Retroperitoneal Pathology Ch 16 Flashcards
Adrenal cortical syndromes..
- Addison’s disease
- adrenogenital syndrome/adrenal virilism
- Conn’s syndrome (aldosteronism)
- Cushing’s syndrome
- Waterhouse-Friderishsen syndrome
- affects males and females equally
- adrenocortical insufficiency
- hyopfunction of adrenal gland**
- atrophy of the adrenal cortex with decreased production of cortisol and sometimes aldosterone
Addison’s disease
causes and examples of Addison’s disease
- autoimmue process
- tuberculosis (TB)
- inflammatory process
- primary neoplasm
- fungal infection (histoplasmosis)
- adrenal hemorrhage (anticoagulation therapy)
- bilateral mets
- results in..
- oversecreation of sex hormones and adrenal androgens (hirsutism)
- congenital causes (impaired synthesis of cortical and aldostrone)
- acquired causes (tumors)
- adrenals are symmetrically enlarged
adrenogenital syndromes
-hyperaldosteronism
most commonly due to cortical adenoma
-adenomas are more common with females and tend to be small, less than 2cm
- hyperplasia is more common in males
-adrenal carcinoma is a less frequent cause
Conn’s Syndrome
clinical symptoms of Conn’s syndrome
muscle weakness, hypertension, and abnormal electrocardiogram
- hypercortisolism
- causes … adrenal hyperplasia, cortical adenoma, adrenal carcinoma, increase in ACTH-produced by pituitary gland(resulting from pituitary adenoma)
Cushing syndrome
-truncal obesity, pencil thin extremities, “buffalo hump”, “moon face”, hypertension, renal stones, irregular menses and psychiatric disturbances
Cushing syndrome
results from bilateral hemorrhage into the adrenal glands and caused by severe meningococcal infection
Waterhouse-Friderinchsen syndrome
-uncommon, usually small and asymptomatic, females affected more than males, usually unilateral found incidentally, may become calcified
adrenal cysts**
- in adult is usually caused by severe trauma or infection
- most common in the neonate, caused by the large size of the adrenals and high degree of vascularity
- sonographically varies depending upon the age of the hemorrhage
Adrenal hemorrhage
- can account for hypersecretion of cortical hormones
- may be hyperfunctioning or non hyperfunctioning
- may cause cushing’s syndrome, Conn’s syndrome, or adrenogenital syndrome
- solid, well-defined, and round
Adrenal Adenomas
-rare, highly malignant tumors with poor prognosis
may be hyperfunctional or nonfunctional
-difficult to differentiate from benign adenoma
larger, 3-6cm
-typically well-defined homogenous mass when small
-larger tends to have necrosis, hemorrhage or calcifications
-(rt) tumor may invade IVC and renal veins
Adrenal Malignant Tumors
- commonly caused by primary lung, breast, stomach, colon, or kidney
- metastases to the adrenal gland typically cause adrenal insufficency
- differentiation of common benign adenoma is sometimes difficult when there is no other evidence of mets and the adreanl mass is unilateral
Adrenal Mets
- orginate in the adrenal medulla
- secretes epinephrine and norepinephrine in excessive amounts
- these hormones produce hypertension
- associated with severe headaches, tachycardia and palpitations, and excess perspiration
Pheochromocytoma
associated with multiple endocrine neoplasm (MEN) and Von Hippel-Lindau disease
Pheochromocytoma
- majority are benign
- usually unilateral, large bulky tumors with a variety of sonographic patterns
- ectopic adrenal pheochromocytomas are rare but may occur anywhere along the sympathetic nerve chain located parallel to the aorta
Phenochromocytoma
- highly malignant tumors of the medulla
- most common tumor of infancy**
- most common malignancy of the adrenal glands in childhood**
- presents as an abdominal mass in childhood
- typically seen as an echogenic mass with poorly defined margins
- must be differentiated from Wilm’s tumor (nephroblastoma), and hepatobalstoma
Neuroblastoma
- benign, nonfunctioning mas that contains both fat and bone marrow elements
- hyperechoic mass most commonly seen in the adrenal bed
retroperitoneal fat myelipoma
- originates independently within the retroperitoneum
- most are malignant**
- types: lyphoma, leiomyoscarcoma, fibrosarcomas and rhabdomyosarcomas
primary retroperitoneal tumors
-most common primary retroperitoneal tumor
lymphoma
- complex sonographic pattern
- liposarcomas- highly reflective due to fat
leiomyosarcoma
-may mimic lymphomas and extends across midline
fibrosarcomas and rhabdomyosarcomas
-refers to enlargement of lymph nodes
lymphadenopathy
