of fetal zone in the cortex, that involutes after birth
Three factors that make adrenals easy to visualize in neonates?
- Proportionally larger than adult glands (1/3 vs 1/13 of kidney size)
- Scarcity of perirenal fat allows better image resolution than the abundance of fatty tissue in the adult
- Closer to the skin surface, which permits the use of higher frequency transducers
ultrasound of adrenals challenges?
- small size in older children
- obesity
- overlying bowel gas
Adrenal Gland Function?
- 2 endocrine glands in one organ
- important hormone secretion function
- essential to life
Hormones secreted by Adrenal Cortex?
- outer
- middle
- inner
outer:
- mineralocorticoids (aldosterone)
middle:
- glucocorticoids (cortisol/cortisone.hydrocortisone)
Inner:
- gonadocorticoids
(estrogen and testosterone)
Adrenal Gland Function- medulla?
- Secretes catecholamines
- Epinephrine (adrenalin)(80%)
- Norepinephrine (noradrenalin)
During a stress hormones accelerate heart rate, increase blood pressure, accelerate respiratory rate, increase blood sugar levels, etc.
what is this phsiological response known as?
fight or flight
Ganglioneurblastoma and ganglioneuroma
are seen in what age group?
older children
- average 7 years old
Ganglioneurblastoma and ganglioneuroma
characterisitics?
- incidental finding on routine exams or chest x-rays
- moderately malignant to completely benign
- might be an asymptomatic mass
Ganglioneurblastoma and ganglioneuroma
can be found where?
- adrenal glands and in nervous system
Neuroblastoma clinically?
Palpable mass Fever Weight loss Irritability Hypertension Abdo distention Spreads rapidly to other organs
Neuroblastoma prognosis?
- Early detection – better outcome
- Prognosis better in neonates and young infants vs. older children
- These tumors can also arise from sympathetic ganglia in abdo, pelvis, chest, neck
Neuroblastoma sono features?
Echogenic mass Poorly defined borders Calcifications with PAS Areas of necrosis (hypoechoic) Displaced kidney Mets – often at presentation
Adrenocortical Carcinoma symptoms?
Virilizing symptoms Abdo mass Deepened voice Hypertension Seizures
Highly malignant
Invasive (LNs, veins)
Mets (liver, lungs, bone, brain)
Adrenocortical Carcinoma sono features?
- Echogenic
- Complex/heterogenous - from necrosis and hemorrhage
May have:
- Thick echogenic capsule
- Calcifications
Pheochromocytoma?
- Rare
- Functioning
- Originates in medulla
- Can be found outside of adrenals along the sympathetic chain
Pheochromocytoma clinical presentation?
- ↑ BP
- Headache
- Palpitations
- Diaphoresis
Pheochromocytoma sono features?
- Solid
- Mixed – solid and cystic
- Cystic
- Large lesions have hemorrhage and necrosis
- Almost always – sharply encapsulated
Adrenal hemorrhage causes?
- Prematurity
- Neonatal sepsis or hypoxia
- Birth trauma
- Adrenal glands large in size and have ↑ vascularity
Adrenal hemorrhage clinically?
- Palpable mass
- Anemia
- Jaundice (resorption of excess Hb)
- ↓ BP
- Scrotal discoloration in boys
Adrenal hemorrhage sono features?
- Echogenic mass
- Anechoic if liquefies
- Follow up scans to see change and establish disease
- In a few weeks or months Ca2+ appears
Adrenal Cysts?
- Rare
- Unilateral
- Mainly asymptomatic , benign
- May occur secondary to hemorrhage
adrenal cysts sono features?
- Anechoic
- Well-defined walls
- Enhancement
- Displace the kidney inferiorly
- Can contain debris
- Must be distinguished from renal cysts, - hydronephrosis, splenic and pancreatic cysts
Adrenal Abscess?
- Rare condition
- Complication of hemorrhage
- Sonographically difficult to differentiate from adrenal hemorrhage
- Echogenic debris
- Fluid-debris level
adrenal abscess clinically?
signs and symptoms of infection
Congenital Adrenal Hyperplasia (CAH)?
Autosomal-recessive condition caused by an enzyme deficiency in the adrenal cortex and accumulation of androgenic precursors
Congenital Adrenal Hyperplasia (CAH) clinical signs?
- virilism in newborn females
- premature masculinization in males
- advanced somatic development in both sexes
Congenital Adrenal Hyperplasia diagnosis?
biochemical test
Congenital Adrenal Hyperplasia sono features?
- Increased adrenal size
- Enlargement involves mostly the cortex
- Preserved sonographic appearance
- Cerebriform appearance
Measurements suggestive of CAH?
Length > 20mm
Width > 4mm
Renal agenesis aka?
laying-flat adrenal
renal agenesis causes?
Renal agenesis
Potter syndrome
Ectopic kidney
