Random
Where does the right adrenal vein drain into?
IVC
MC reason of hyperaldosteronism?
B/l idiopathic adrenal hyperplasia (60-65%) - Managed medically (Spironolactone, ACE inhibitors, CCB like nifedipine, & K replacement)
If localized (adrenalectomy)
If b/l - Fludrocortisone supplementation postoperatively
Buffalo hump, moon face, acne, HTN, thin skin, fat pads, abdominal stretch marks, muscle weakness, weight gain, osteoporosis, skin ulcers, menstrual irregularities, elevated BG
Rule of 10's for pheochromocytoma?
10% malignant, 10% bilateral, 10% in children, 10% familial, 10% extra-adrenal
Most common etiology of Cushing syndrome?
Exogenous steroids
How do you distinguish between primary and secondary hyperaldosteronism?
Renin - Primary has low renin and secondary usually has elevated renin
At what size should you consider resection of adrenal myelolipoma?
>7 cm size or symptomatic
If initial step of work-up for hypercortisolism is concerning, what's the next test to order?
ACTH level
What imaging study should be ordered if biochemical work-up suggests pheo, but no masses identified on CT adrenal or MRI?
MIBG
Most common etiology of adrenal insufficiency?
Globally: Tuberculosis
Developed countries: Autoimmune
If a patient has hyperaldosteronism, and you're unable to determine which side needs an adrenalectomy, what's the next best step?
Adrenal vein sampling
If an adrenocortical adenocarcinoma is functional, what is most likely being overproduced?
Cortisol
Hypercortisolism - What does an elevated ACTH level mean and how do you differentiate between the potential causes?
Concern for pituitary source (Cushing's disease) or ectopic
High-dose dexamethasone suppression test (8 mg)
Management of pheochromocytoma and what structure should be ligated first?
Adrenalectomy, Ligate adrenal veins first to avoid catecholamine crisis w/ tumor manipulation
Screening test for adrenal insufficiency?
AM serum cortisol
Where does the superior adrenal artery branch from?
Phrenic artery
What biochemical studies should be done when an incidentaloma is discovered on CT (7)? Name at least 3
Urine metanephrines, VMA, Catecholamines, Low-dose dexamethasone suppression test, Serum K, renin, aldosterone
Workup for suspected hypo-cortisolism?
Initially, AM cortisol
If low, ACTH stimulation test - Cosyntropin, measure cortisol, cortisol will remain low
Where else can catecholamine-producing tumors form (most common)?
Organ of Zuckerkandl (near origin of IMA)
+ paragangliomas along sympathetic chain
A patient is undergoing resection of a pheochromocytoma & becomes hypertensive. How is this managed?
Nitroprusside
If a patient has a 21-hydroxylase deficiency, how is aldosterone and testosterone impacted?
Increased testosterone & decreased aldosterone
Concerning imaging features of adrenal incidentaloma (6)? Name at least 3
>4 cm, >10 HU, high vascularity, interval tumor growth, internal calcifications or hemorrhage, heterogenous
What do you do if patient undergoes trans-sphenoidal resection of pituitary mass and they still have hypercortisolism?
B/l adrenalectomy
Optimal preoperative management of patient w/ suspected pheochromocytoma?
Volume replacement & alpha blockade w/ phenoxybenzamine or prazosin, then beta blockade
Want to avoid a hypertensive crisis!!!!
Most common primary cancer site for adrenal mets?
Lung