Left adrenal vein comes off the
Left renal vein
Right adrenal vein comes off the
Directly off the IVC
Blood supply: superior adrenal a.
Off inferior phrenic artery
Blood supply: middle adrenal a.
Aorta
Blood supply: inferior adrenal a.
Off the renal artery
Concerning adrenal findings (5)
Size >4cm
Hf units > 10
Heterogeneous
Delayed washout
Irregular margins /invasive into surrounding area
Adrenal: G-F-R
Glomerulosa: aldosterone
Fasciculata: glucocorticoids
Reticularis: androgens/estrogen
Corticotropin releasing hormone comes from … and acts on …
Hypothalamus-> ant. Pituitary to release ACTH
Adrenocorticotropic hormone comes from … and acts on …
Ant. Pituitary-> adrenal to release cortisol
When does cortisol peak?
What affects does it have? (5)
4-6am
Inotropic
Increased vascular resistance
Proteolysis
Gluconeogenesis
Decrease inflammation
Aldosterone activity (2)
reabsorb sodium
excrete K
What stimulates aldosterone release?
HyperK
Angiotensin II
Renin level in primary vs secondary hyperAldo
Plasma aldo : renin ratio
> 20. Primary
< 20. Secondary
Diagnose adrenal insufficiency
Cosyntropin test (ACTH stim test)
-> measure cortisol at 30 and 60 minutes
High ACTH high cortisol. Cause?
Ant. Pituitary adenoma
Ectopic (eg Small cell lung CA)
Low ACTH high cortisol. Cause?
Adrenal is culprit!
Adenoma or hyperplasia
How to diagnose pituitary adenoma vs ectopic source?
Give high dose dexamethasone.
Measure urine cortisol
if low-> pituitary, if high-> ectopic
Treatment: adrenal hyperplasia
Metyrapone
(Blocks cortisol synthesis)
or
Aminoglutethimide
(Inhibits steroid production)
Adrenocortical carcinoma: symptomatic?
50% of time they’re FUNCTIONING
Medical txt for adrenal carcinoma
Mitotane (adrenal-lytic)
20% 5-yr survival rate
Pheo: preop BP control?
Alpha blockade!! Before beta blockade (so don’t get unopposed alpha)
Also replete volume
Why do we ligate vein first for pheo?
Avoid spilling catecholamines
Most common site of extra medullary pheo
Organ of Zuckerlkandl
Inferior aorta before bifurcation
