Chapter 8: The Adrenal Glands (Penny)

SONOGRAPHIC FINDINGS OF ADRENAL CYSTS

1. Anechoic 2. Round 3. Acoustic enhancement

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 CONN SYNDROME

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

CLINICAL FINDINGS OF ADDISON DISEASE

1. Hypotension 2. Weakness and fatigue 3. Loss of appetite and 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

SONOGRAPHIC FINDINGS OF PHEOCHROMOCYTOMAS

1. Large, hyperechoic mass in the area of the adrenal gland 2. Can have various sonographic appearances including hypoechoic or diffusely heterogeneous

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)

CLINICAL FINDINGS OF ADRENAL ADENOMAS

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

SONOGRAPHIC FINDINGS OF ADRENAL ADENOMAS

1. Solid, hypoechoic mass in the area of the adrenal gland

CLINICAL FINDINGS OF PHEOCHROMOCYTOMAS

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

Adrenal rests disseminate during embryologic development and can form mass-like structures within the affected organs or structures. The cells are responsive to the secretion of ______ by the pituitary gland

ACTH

is an endocrine disorder that results from the hypofunction of the adrenal cortex

Addison Disease

The chronic form of the disease typically leads to an atrophic and calcified gland

Addison disease

___________ is also referred to as primary adrenocortical insufficiency or chronic primary hypoadrenalism

Addison disease

can be found within the testes, epididymis, ovaries, and inguinal canal

Adrenal Rests

_________________ may be noted in the area of the adrenal gland and can often be difficult to separate from the liver, spleen, or upper pole of the kidneys

Adrenal cysts

They are often associated with congenital adrenal hyperplasia and Cushing syndrome

Adrenal rests

___________ is responsible for regulating blood pressure by controlling the amount of sodium and water in the body.

Aldosterone

is responsible for regulating blood pressure by controlling the amounts of sodium and water in the body

Aldosterone

responsible for regulating blood pressure by controlling the amounts of sodium and water in the body

Aldosterone

Hormones of the adrenal cortex

Aldosterone, Androgens, Cortisol (hydrocortisone)

minimal impact on the development of male characteristics

Androgens

Caused by a functioning tumor within the adrenal cortex that causes the adrenal gland to produce excess amounts of aldosterone

Conn Syndrome

____results from high levels of aldosterone secretion by the adrenal cortex

Conn Syndrome

______________ also referred to as primary hyperaldosteronism

Conn syndrome

________________ like Cushing syndrome, can be caused by a functioning tumor within the adrenal cortex--most likely a benign, aldosterone-producing adrenal adenoma--that causes the adrenal gland to produce excessive amounts of aldosterone

Conn syndrome

glucose metabolism, blood pressure regulation, immune function, inflammatory response

Cortisol (hydrocortisone)

This syndrome can be associated with a benign tumor that leads to the overproduction of cortisol by the adrenal glands

Cushing syndrome

_____ results from high levels of cortisol secretion by the adrenal cortex. Associated with a benign tumor that leads to overproduction of cortisol by the adrenal glands. Often located within the adrenal gland itself (adrenal adenoma) or within the pituitary gland.

Cushing syndrome

___________________ can result from a tumor in the anterior pituitary gland (Cushing disease) or an adrenal tumor that causes an increase in cortisol secretion by the adrenal cortex--termed ________________

Cushing syndrome; hypercortisolism

is the primary hormone produced by the medulla

Epinephrine

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

Epinephrine (adrenaline)

Hormones of the adrenal medulla

Epinephrine (adrenaline), Norepinephrine

accelerates heart rate, increases blood pressure, contracts blood vessels

Norepinephrine

They receive their blood supply by means of three arteries: the suprarenal branches of the inferior phrenic arteries, the suprarenal branches of the aorta, and the suprarenal branches of the renal arteries

The adrenal glands

hematoma

a localized collection of blood

Conn syndrome

a syndrome caused by a functioning tumor within the adrenal cortex that produces excess amounts of aldosterone; patients will have hypertension, excessive thirst, excessive urination, and low levels of potassium in the blood

Cushing syndrome

a syndrome that results from a pituitary or adrenal tumor that causes overproduction of cortisol by the adrenal glands; patients may present with obesity, thinning arms and legs, hypertension, hyperglycemia, and severe fatigue

tachycardia

abnormally rapid heart rate

The tumor is often located within the adrenal gland (most likely an _______________) or within the pituitary gland

adrenal adenoma

_____ is the most common benign solid mass of the adrenal gland

adrenal adenoma

The ___________ are the fourth most common site of metastasis

adrenal glands

Accessory adrenal gland tissue, commonly referred to as

adrenal rests

Epinephrine may also be referred to as

adrenaline

The hypothalamus controls the release of ______________ by the _____________________________-

adrenocorticotropic hormone (ACTH); anterior pituitary gland

Among the hormones produced by the cortex is

aldosterone

Conn syndrome results from high levels of

aldosterone secretion by the adrenal cortex

The cortex also produces __________________________, which play a part in the development of male characteristics

