ABSITE ch 21 adrenal gland.txt

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alshada
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ABSITE ch 21 adrenal gland.txt
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2010-01-11 11:06:16
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adrenal ABSITE
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ABSITE ch 21 adrenal
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  1. Origin of superior adrenal artery
    Inferior phrenic artery
  2. Origin of middle adrenal artery
    Aorta
  3. Origin of inferior adrenal artery
    Renal artery
  4. Destination of left adrenal vein
    Left renal vein
  5. Destination of right adrenal vein
    IVC
  6. Surgical indications for adrenal mass
    >4-6cm, functioning, enlarging
  7. Labwork after asymptomatic/incidental adrenal mass is found (3 categories)
    Urine metanephrines/VMA/catecholamines, plasma rennin/aldosterone, CXR/stool guiac/colonoscopy/mammogram
  8. Common tumors that metastasize to adrenals (4)
    Breast, melanoma, renal, lung
  9. Layers of adrenal cortex (from outside to inside)
    Glomerulosa, fasiculata, reticularis
  10. Primary hormone secreted by adrenal glomerulosa
    Aldosterone
  11. Primary hormone secreted by adrenal fasciculate
    Glucocorticoids
  12. Primary hormone secreted by adrenal reticularis
    Androgens/estrogens
  13. Nerve innervation to adrenals
    Cortex (none) and medulla (splanchnics)
  14. Hormone causing adrenal cortisol release
    ACTH
  15. Hormones that stimulate aldosterone release
    ACTH, angiotensin II, hyperkalemia
  16. Actions of aldosterone (4)
    Inc renal Na resorption, inc potassium, H+, and ammonia secretion
  17. Enzyme defect in cortisol synthesis causing aberrant sex hormone excretion
    Congenital adrenal hyperplasia
  18. Enzyme deficiency causing precocious puberty in males and virilization in females , and increase in 17-OH progesterone
    21-hydroxylase deficiency
  19. Enzyme deficiency causing precocious puberty in males, virilization in females, and increase in 11-deoxycortisone
  20. Enzyme deficiency causing ambiguous genetalia in males at birth
    17-hydroxylase deficiency
  21. Disease with HTN from sodium retention hypokalemia, weakness, polydipsia and polyuria
    Conn?s syndrome (hyperaldosteronism)
  22. Causes of primary Conn?s syndrome (3)
    Adenoma (#1), hyperplasia, cancer
  23. Causes of secondary Conn?s syndrome (6)
    CHF, renal artery stenosis, liver failure, pregnancy, diurectics, renin-secreting tumor
  24. Diagnostic tests for primary Conn?s (5)
    Urine aldosterone after salt load (will be high), serum K, urine K, serum Na, plasma renin activity
  25. Localizing studies for Conn?s syndrome
    NP-59 scintigraphy, adrenal vein sampling, MRI
  26. Diagnostic studies indicating cancer in adrenal mass + Conn?s syndrome
    Suppressed aldosterone and renin in upright position, high 18-OH corticosterone
  27. Diagnostic studies indicating hyperplasia in adrenal mass + Conn?s syndrome
    Increased aldosterone and renin in upright position, low 18-OH corticosterone
  28. Adrenal disease causing hypotension, fever, lethargy, abdominal pain, dec mental status
    Adrenal insufficiency (Addison?s disease)
  29. Most common cause of adrenal insufficiency
    Steroid withdrawl
  30. Most common cause of primary renal insufficiency
    Autoimmune disease
  31. Diagnostic studies for adrenal insufficiency/Addisons (3)
    Serum Na, serum K, ACTH stimulation test
  32. Diagnostic study for Cushing syndrome
    24 hour urine cortisol, dexamethasone suppression test
  33. Most common noniatrogenic cause of Cushing?s
    Pituitary adenoma
  34. #2 iatrogenic cause of Cushings
    Ectopic ACTH from tumors (SCLC)
  35. High cortisol, not suppressed with dex test: diagnosis?
    Ectopic ACTH or adrenal adenoma
  36. High cortisol, suppressed with dex test: diagnosis?
    Pituitary adenoma
  37. Treatment of adrenal hyperplasia
    Bilateral adrenalectomy
  38. Drugs for ectopic ACTH or adrenal cancer that inhibit steroid formation (2)
    Ketoconazole, metyrapone
  39. Drugs for ectopic ACTH or adrenal cancer that inhibit cholesterol conversion
    Aminoglutethimide
  40. % of adrenal carcinomas that are functioning
    50
  41. Treatment of adrenal carcinoma
    Radical adrenalectomy, mitotane (adrenal-lytic)
  42. Rate limiting step in creation of catecholamines
    Tyrosine hydroxylase
  43. Enzyme that converts norepinephrine to epinephrine
    PNMT
  44. Only tumor that produces epinephrine
    Adrenal pheochromocytoma
  45. Enzyme that converts norepinephrine to normetanephrine and epinephrine to normetanephrine
    MAO (monoamine oxidase)
  46. Most common site of extra-adrenal rest of neural crest tissue
    Organ of Zuckerkandl
  47. Adrenal tumor arising from ectopic neural crest cells causing HTN, headache, diaphoresis, palpitations
    Pheochromocytoma
  48. Congenital syndromes that pheochromocytoma is associated with (5)
    MEN 2a, MEN 2b, von Recklinghausen?s, tuberous sclerosis, Sturge-Weber
  49. Diagnostic studies for pheo
    Urine metanephrines, VMA
  50. Localization study for pheo
    MIBG scan
  51. Preoperative drugs for pheochromocytoma
    Alpha blocker THAN beta blocker
  52. Order of vessel ligation in pheochromocytoma
    Vein first, then arteries
  53. Drug inhibiting tyrosine hydroxylase causing decreased catecholamine synthesis
    Metyrosine
  54. Other sites of pheochromocytomas (4)
    Vertebral bodies, opposite adrenal, bladder, aortic bifurcation
  55. Rare, benign asymptomatic tumor of neural crest origin in the adrenal medulla
    Gaglioneuroma

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