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
