The Adrenal Glands CH 8

CLINICAL FINDINGS OF CONN SYNDROME

1. Hypertension 2. Excessive thirst 3. Excessive urination 4. High levels of sodium in the (hypernatremia) 5. Low levels of potassium in the blood (hypokalemia) 6. Muscle cramps and weakness

CLINICAL FINDINGS OF PHEOCHROMOCYTOMAS

1. Uncontrollable hypertension 2. Headaches 3. Tachycardia 4. Tremors 5. Anxiety 6. Excessive sweating

Gerota's fascia

Surrounds the kidney and perirenal fat. Anchors the kidneys and limits any infection arising from them.

adrenocorticotropic hormone

a hormone produced by the anterior pituitary gland that stimulates the adrenal cortex

SONOGRAPHIC FINDINGS OF ADRENAL CYSTS

1. Anechoic 2. Round 3. Acoustic enhancement

SONOGRAPHIC FINDINGS OF NEUROBLASTOMA

1. Large, heterogeneous mass containing areas of calcification and hemorrhage located in the area of the adrenal gland 2. Metastasis often present at the time of discovery

SONOGRAPHIC FINDINGS OF PHEOCHROMOCYTOMAS

1. Large, hyperechoic mass in the area of the adre- nal gland in- 2. Can have various sonographic appearances cluding hypoechoic or diffusely heterogeneous

CLINICAL FINDINGS OF ADRENAL ADENOMAS

1. Signs and symptoms of Cushing syndrome of Conn syndrome 2. Signs and symptoms 3. May be asymptomatic

SONOGRAPHIC FINDINGS OF ADRENAL ADENOMAS

1. Solid, hypoechoic mass in the area of the adre- nal gland

pheochromocytoma

Benign adrenal mass that causes the adrenal gland to release excessive amounts of epinephrine and norepinephrine into the bloodstream leading to uncontrollable hypertension

Cushing disease/syndrome

Presence of a Brain tumor in the pituitary gland that increases the release of adrenocorticotropic hormone resulting in Cushing syndrome

37. All of the following are clinical findings of a pheochromocytoma except: a. Bradycardia b. Uncontrollable hypertension c. Excessive sweating d. Tremors

a. Bradycardia

12. Which types of glands release their hormones directly into the bloodstream? a. Endocrine glands b. Exocrine glands

a. Endocrine glands

3. When internal bleeding is suspected, what laboratory value is most useful for a sonographer to evaluate? a. Hematocrit b. Blood urea nitrogen c. Androgenic hormone d. Alkaline phosphatase

a. Hematocrit

36. All of the following are most likely a benign adrenal mass except: a. Adrenal adenoma b. Neuroblastoma c. Pheochromocytoma d. Adrenal hematoma

b. Neuroblastoma

6. All of the following are true statements about the adrenal glands except: a. The adrenal glands are easily identified in the fetus, b. The adrenal glands are exocrine glands. c. The adrenal glands are composed of a me- dulla and cortex. d. The adrenal glands may also be referred to as the suprarenal glands.

b. The adrenal glands are exocrine glands.

CLINICAL FINDINGS OF ADRENAL HEMORRHAGE

1. Abdominal mass 2. Jaundice 3. Anemia 4. Acute drop in hematocrit and blood pressure

Location of Left Adrenal Gland

1. Medial to the upper pole of the left kidney 2. Superior segment is located poste- rior to the lesser sac 3. Inferior segment is located poste- rior and lateral to the pancreas

CLINICAL FINDINGS OF NEUROBLASTOMA

1. Palpable abdominal mass 2. Abdominal pain 3. Bone pain

Conn syndrome

a syndrome caused by a functioning tumor within the adrenal cortex that produces excess amounts of aldosterone

16. Which of the following has a clinical finding of bronzing of the skin? a. Addison disease b. Cushing disease c. Cushing syndrome d. Conn syndrome

a. Addison disease

Tachycardia

abnormally rapid heart rate

Hormones of the adrenal medulla Epinephrine (adrenaline):

accelerates heart rate, in- creasing blood pressure, opens airways in the lungs, narrows blood vessels in the skin and intestine to increase blood flow to major muscle groups

