adrenal.txt

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Author:
nsmallwood
ID:
125038
Filename:
adrenal.txt
Updated:
2011-12-26 16:14:47
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absite
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Description:
adrenal
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  1. arterial supply to adrenal
    • inf phrenic
    • aorta
    • renal
  2. all zones have what enzymes
    21 and 11 beta hydoxylase
  3. glomerulosa secretes what
    aldosterone
  4. steroid pathway
    cholesterol-progesterone-androgens/cortisol/aldosterone
  5. lymphatics of adrenal gland drain where
    subdiaphragmatic and renal
  6. adrenal cortex derived from what embryonic layer
    mesoderm
  7. enzyme only found in medulla
    phenylethanolamine
  8. VMA is a biproduct of
    normetanephrine and metanephrine
  9. mcc of ambiguous genitalia
    21 hydroxylase def
  10. 21 hydroxylase def results in an increase in what hormones
    17-OH Progesterone and testosterone
  11. 11 hydroxylase def results in an increase in
    11 deoxycortisone and testosterone
  12. hormones increased in 17 hydroxylase def
    progesterone and pregnenolone
  13. sxs/characteristics of 17 hydroxylase def
    • HTN
    • ambiguous genitalia in males at birth
    • females miss puberty if estrogens not given to induce
  14. diagnostic w/u for malignant HTN
    • bmp (bun/cr)
    • 24 hr urine of epi, ne, vma meta/normetanephrine and cortisol
    • serum nephrines, cortisol, aldosterone, renin
    • u/s kidneys and carotids
    • CT chest/abd/pelvis
  15. common mets to adrenal
    lung breast melanoma renal
  16. chararcteristics which make an adrenal incidentaloma benign appearing
    • < 10 hounsfield, lipid based
    • well circumscribed
  17. FNA indicated for which incidentalomas
    • >10 HU
    • CT washout < 50% at 10min
    • young age
  18. surgery indicated for what adrenal masses
    • > 5cm
    • ominous characteristics
    • functional tumor
    • enlarging
  19. what are some ominous characteristics
    • complex
    • hemorrhagic areas, irregular margins, heterogeneous
    • dense
    • vascular
  20. most sensitive for cushing syndrome
    24hr urine free cortisol
  21. next step if 24hr urine cortisol is high but ACTH is low
    get abd ct
  22. how can you differentiate hyperplasia from adenoma
    NP-59 scintigraphy
  23. #2 noniatrogenic cause of cushings
    ectopic
  24. sxs of adrenocortical CA
    virilization and precocious puberty in children

    feminization and masculinization, HTN abd pain, weight loss in adults
  25. inhibits cholesterol formation
    aminogluethimide
  26. medical agents used in adrenal pathology
    • metyrapone
    • aminoglutethimide
    • ketoconazole
    • mitotane
  27. mc side for pheo
    right
  28. 10% rule
    • extraadrenal
    • familial or MEN
    • children
    • cancer
    • bilateral
  29. genetic syndromes with pheo
    • MEN 2A/B
    • vHL
    • NF 1
    • familial paraganglioma
    • tuberous sclerosis
    • Sturge-Weber
  30. MIBG is an analogue of
    norepinephrine
  31. metabolite that is most specific
    VMA
  32. other sites to look for pheo
    • aortic bifurcation
    • sympathetic chain
    • vertebral bodies
    • bladder
    • opposite adrenal
  33. tx HTN during removal
    esmolol or nipride
  34. syndrome associated with increase secretion of renin
    Bartters
  35. next step once lab values characteristic of hyperaldosteronism
    • aldosterone to renin ratio
    • if 15-20:1 then proceed with
    • salt suppression test
  36. mcc of hypoaldosteronism
    diabetic neuropathy causing hypo-reninemic hypolaldosteronism
  37. what sign distinguishes chronic versus acute adrenal insufficiency
    hyperpigmentation
  38. characteristics of vHL
    • hemangioblastomas of cerebellum/spinal cord or retina
    • renal angioma or renal cell CA
    • pheo
  39. what characterizes the carney complex
    • PR-KAR tumor suppressor
    • myxomas
    • skin hyperpigmentation
    • endocrine overactivity

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