Sos- Adrenal Disorders

Question 1

____ glands are crucial for homeostasis

Answer 1

endocrine

Question 2

what to be mindful of when removing R kidney

Answer 2

IVC (due to short suprarenal vein)

Question 3

how adrenal medulla is connected to nervous system

Answer 3

innervated by sympathetics and chromaffin cells are stimulated by Ach that is released

Question 4

location of adrenal glands

Answer 4

T12-L1 (retroperitoneal too)

Question 5

zona glomerulosa regulated by

Answer 5

Ang II (RAAS)

Question 6

zona fasciculata and reticularis regulated by what

Answer 6

CRH and ACTH

Question 7

chromaffin cells of medulla are regulated by what

Answer 7

preganglionic sympathetic fibers

Question 8

normally, ____ acts to block inflammation and maintain homeostasis in the body

Answer 8

cortisol

Question 9

Autonomic NS is fast and overrides _____ in moments of fight or flight

Answer 9

endocrine

Question 10

someone with HTN, obesity, advanced diabetes

Answer 10

overriding endocrine system to the point where it’s not functioning anymore

Question 11

21-hydroxylase deficiency is the most common cause

Answer 11

congenital adrenal hyperplasia (bilateral)

Question 12

Most common cause of ambiguous genitalia in female newborns

Answer 12

congenital adrenal hyperplasia

Question 13

75% have salt wasting
Weight loss and dehydration
Adrenal crisis
Elevated 17oh progesterone 48 hrs
Skin pigmentation due to melanocyte stimulating hormone

Answer 13

congenital adrenal hyperplasia

Question 14

what happens in congenital adrenal hyperplasia when the cause is 21-hydroxylase deficiency

Answer 14

decreased cortisol and aldosterone and increased androgens

Question 15

Most common
Infants have salt wasting
Precocious puberty
XX virilization

Answer 15

21-hydroxylase deficiency

Question 16

Answer 16

21-hydroxylase deficiency

Question 17

why does K+ increase with 21-hydroxylase deficiency

Answer 17

b/c aldosterone (and cortisol) are decreased, so that will increase K+ in the serum

Question 18

primary hypothalamic/pituitary disease associated with hypersecretion of ACTH

Answer 18

Cushing Disease

Question 19

____disease results in ____ syndrome and also there can be many causes for the syndrome

Answer 19

Cushing

Question 20

most common exogenous cause of Cushing Syndrome

Answer 20

(medications)/iatrogenic

Question 21

most common endogenous cause of Cushing syndrome

Answer 21

pituitary adenoma (ACTH)

Question 22

ACTH dependent endogenous cause of Cushing syndrome that is not pituitary adenoma

Answer 22

paraneoplastic

Question 23

main cause of cushing syndrome that is ACTH independent

Answer 23

adrenal cortex adenoma

Question 24

Presents with muscle weakness (cortisol metabolizes muscle), HTN, osteoporosis, immune suppression, moon facies truncal obesity and back fat accumulation

Answer 24

Cortisol Syndrome

Question 25

Answer 25

exogenous corticosteroids causing Cushing syndrome

Question 26

Answer 26

primary adrenal adenoma causing cushing syndrome

Question 27

Answer 27

ACTH secreting pituitary adenoma causing Cushing syndrome

Question 28

Answer 28

Paraneoplastic ACTH secretion causing Cushing syndrome

Question 29

most common form of Cushing syndrome

Answer 29

Iatrogenic Cushing Syndrome

Question 30

used to treat autoimmune and inflammatory diseases and causes iatrogenic cushing syndrome

Answer 30

glucocorticoids

Question 31

Answer 31

Pituitary ACTH adenoma causing Cushing's Syndrome

Question 32

Secretion of ectopic ACTH by non-pituitary tumors accounts for 10% of cases of Cushing Syndrome

Answer 32

ectopic paraneoplastic cushing syndrome

Question 33

Associated neoplasms: Small cell carcinoma of the lung Neuroendocrine tumors Medullary carcinoma of the thyroid

Answer 33

paraneoplastic cushing syndrome

Question 34

Answer 34

adrenal cushing syndrome caused by cortical adenoma

Question 35

well circumscribed, cortical, yellow in color

Answer 35

Adrenal adenoma

Question 36

decreased production of cortisol and aldosterone; rare Develops slowly and when the patient has a stress (illness or trauma), symptoms worsen

Answer 36

Addison's disease

Question 37

adrenal insufficiency that worsens due to stress (illness or trauma)

Answer 37

Addison's disease

Question 38

Symptoms: Hypoglycemia, hypotension, fatigue Abdominal pain, nausea, diarrhea and vomiting Salt craving Muscle and joint pain Weight loss Can progress to a crisis state

Answer 38

Addison's Disease

Question 39

Young (30-50) Not diagnosed at birth Stress to body, and then it appears Adrenal glands fail and the individuals cant cope with it and cant make cortisol or aldosterone (electrolytes out of whack)

Answer 39

Adrenal Crisis

Question 40

Clinical presentation: Unexplained hypoglycemia and fever Dehydration, hypotension or shock out of proportion to current illness Abdominal pain, nausea and vomiting with a history of weight loss Hyponatremia, hyperkalemia, hypercalcemia

Answer 40

Adrenal Crisis

Question 41

way too much aldosterone treatment resistant HTN affects kidneys, heart, blood vessels

Answer 41

Conn's disease (primary aldosteronism)

Question 42

2 adrenal medullary tumors

Answer 42

neuroblastoma pheochromocytoma

Question 43

Racoon eyes (cancer metastasized to behind the eyes) + mass in abdomen

Answer 43

neuroblastoma of adrenal medulla

Question 44

Catch before 2 years-----80% survival neural crest derived increased levels of urinary catecholamines

Answer 44

Neuroblastoma

Question 45

Homer-Wright rosettes IHC + for NSE, synaptophysin, chromogranin

Answer 45

Neuroblastoma

Question 46

arises from adrenal medulla or sympathetic chain ganglia

Answer 46

Neuroblastoma

Question 47

Zellballen pattern (nests or balls of cells surrounded by connective tissue)

Answer 47

Pheochromocytoma

Question 48

Rule of 10’s 10% malignant, bilateral, extra-adrenal, calcify, in kids

Answer 48

pheochromocytoma

Question 49

IHC+ for NSE, synaptophysin, and chromogranin Most common tumor in adults, but rare

Answer 49

pheochromocytoma

Question 50

HTN that doesn’t respond to HTN meds Mahogany brown (cortex still functioning) but medulla growing

Answer 50

pheochromocytoma

Question 51

produces large amount of epinephrine

Answer 51

pheochromocytoma

Question 52

Episodic hyperadrenergic symptoms, the 5 P’s: Pressure, increased BP Palpitations, heart tachycardia Pain, headaches Perspiration Pallor

Answer 52

Pheochromocytoma