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3 Cards in this Set

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Adrenal Mass: Clinical Presentation, When to Refer, CT characterisitics, Investigations if Hyperfunctional, Differential if Hyperfunctional, Indications for Surgery
1. Clinical Presentation: incidentaloma, hypertension, perspiration, headaches, palpitations
2. When to Refer: >2cm, new or growing
3. CT Characteristics: benign (smooth, round, homogenous, low intensity, rapid contrast washout), malignant (irregular border, heterogeneous, high intensity, slow washout of contrast)
4. Differential: incidentaloma (majority), functional (pheochromocytoma, Cushing's syndrome, hyperaldosteronism), primary adrenal carcinoma (adenoma, carcinoma)
5. Investigations if Hyperfunction: serum electrolytes/creatinine, 24 hour urine creatinine/metanephrines/catecholamines, dexamethasone suppression test (DST), aldosterone:renin ratio (hypokalemia/hypertension)
6. Indications for Surgery: >4cm, growing, malignant appearance, functional
ACTH Independent Cushings: Pathophysiology, Differential Diagnosis, Screening Tests, Lab Findings
1. Pathophysiology: excess cortisol from adrenal cortical tumour
2. Differential Diagnosis: ACTH dependent (pituitary tumour, ectopic ACTH, ectopic CRH), ACTH independent (adrenal tumour) iatrogenic (glucocorticoid drug-most common)
3. Screening Tests: 24hr urine (metanephrines, catecholamines, creatinine)
4. Lab Findings: increased free cortisol in urine (refractory to DST), decreased ACTH, adrenal tumour/hyperplasia on imaging
Pathology: Role of Pathologist, Adrenal Anatomy, Differential Diagnosis, Pheochromocytoma
1. Role of Pathologist: define lesion (primary vs secondary, medullary vs cortical, hyperplastic vs neoplastic, benign vs malignant), decide if pathologic findings explain clinical findings
2. Adrenal Anatomy: zona glomerulosa (aldosterone), zona fasciculata (cortisol), zona reticularis (androgen)
3. Differential Diagnosis: Cushing's syndrome (pituitary adenoma, ectopic ACTH, adrenal cortical adenoma, adrenal cortical carcinoma), increased mineralcorticoids (zona glomerulosa hyperplasia, adrenal cortical adenoma), virilism/feminization (adrenal cortical carcinoma), excess catecholamines (pheochromocytoma)
4. Pheochromocytoma: 25% have germline mutation (VHL,RET,Succinate Dehydrogenase), 3-5% are malignant