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51 Cards in this Set
- Front
- Back
What is the Adrenal Cortex derived from?
What is the Adrenal Medulla derived from? |
Cortex = Mesoderm
Medulla = Neural Crest |
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Label the layers of the Adrenal Glands
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-
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List the hormone secreted from each layer of the Adrenal Gland
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Glomerulosa = Aldosterone = increases Na+ reabsorption; increase K+ & H+ secretion
Fasciculata = Cortisol Reticularis = Sex Hormones = Testosterone, DHEA, Androstenedione Medulla = Catecholamines |
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What are the stimulators & inhibitors of release of each layer of the Adrenal Glands?
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Glomerulosa
-Stimulators = Angiotensin II; hyperkalemia; ACTH Fasciculata -Stimulator = ACTH -Inhibitor = Cortisol Reticularis -Stimulator = ACTH -Inhibitor = Cortisol Medulla -Stimulator = ACh from SNS |
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Another name for "Acute Bilateral Hemorrhagic Adrenal Infarction"
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Waterhouse-Friderichsen Syndrome
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What is Waterhouse-Friderichsen Syndrome usually associated with?
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Septicemia from Neisseria Meningitidis
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What bacteria can cause Waterhouse-Friderichsen Syndrome?
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1. N. menigitidis
2. Pneumococcus 3. Staph 4. Strep 5. Hemophilus |
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What virus can cause Waterhouse-Friderichsen Syndrome?
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Herpes
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Other than infections, what are other causes of Acute Adrenocortical Insufficiency?
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1. abrupt withdrawal of Corticosteroids
2. Stress 3. Surgery |
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What is the mechanism of Waterhouse-Friderichsen Syndrome?
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release of tissue Thromboplastin due to Endotoxin causes DIC
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Waterhouse-Friderichsen Syndrome due to N. menigitidis
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What is this called?
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Waterhouse-Friderichsen Syndrome = Acute bilateral adrenal hemorrhage
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What is the name of this condition?
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Waterhouse-Friderichson Syndrome = DIC
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This is a Glomerulus. What adrenal condition is associated with this?
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Chronic Adrenocortical insufficiency = ?
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Addison Disease
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What are the clinical features of Addison's Disease?
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Insidious onset
Signs of decreased Glucocorticoids -weakness & fatigue -GI disturbances -HYPOGLYCEMIA -SKIN HYPERPIGMENTATION = due to MSH, a by-product of increased ACTH production Decreased Alodsterone -HYPOTENSION -Hyperkalemia -Hyponatremia |
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Addison's disease = primary adrenocortical insufficiency
Low Cortisol does not produce feedback inhibition on ACTH production = high ACTH yields MSH as a by-product of ACTH production from POMC |
What adrenal condition would cause this? What is the mechanism?
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What are the causes of Addison's disease?
1. 60% = ? 2. 25% = ? 3. 15% = ? |
1. Autoimmune destruction of Adrenal Gland = Autoimmune Adrenalitis
2. Granulomatous Adrenalitis due to TB or Histoplasmosis 3. Other = trauma, metastatic tumor, amyloidosis |
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Tuberculous granulomas
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What would be the cause of this Addison's diseased adrenal gland?
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Autoimmune Adrenalitis
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What would be the cause of this Addison's diseased adrenal gland?
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Addison's Disease due to Autoimmune Adrenalitis
-atrophied cortex with lymphocytic infiltration |
What are these pictures showing?
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What are the clinical features of Cushing Syndrome
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Weight gain = due to hyperinsulinism fom hyperglycemia (due to Cortisol)
-truncal obesity, moon facies, buffalo hump Hypertension = due to increase in weak mineralcorticoids & glucocorticoids = Na+ retention Osteoporosis = due to high cortisol Lymphopenia & Eosinopenia |
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What are the lab findings in Cushing Syndrome?
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1. increased Cortisol levels
2. increased 17-hydroxycorticoids & Cortisol in urine |
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Cushing Syndrome
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What syndrome are these clinical findings associated with?
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List the causes of Cushing Syndrome
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Iatrogenic = Corticosteroid therapy
Cushing Disease = ACTH-secreting Pituitary adenoma Adrenal Cortical Adenoma/Carcinoma = decreased ACTH; increased Cortisol Ectopic ACTH = Small Cell Carcinoma of Lung = markedly increased ACTH & Cortisol |
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A 45 yoa woman presents complaining of increased urination over the past several months. She has also gained 35 lbs. over the past year, bruises easily, & has grown hair on her chin. While speaking with her, you note that she has moon facies & increased fat pads on the back of her neck. Blood tests reveal hyperglycemia, increased Cortisol levels, & increased ACTH levels. Dexamethasone suppression test causes decreased Cortisol levels
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Cushing Syndrome caused by Pituitary Adenoma secreting ACTH
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How do you differentiate b/w the different causes of Cushing Syndrome?
