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28 Cards in this Set

  • Front
  • Back
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?
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
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
hyperpigmented skin
does aldosterone deficiency accompany primary or secondary adrenal insufficiency
primary (not really under feedback control of ACTH)
three signs of aldosterone deficiency
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
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
are most pheochromocytoma's benign or malignant
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