Hormones of the adrenal medulla Norepinephrine:

accelerates heart rate, increases blood pressure, contracts blood vessels

Adrenal rests

accessory adrenal gland tissue

31. Which of the following is associated with hypernatremia? a. Cushing syndrome b. Conn syndrome c. Pheochromocytoma d. Addison disease

b. Conn syndrome

5. The syndrome associated with hypertension, hyperglycemia, obesity, and an adrenal mass is: a. Edwards syndrome b. Cushing syndrome c. Juliet syndrome d. Hirschsprung sundrome

b. Cushing syndrome

10. With active internal hemorrhage, the patient's hematocrit will: a. Increase b. Decrease c. Become stable d. Not change

b. Decrease

13. A localized collection of blood describes a: a. Hemangioma b. Hematoma c. Hypertoma d. Hydrocele

b. Hematoma

32. The most common sonographic appearance of a neuroblastoma is: a. Hyperechoic mass b. Heterogeneous mass with calcifications C. Anechoic mass d. Hypoechoic mass

b. Heterogeneous mass with calcifications

adrenal adenoma

benign solid mass located within the adrenal glands

20. Which of the following is produced by the adrenal medulla? a. Cortisol b. Aldosterone c. Norepinephrine d. Androgens

c. Norepinephrine

24. Which of the following best describes the location of the right adrenal gland? a. Posterior and lateral to the pancreas b. Medial to the lower pole of the right kidney c. Posterior and lateral to the IVC d. Medial to the crus of the diaphragm

c. Posterior and lateral to the IVC

15. The arterial blood supply to the adrenal glands is accomplished by means of the: a. Celiac trunk b. Subphrenic arteries c. Suprarenal arteries d. Superior mesenteric artery

c. Suprarenal arteries

33. The neuroblastoma typically presents before the age of: a. 1 year b. 2 years C. 4 years d. 5 years

d. 5 years

35. Which hormone, secreted by the anterior pituitary gland, controls the release of hormones by the adrenal glands? a. Epinephrine b. Cortisol C. Aldosterone d. ACTH

d. ACTH

17. Hyperfunctioning adrenal adenomas are associated with all of the following except: a. Cushing syndrome b. Conn syndrome c. Hypoechoic mass in the area of the adrenal gland d. Acute drop in hematocrit

d. Acute drop in hematocrit

23. Which of the following is associated with hyponatremia? a. Cushing syndrome b. Conn syndrome c. Pheochromocytoma d. Addison disease

d. Addison disease

25. Upon sonographic examination of the right upper quadrant in a 32-year-old female patient complaining of generalized abdominal pain, you visualize an anechoic mass with posterior enhancement superior and medial upper pole of the right kidney. This most likely represents a(n): a. Adrenal metastatic lesion b. Pheochromocytoma c. Neuroblastoma d. Adrenal cyst

d. Adrenal cyst

11. Which of the following would result in buffalo hump and moon-shaped face clinical findings? a. Conn syndrome b. Addison disease c. Adrogenism d. Hypercortisolism

d. Hypercortisolism

27. The adrenal mass often associated with uncontrollable hypertension, tachycardia, and tremors is the: a. Neuroblastoma b. Adrenal hematoma c. Oncocytoma d. Pheochromocytoma

d. Pheochromocytoma

39. The adrenal glands receive a portion of their blood supply from all of the following except the: a. Suprarenal branches of the inferior phrenic arteries b. Suprarenal branches of the aorta c. Suprarenal branches of the renal arteries d. Suprarenal branches of the celiac trunk

d. Suprarenal branches of the celiac trunk

hyperpigmentation

darkened areas of skin caused by excessive amounts of melanin

Hypokalemia

deficient potassium in the blood

Hyponatremia

deficient sodium in the blood

Addison's disease

endocrine disorder characterized by adrenocortical insufficiency. Symptoms may include weakness, fatigue, weight loss, hyperpigmentation of skin and mucous membranes.