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Pituitary Adenoma
-Cortisol suppression with Dexamethasone suppression test -high ACTH & Cortisol Paraneoplastic Syndrome -markedly high ACTH; high cortisol -no cortisol suppression by Dexamethasone Adrenocortical Adenoma -high Cortisol; low ACTH -No cortisol suppression by Dexamethasone |
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What would 17-alpha-hydroxylase deficiency cause?
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low Sex hormones & Cortisol
high Mineralcorticosteroids Hypertension, Hypokalemia Phenotypically female but no maturation |
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What would 21-beta-hydroxylase deficiency cause?
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low Cortisol & Mineralcorticoids
high Sex Hormones Masculinization Hypotension Hyperkalemia Salt wasting can lead to Hypovolemia Ambiguous genitalia in females Precocious puberty in males |
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What would 11-beta-hydroxylase deficiency cause?
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low Cortisol & Aldosterone
high Sex hormones & 11-deoxycorticosterone Hypertension = due to increased 11-deoxycorticosterone Masculinization |
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Congenital Adrenal Hyperplasia due to 21-hydroxylase deficiency
-Clitoral enlargement |
What is the cause of this?
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Congenital Adrenal Hyperplasia (21-hydroxylase deficiency)
-Adrenal gland is under constant stimulation by ACTH but only the Reticularis can responds b/c it contains the only cells that do not need 21-hydroxylase to make their product = Sex hormones |
What is the cause of this?
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Primary Hyperaldosteronism due to a benign adenoma in the Zona Glomerulosa
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Conn's Syndrome
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What are the clinical features of Conn's Syndrome?
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-Hypertension = due to Aldosterone causing Na+ retention
-Metabolic Alkalosis & Hypokalemia = due to increase K+ & H+ secretion -Decreased Renin levels -decreased Serum Potassium |
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List the causes of Conn's Syndrome
1. 90% 2. 10& 3. very rare |
1. Cortical Adenoma = Aldosteronoma
2. Nodular Cortical Hyperplasia 3. Adrenocortical Carcinoma |
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Adrenal Cortical Adenoma as seen in Conn's Syndrome = Primary Hyperaldosteronism
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What is seen here?
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Lipid-filled Adrenal Cortical cells in a Benign Adrenal Adenoma = Conn's Syndrome
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What is seen here?
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Describe a Neuroblastoma
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Small cell malignant neoplasm arising in the Adrenal Medulla
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Neuroblastoma:
1. Most common presenting age? 2. How does it present? 3. What are the frequent metastasis sites? 4. Who has a better prognosis? 5. What do the tumor cells secrete? 6. What is increased in the urine? |
1. 1-10 years of age
2. large abdominal mass 3. lungs & marrow 4. pts under 1 year of age 5. Epi or NE 6. VMA |
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Neuroblastoma = malignant tumor of Adrenal Medulla
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What is seen here?
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Neuroblastoma
-small, hyperchromatic malignant cells -"rosettes" Neural Ectoderm |
What is this? What is it derived from?
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Ganglioneuroma = Neuroblastoma that has reverted to a benign state
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What is seen here?
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What gene is Neuroblastoma associated with?
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N-myc oncogene
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Define Pheochromocytoma
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Neoplasm of Chromaffin cells of the Adrenal Medulla that produces Catecholamines
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Pheochromocytoma
1. peak incidence? 2. what do tumor cells secrete? 3. unilateral or bilateral 4. benign or malignant? |
1. 30-50
2. Epi &/or NE = cause surgically-correctable HTN 3. Unilateral 4. Benign |
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What conditions are Pheochromocytomas associated with?
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1. Neurofibromatosis
2. MEN II = Medullary Thyroid CA + Pheochromocytoma + Parathyroid Hyperplasia or Adenoma 3. von Hippel-Lindau disease |
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What are the clinical manifestations of Pheochromocytoma?
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Intermittent attacks of HTN, headache, palpitations
Anxiety Drenching sweats |
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What are the laboratory findings in Pheochromocytomas?
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increased 24-hour urinary VMA & Metanephrine levels
increased urinary & plasma Catecholamines |
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Pheochromocytoma
-expanded Medullary space in the Adrenal gland |
What is seen here?
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Pheochromocytoma
-nests of polygonal chromaffin cells containing catecholamine-rich granules |
What is this from?
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Pheochromocytoma
-secretory granules staining brownish with the chromate stain |
What is seen here?
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List the "Rule of 10's" associated with Pheochromocytomas
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1. 10% occur in children
2. 10% are bilateral 3. 10% occur outside the Adrenal Gland = Paraganglioma 4. 10% are malignant 5. 10% are familial (MEN II & III) |