androgenic hormones

suprarenal glands

another name for the adrenal glands

adrenal cysts

benign simple cysts located within the renal glands

pheochromocytoma

benign solid adrenal tumor associated with uncontrollable hypertension

adrenal adenoma

benign solid mass located within the adrenal glands

Although ________________________ is the modality of choice for the diagnosis of Addison disease, the hemorrhagic, enlarged appearance of the adrenal glands in the acute stages of the disease could possibly be noted with sonography

computed tomography

The hypothalamus controls the release of adrenocorticotropic hormone (ACTH) by the anterior pituitary gland, which in turn

controls the release of hormones by the adrenal glands

With Addison disease, the cortex inadequately secretes _____________ resulting from partial or complete destruction of the adrenal glands

corticosteroids

Cushing syndrome is the result of the overproduction of _____ by the adrenal cortex and is associated with moon-shaped face, buffalo hump, and hypertension

cortisol

The cortex also produces __________, which controls the body's use of fat, carbohydrates, and protein

cortisol

Adrenal rests disseminate during

embryologic development and can form mass-like structures within the affected organs or structures

the medulla, produces ________ and ___________

epinephrine and norepinephrine

hirsutism

excessive hair growth in women in areas where hair growth is normally negligible

both epinephrine and norepinephrine are responsibile for the ______

fight or flight response

the adrenal glands are enclosed in the ____

gerota fascia

endocrine glands

glands that release their hormones directly into the bloodstream

Cortisol plays an important role in

glucose metabolism, blood pressure regulation, immune function, and inflammatory response

hypertension

high blood pressure

hypernatremia

high levels of sodium in the blood

adrenocorticotropic hormone

hormone secreted by the anterior pituitary gland, which controls the release of hormones by the adrenal glands

_______ adenomas are often seen in patients suffering from Cushing syndrome or Conn syndrome

hyperfunctioning

a renal adenoma can either be _____ or _____

hyperfunctioning nonhyperfunctioning

_____ high levels of sodium in the blood

hypernatremia

Although not routinely identified in the adult patient secondary to surrounding adipose tissue, the normal adrenal glands are often easily visualized in the fetus and in the pediatric patient as _____________ structures anterior, medial, and superior to the upper pole of each kidney

hypoechoic

____low levels of potassium in the blood

hypokalemia

the paired adrenal glands, which are controlled by hormones produced by the ____, and subsequently the ____, are _____ glands

hypothalamus anterior pituitary gland retroperitoneal endocrine This complex feedback system is referred to as the hypothalamic-pituitary-adrenal axis

Addison disease can be ___________, but it can also be caused by an

idiopathic; autoimmune disorder, infection, or tuberculosis

The right suprarenal vein drains directly into the

inferior vena cava (IVC)

he left suprarenal vein drains into the

left renal vein

hypokalemia

low levels of potassium in the blood

metastases to the adrenal glands originates most often in the ____,____,____,____ or from _____. Specifically, there is a high probability that the primary sites are the lung, breast, or lymphoma in many patients.

lungs breast colon kidneys melanoma

adrenal cysts that have a rim of calcification around them are much more worrisome for

malignancy

neuroblastoma

malignant tumor that can occur within the adrenal gland and anywhere within the sympathetic nervous system

describe the location of the left adrenal gland

medial to the upper pole of the left kidney superior segment is located posterior to the lesser sac inferior segment is located posterior and lateral to the pancreas

The inner part of the adrenal glands, the

medulla

The pheochromocytoma, which arises from the adrenal

medulla

Each gland is composed of a

medulla and a cortex

Simple cysts may be incidental findings with

no clinical complaints provided

The cortex is the _______ part of the adrenal gland.

outer

_____ is typically a hyperfunctioning, benign adrenal mass that causes the adrenal gland to release excessive amounts of epinephrine and norepinephrine into the bloodstream, thus leading to uncontrollable hypertension

pheochromocytoma

causes the adrenal gland to release excessive amounts of epinephrine and norepinephrine into the bloodstream, thus leading to uncontrollable hypertension

pheochromocytoma

describe the location of the right adrenal gland

posterior and lateral to the inferior vena cava medial to the right lobe of the liver lateral to the crus of the diaphragm

________ is rare. often produces symptoms associated with cushing syndrome, as they may be functional tumors that produce hormones

primary adrenal carcinoma

Primary adrenal carcinoma, such as adenocarcinoma, is

rare

The adrenal glands may also be referred to as the

suprarenal glands

The adrenal glands venous drainage is performed by means of the

suprarenal veins

In the male, adrenal rest tumors may be found in the

testicles

Gerota Fascia

the fibrous envelope of tissue that surrounds the kidney and adrenal gland

hematocrit

the laboratory value that indicates the amount of red blood cells in the blood

The pheochromocytoma is associated with

uncontrollable hypertension

The cortex is composed of three zones:

zona glomerulosa, zona fasciculata, and zona reticularis