hirsutism

excessive hair growth

Hyperkalemia

excessive potassium in the blood

CLINICAL FINDINGS OF ADRENAL CYSTS

1. Asymptomatic 2. Large, infected, or hemorrhagic cysts can cause pain

SONOGRAPHIC FINDINGS OF ADDISON DISEASE

1. Enlarged appearance of the adrenal glands in the acute stages of the disease 2. Atrophic or calcified gland in the chronic stage (may be difficult to identify sonographically)

CLINICAL FINDINGS OF ADDISON DISEASE

1. Hypotension 2. Weakness 3. Loss of appetite or weight loss 4. Bronzing of the skin (hyperpigmentation) 5. Elevated liver enzymes 6. Hyperkalemia (high levels of potassium) 7. Hyponatremia (low levels of sodium) 8. Increased ACTH

CLINICAL FINDINGS OF ADRENAL CARCINOMA

1. May mimic symptoms of Cushing syndrome

CLINICAL FINDINGS OF CUSHING SYNDROME

1. Obesity 2. Thinning arms and legs 3. Hypertension 4. Hirsutism 5. Hyperglycemia 6. Severe fatigue 7. Poor wound healing 8. Buffalo hump 9. Moon-shaped face 10. Red or purple striae over the abdomen and thighs

SONOGRAPHIC FINDINGS OF CONN SYNDROME

1. Possible identification of an adrenal mass (most likely an adrenal adenoma)

SONOGRAPHIC FINDINGS OF CUSHING SYNDROME

1. Possible identification of an adrenal mass (most likely an adrenal adenoma)

Location of Right Adrenal Gland

1. Posterior and right lateral to the inferior vena cava 2. Medial to the right lobe of the liver 3. Lateral to the crus of the diaphragm

SONOGRAPHIC FINDINGS OF ADRENAL HEMORRHAGE

1. Round or triangular-shaped mass in the area of the adrenal gland 2. Various sonographic appearances based on the age of hemorrhage 3. Echogenic during the acute stage 4. With time it will become heterogeneous, hy- poechoic, and possibly cystic 5. Residual calcifications may remain following resolution of the hemorrhage

SONOGRAPHIC FINDINGS OF ADRENAL CARCINOMA

1. Solid, hypoechoic mass 2. Large, heterogeneous mass

Crus of diaphragm

A tendinous structure that extends from the diaphragm to the vertebral column; there are two Crura - a right and left

19. The adrenal cortex produces all of the following except: a. Cortisol b. Androgens c. Aldosterone d. Adrenaline

D. Adrenaline

buffalo hump

Excessive amount of fat on the back between the shoulders

endocrine glands

Glands of the endocrine system that release hormones into the bloodstream

congenital adrenal hyperplasia

a group of inherited disorders of the adrenal gland whereby individuals born with this condition lack an enzyme needed by the adrenal gland to make the hormones cortisol and aldosterone

1 An abdominal sonogram is requested for a new born in the intensive care unit. The new born is suffered from brief anoxia at birth and is now suffering from jaundice. Superior to the right kidney, you visualize a triangular-shaped, heterogeneous mass. What is the most likely diagnosis? a. Adrenal hemorrhage b. Adrenal adenoma c. Pheochromocytoma d. Cushing syndrome

a. Adrenal hemorrhage

38. Which plays a part in the development of male characteristics? a. Androgens b. Cortisol c. Aldosterone d. Hematocrit

a. Androgens

14. What is the cause of Cushing disease? a. Anterior pituitary gland tumor b. Adrenal hemorrhage c. Neuroblastoma d. Hyperaldosteronism

a. Anterior pituitary gland tumor

22. Which of the following hormones are responsible for the "flight-or-fight" response? a. Epinephrine and norepinephrine b. Cortisol and androgens c. Cortisol and aldosterone d. ACTH and aldosterone

a. Epinephrine and norepinephrine

29. The most common sonographic appearance of a pheochromocytoma is a(n): a. Hyperechoic mass b. Hypoechoic mass c. Anechoic mass d. Complex mass

a. Hyperechoic mass

26. The right suprarenal vein drains directly into the a. IVC b. Abdominal aorta C. Celiac trunk d. Left renal vein

a. IVC

Addison disease can be caused by

an autoimmune disorder, infection, or tuberculosis and is associated with hyperkalemia, hyponatremia, and bronzing of the skin.

