Adrenal Glands

Where are the adrenal glands located?

retroperitoneal/suprarenal

What type of glands are the adrenals?

endocrine (hormones) controlled by the pituitary gland

What is the function of the adrenal glands?

• maintain metabolism

• supporting immune system

• responding to stress

What is the adrenal gland blood supply?

suprarenal arteries

Where are the adrenal glands located in relation to the diaphragm?

lateral to diaphragm

What is the sonographic appearance of a pediatric adrenal gland?

• hypoechoic outer cortex

• echogenic inner medulla

• pyramid or wishbone shaped

What tells the pituitary what to do?

hypothalmus

What does the anterior pituitary control?

adrenal gland

What hormone comes from the pituitary gland and stimulates the adrenal?

adrenocorticotropic hormone (ACTH)

What hormones does the adrenal gland produce?

• aldosterone

• androgens

• cortisol

• epi-norepi

What is aldosterone?

controls BP/sodium

What are androgens?

male hormone

What is cortisol?

glucose metabolism

What is epinephrine/norepinephrine?

fight or flight

Which hormones is the outer layer/cortex responsible for?

• aldosterone

• androgens

• cortisol

Which hormones is the medulla/inner layer responsible for?

epi/norepi

What is Addison disease?

• primary adrenocortical insufficiency/chronic primary hypoadrenalism

• caused by autoimmune disease or infection

• gland is damaged=hypofunction

What hormone will be increased in the case of Addison disease?

adrenocorticotropic hormone (ACTH)

What is the clinical presentation of Addison disease?

• hypotension

• weakness

• fatigue

• bronzing of skin

• hyperkalemia (high potassium)

• hyponatremia (low calcium)

• increased ACTH

What is the sonographic appearance of Addison disease?

• adrenal enlargement

• possible calcifications

What is the MC benign solid mass of the adrenal?

adenoma

Where is an adenoma located?

cortex

If an adenoma is functioning, what conditions will it cause?

Conn or Cushing

What is the sonographic appearance of an adenoma?

solid, hypoechoic mass

What is Cushing syndrome?

• hypercortisolism

• may be caused by adenoma

What is the clinical presentation of Cushing syndrome?

• hypertension

• obesity

• buffalo hump

• round moon shaped face

• hirsutism

• hyperglycemia

• purpura streaks on torso and thighs

What is Conn syndrome?

• primary aldosteronism

• aldosterone regulates BP by controlling sodium/water ratio in body

• may be caused by adenoma

What is the clinical presentation of Conn syndrome?

• hypertension

• thirsty

• urinary frequency

• hypernatremia (high sodium)

• hypokalemia (low potassium)

What is a pheochromocytoma?

• hyperfunctioning medullary tumor

• too much epi/norepi—like a constant adrenaline rusn

What is the clinical presentation of a pheochromocytoma?

• uncontrollable hypertension

• tachycardia

• tremors

• sweating

• headaches

• anxiety

What is the clinical appearance of a pheochromocytoma?

large, hyperechoic, may be heterogenous

What condition will adrenal carcinoma typically present with?

• Cushings

• rare in adults

What are adrenal rests?

• ectopic or accessory adrenal tissue

• can be found on testicles

• may have signs of hyperfunction

What is a major difference between an adenoma and a pheochromocytoma?

• adenoma may or may not be functional

• a pheochromocytoma is always functional

What is the MC extracranial malignancy in peds?

neuroblastoma

What is the MC location for a neuroblastoma?

adrenal glands

What is often found upon discovery of neuroblastoma?

liver mets

What is the clinical presentation of neuroblastoma?

• palpable mass

• pain

• maybe related to Beckwith-Widemann

What is the sonographic appearance of neuroblastoma?

large heterogenous mass and liver mets

What is the MC adrenal pathology in newborn?

adrenal hemorrhage

What is the clinical presentation of an adrenal hemorrhage?

• neonate

• decreased hematocrit

• drop in BP

What is the sonographic appearance of adrenal hemorrhage?

varied echotexture depending on age