Anatomy and Physiology
Adrenal insufficiency
Cortex and Medulla
Surgical principles
Everything else
100
How many adrenal arteries and veins are there per side?
3 arteries, 1 vein
100
_ syndrome is a condition characterized by pituitary infarction following postpartum hemorrhage
Sheehan
100
Screening test of choice in suspected pheochromocytoma?
plasma free metanephrines
100
What is the most important predictor of survival in resectable adrenal carcinoma?
adequacy of resection
100
Diagnostic tests for Cushing syndrome? (3)
1mg overnight dexamethasone suppression test, salivary cortisol, 24hr urinary-free cortisol excretion
200
The right adrenal vein drains into the _ while the left adrenal vein drains into the _
vena cava; left renal vein
200
_ adrenal insufficiency is due to low ACTH, often due to endogenous steroid use
Secondary
200
Most common cause of Cushing syndrome
pharmacologic glucocorticoid use
200
Open surgical resection is indicated over laparoscopy in what size adrenal tumor?
>8cm
200
Mechanism of phenoxybenzamine?
nonspecific, noncompetitive (irreversible), long-acting (half-life of 24 hours) α-adrenergic antagonist
300
What are the three zones of the cortex and what do they secrete?
Glomerulosa - aldosterone
Fasciculata - cortisol
Reticularis - androgens (DHEA)
300
This type of adrenal insufficiency is characterized by deficient glucocorticoids and mineralocorticoids, often from an autoimmune process
Primary (Addison disease)
300
Most common site of extra-adrenal pheochromocytomas?
Organ of Zuckerkandl (paraganglion tissue between IMA and aortic bifurcation)
300
This single-access adrenalectomy technique is an option for a lean pt with a tumor <4cm
Posterior retroperitoneoscopic adrenalectomy
300
An adrenal incidentaloma of what size warrants surgical resection in a healthy patient?
4cm or greater
400
What cell type secretes epinephrine?
chromaffin cells in the adrenal medulla
400
Patients with adrenal insufficiency have hypotension due to lack of stimulation of what hormone receptor
alpha-1
400
Hypertension refractory to multiple meds can be caused by this adrenal neoplasm (not pheo)
aldosteronoma
400
The _ technique is used to laparoscopically orient oneself when dissecting between the spleen and kidney during left adrenalectomy
Open book technique
400
A ratio of _:1 is positive for aldosteronoma when conducting adrenal vein sampling
4:1
500
What is the primary test for adrenal insuffiency and how is it done?
Cosyntropin test:
Measure baseline cortisol (usually at 8 AM).
Give 250 µg of cosyntropin IV or IM.
Measure cortisol at 30 and 60 minutes after injection.
No rise in cortisol = insufficient response by adrenals
500
A patient that has been taking prednisone 10mg daily for the last 2 weeks presents for elective lap chole. How much prednisone do you give for stress dose steroids pre-op?
None. Pts taking <20mg steroids for less than 3 weeks don't require stress dosing for 'minor' procedures
500
This enzymatic mutation can lead to familial pheochromocytomas (not MEN)
Succinate dehydrogenase (B and D)
500
During laparoscopic resection for pheochromocytoma, early ligation of _ prevents unnecessary catecholamine release?
adrenal vein
500
First-line pharm management for intraoperative hypertensive crisis during pheochromocytoma resection?
IV nitroprusside