suprarenal glands

another name for the adrenal glands

The adrenal glands are endocrine glands that are controlled by the release of ACTH by the

anterior pituitary gland.

18. Which of the following is also referred to as primary adrenocortical insufficiency? a. Conn syndrome b. Addison disease c. Cushing disease d. Congenital adrenal hyperplasia

b. Addison disease

4. Which of the following mass-like lesions may be associated with congenital adrenal hyperplasia and found within the testes? a. Adrenal adenomas b. Adrenal rests c. Pheochromocytomas d. Neuroblastomas

b. Adrenal rests

28. A 45-year-old obese woman with thin arms and legs, hypertension, and severe fatigue presents to the ultrasound department for an abdominal sonogram. Based on these clinical findings, you should evaluate the adrenal glands closely for signs of: a. Addison cyst b. Adrenal hemorrhage c. Adrenal adenoma d. Neuroblastoma

c. Adrenal adenoma

34. Which hormone is responsible for regulating blood pressure by controlling the amounts of sodium and water in the body? a. Epinephrine b. Cortisol c. Aldosterone d. ACTH

c. Aldosterone

7. The adrenal glands are surrounded by a connective tissue capsule called: a. Glisson capsule b. Adrenalocortical fascia c. Gerota fascia d. Glisson fascia

c. Gerota fascia

9. Conn syndrome results from: a. Low levels of cortisol b. High levels of cortisol c. High levels of aldosterone d. Low levels of epinephrine

c. High levels of aldosterone

21. What is the term for low levels of sodium in tha blood? a. Hypokalemia b. Hypopigmentation c. Hyponatremia d. Hypodisuria

c. Hyponatremia

40. All of the following are true statements about the adrenal glands except: a. The adrenal glands play an important role in blood pressure regulation. b. The adrenal glands are easily identified in the fetus. c. The left adrenal gland is located lateral to the upper pole of the left kidney. d. The right adrenal gland is located medial to the right lobe of the liver.

c. The left adrenal gland is located lateral to the upper pole of the left kidney.

8. The left suprarenal vein drains directly into the: a. IVC b. Abdominal aorta c. Celiac trunk d. Left renal vein

d. Left renal vein

30. The most common, extracranial, malignant mass in children is the: a. Hepatoblastoma b. Hypernephroma c. Pheochromocytoma d. Neuroblastoma

d. Neuroblastoma

2. All of the following are associated with Conn syndrome except: a. Adrenal adenoma b. Hypertension c. Excessive thirst d. Thinning arms and legs

d. Thinning arms and legs

Hormones of the adrenal cortex Cortisol (hydrocortisone):

glucose metabolism, blood pressure regulation, immune function, inflam- matory response

Hypertension

high blood pressure

Conn syndrome results from

high levels of aldosterone secretion by the adrenal cortex.

Hypercortisolism

high levels of cortisol in the blood

Hypernatremia

high levels of sodium in the blood

anoxia

lack of oxygen

Neuroblastoma

malignant tumor composed principally of cells resembling neuroblasts

Hormones of the adrenal cortex Androgens:

minimal impact on the development of male characteristics

Hormones of the adrenal cortex Aldosterone:

responsible for regulating blood pres- sure by controlling the amounts of sodium and wa- ter in the body

Striae

stretch marks

In the male, adrenal rest tumors may be found in

the testicles.

pheochromocytoma is associated with

uncontrollable hypertension.