Superior adrenal artery is a branch of the _______ artery
Inferior phrenic
Inferior phrenic artery arises from the _______
Aorta
T/F: superior adrenal artery arises from the aorta
False; The inferior phrenic artery arises from the aorta and that branches into the superior adrenal artery.
What structure arises between the inferior mesenteric artery and the bifurcation of the aorta?
islands of Zukerandl
What imaging modality is associated with incidentaloma findings?
CT scan
T/F: pheochromocytomas is a tumor of the adrenal gland, and it usually secretes cortisol and aldosterone
False; it usually secretes norepinephrine
What is necessary for the physician to do before obtaining a biopsy of the adrenal mass?
Determined whether the mass is functional or not
What is the effect of exogenous steroids on adrenal function?
Exogenous steroids like prednisone suppress normal adrenal function
T/F: a MRI without contrast is the best imaging modality used to locate accessory loci of an active pheochromocytoma
False; it is MIBG scan
What is MIBG scan?
The best imaging modality to locate accessory loci of an active pheochromocytoma
What is the most common cause of adrenal calcifications?
Hemorrhage
T/F: pheochromocytoma is the most common cause of adrenal calcifications
False; it is hemorrhage
_____ and _____ carcinomas can invade the IVC
Renal
Adrenal
The most common metastatic tumor to the adrenal gland is ______
Lung cancer
T/F: Lung cancer can invade the IVC
False; renal and adrenal carcinomas can invade the IVC. Lung cancer is the most common metastatic tumor that affect the adrenal gland.
T/F: if a surgeon accidentally ligates the superior and middle adrenal arteries in kidney removal surgery, he should remove the affected adrenal gland and immediately administer steroid bolus
False; he should just do nothing because the affected adrenal gland still has ample blood supply
Accidentally ligated the superior and middle adrenal arteries, what should you do?
Nothing! There are plenty of blood supply for that adrenal gland, so no worries
Patient with a 1.2 cm left adrenal mass detected, what is the next step?
Request serum and urine testing to assess the functionality of the mass
Which one of the adrenal glands is right next to the IVC?
Right adrenal gland
T/F: adrenal cancer can spread to other retroperitoneal organs
True, it is a retroperitoneal organ, just like kidney, “C” loop of duodenum, pancreas and large vessels
Three branches of arterial inflow to adrenal gland:
Superior suprarenal artery (aka superior adrenal artery)
Middle suprarenal a
Inferior suprarenal a
Superior suprarenal a is a branch of the _____ artery. Middle suprarenal comes directly off the _____ and inferior suprarenal artery comes off ______.
Inferior phrenic (branch off the aorta)
Aorta
Renal
Most anterior to most posterior of structures in the renal hilum:
Most anterior: renal vein
Renal artery
Ureter
Adrenal Incidentaloma is an adrenal mass of generally _____ cm or more
1
This is usually discovered incidentally on CT
T/F: incidentalomas are usually benign
True
T/F: when an incidentaloma is detected on CT, do a biopsy to evaluate whether it is benign or malignant
False!; do not do this!!! Don’t biopsy adrenal mass until you can be sure whether the mass is metabolically active or not.
Pheochromocytoma can set off an epinephrine storm
If you biopsy a pheochromocytoma, ______ can occur
Epinephrine storm
Diagnostic modalities used in evaluating an adrenal mass with difficult lesions, such as vascular involvement:
CT and MRI to evaluate, especially pheochromocytomas and paragangliomas
(ultrasound is not routinely used)
Left adrenal gland is usually ____ shape on cross-section, and Righ adrenal gland is _____ shape
Y shape
Banana
What structure on cross section that could be mistaken with adrenal glands?
crus of the diaphragm
Anterior to posterior: pancreatic tail, crus of diaphragm, adrenal gland, splenic vein
Pancreatic tail
Splenic vein
Adrenal gland
Crus of diaphragm
T/F: spleen, like adrenal gland and pancreas, is retroperitoneal organ
False; it is intraperitoneal. Adrenal gland and pancreas are retroperitoneal
T/F: calcified adrenal cysts are usually benign
True
Cushing’s ______ means there is pituitary adenoma
Disease
Cushing’s ____ means there is elevated cortisol
Syndrome
T/F: Aldosterone is increased in Cushing’s syndrome
False; cortisol is increased
What is the most common cause of Cushing’s?
Pituitary adenoma- Cushing’s disease
(second most common is adrenal adenoma- cushing syndrome)
Adrenal hemorrhage is the most common cause of ______, and these could be manifested in/under these conditions:
