Surgery: Adrenal gland
Terms
undefined, object
copy deck
-
collections of what tissue occur in the paraganglia, the mediastinum, and the Organ of Zuckerkandl (no kidding)
what tissue may occur in the ovary or testis or near the kidneys -
adrenal medullary tissue
adrenocortical rests - where does the adrenal medulla come from? the cortex?
-
medulla from ectodermal neural crest cells
cortex from mesodermal cells near genital ridge - comibined weight of the adrenal glands?
- 10kg
- three zones of the adrenal cortex and what do they make
-
zonula glomerulosa- aldosterone (mineralocorticoid)
zonula fasciculata- glucocorticoids (cortisol)
zonula reticularis- androgens and estrogens
GFR- Salt Sugar Sex - three arteries that supply the adrenal glands
-
phrenic
aorta
renal -
right adrenal vein epties into the...
the left into the... -
right into the vena cava
left into the renal vein - why does venous blood from the adrenal cortex containing glucocorticoids drain into the medulla?
- to activate the enzyme that methlyates norepi to epi
- what does urinary 17-hydroxycortcosteroids measure compared to urinary free cortixol?
- the first measures glucocorticoid production and metabolism, the latter is more accurate in states of hypercortisolism
-
renin is made by the ___ cells of the kidney.
Renin converts "A" to "B".
"B" is converted to "C" by ACE.
"C" stimulates the adrenal cortex to release aldosterone -
juxtaglomerular cells
"A"= angiotensinogen (made in liver)
"B"= angiotensin I
"C"= angiotensin II - three things made in the adrenal medulla
- norepi, epi, dopamine
-
female with pseudohermaphroditism or male with macrogenitosomia precox
with or without a salt-losing state causing vascular collapse
What is the deficiency? -
congenital virilizing adrenal hyperplasia
C-17 for salt sparing
C-21 for salt wasting
(remember that there is a cortisol deficiency --> increases ACTH --> adrenal hyperplasia --> cortisol precursors shunted into androgen production) - What do patients with Addison's disease need during surgery to survive
- adrenalcorticoid support
- what is the most common cause of adrenal insufficiency (Addison's) encountered in the surgical patient
- ACTH suppression by corticosteroid drugs
- Manifestations of cortisol deficiency (at least 3)
-
anorexia/malaise/weight loss
poor stress tolerance
hypoglycemia
hypotension
hyperpigmented skin - does aldosterone deficiency accompany primary or secondary adrenal insufficiency
- primary (not really under feedback control of ACTH)
- three signs of aldosterone deficiency
-
hypovolemia
hyponatremia/hyperkalemia
azotemia/acidosis - if patient's have taken steroids within ___ (what time frame) what test should be done to determine if they have sufficient adrenocortical reserve
-
within 1 year
ACTH stimulation test -
What is more common: ACTH independent Cushings (adenoma/carcinoma/nodular dyspasia/ectopic cortisol tumors)
ACTH dependent Cushing's (ectopic ACTH producing tumors) -or-
Pituitary Cushing's (ACTH overproduction by pituitary) -
Puitary Cushing's = Cushing's Disease
(70%) - test to distinguish ectopic from pituitary cushing's syndrome
- high-dose dexamethasone suppression test
- what is the syndrome where after a bilateral adrenalectomy, an ACTH secreting tumor develops
- Nelson's syndrome
- what is conn's syndrome and what is the MCC
- primary hyperaldosteronism; unilateral adrenal adenoma
- how do you differentiate primary from secondary hyperaldosteronism
-
in primary- renin levels are normal to low
in secondary they are elevated (from decreased pressures juxtaglomerular cells in kidney) - what is the medical management of primary hyperaldosteronism
- sprinolactone
- are most pheochromocytoma's benign or malignant
- benign
- rule of 10's for pheochromocytomas
-
10% malignant
10% bilateral
10% extra-adrenal
10% multiple
10% children
10% familial - dx of pheo's
-
urinary metanephrine and VMA
consider fractionated plasma and urinary catecholamines - what is achieved first during surgery for pheo's; alpha or beta blockade
-
alpha- phenoxybenzamine begun 2 weeks before;
beta- propranolol begun 3 days before - course of action with an adrenal incidentaloma
-
most are adenomas
patients should get repeat CT or MRI in 6 mo.
If mass is enlarging or >6cm --> surgical excision