Addison Disease:
Affects men and women equally; not related to ____
Atrophy of the adrenal cortex occurs with decreased production
of _______ and sometimes aldosterone Majority of the
cortical tissue is often destroyed before adrenal _________ is
diagnosed.

age
cortisol
insufficiency

Addison Disease:
Primary causes of reduced adrenal cortical tissue? (5)

Autoimmune process, Tuberculosis (TB), Inflammatory process, Primary
neoplasm, and Metastases

Adrenogenital Syndrome (adrenal virilism):
Results from the excessive secretion of the ____ hormones and
adrenal androgens
Caused by either an adrenal tumor or _______

sex
hyperplasia

Adrenogenital Syndrome (Adrenal Virilism)
Symptoms and clinical signs vary depending on the age and sex
of the person. In a newborn, there may be ambiguous
_______, with or without adrenal hyperplasia.

genitalia

Adrenogenital Syndrome (Adrenal Virilism):
Has __________ effects on adult women
Clinical signs and symptoms in a female adult? (6)
Prepubescent boys will have signs of masculine development,
deepening voice, and an increase in body hair.

masculinizing
Hirsutism, baldness, and acne; Deepening of the voice; Atrophy of
the uterus; Decreased breast size; Clitoral hypertrophy; Increased muscularity

Conn's Syndrome (Aldosteronism)
Occurs in 0.5% of patients with sustained _________.
Caused by excessive secretion of ________, usually because of a
cortical adenoma of the glomerulosa cells.

hypertension
aldosterone

Conn's Syndrome (Aldosteronism)
Less frequent causes of excessive secretion include adrenal
__________ or adrenal carcinoma. Hyperplasia is more common
in ____; adrenal adenomas are more common in _______.

hyperplasia
men; women

Conn's Syndrome (Aldosteronism)
Adenomas measure ___ to ____cm in diameter. Contralateral
adrenal atrophy is identified.
Clinical signs and symptoms: Muscleweakness, Hypertension, and
Abnormal electrocardiogram
If hyperaldosteronism is caused by an _______, it is
removed.

0.5 to 3
adenoma

Cushing's Syndrome
Caused by excessive secretion of ______, resulting from
adrenal hyperplasia, cortical adenoma, adrenal carcinoma, or
elevated _____ from a pituitary adenoma

cortisol; ACTH

Cushing's Syndrome
Truncal obesity and _______ extremities �______ hump�
or �______ face� Hypertension and renal stones
Irregular menses Psychiatric disturbances

pencil-thin
Buffalo; moon

Cushing's Syndrome
If adrenal tumor is present, the secretion of androgens may
increase and cause _________ effects in women. Also caused
by an _____ _________ tumor. Functioning adrenal adenomas
are usually small (2 to 5 cm) and _____echoic.

masculinizing
anterior pituitary
hypoechoic

Adrenal Cysts:
________ lesions that produce no clinical symptoms when the
lesion is small
Affect ______ more (3:1) May be unilateral,
unilocular, or multilocular

Uncommon
women

Adrenal Cysts Sonographic findings:
Adrenal cysts exhibit a typical _____ pattern, with a strong
posterior wall, no internal echoes, and ____
through-transmission.

cystic, good

Adrenal Hemorrhage:
Very ____ in adults Usually caused by severe _______
or infection Posttraumatic hemorrhage usually unilateral
and does not cause any major clinical problem Bilateral
hemorrhage may cause adrenal _______.

rare
trauma
insufficiency

Adrenal Hemorrhage:
More common in _______ who experience traumatic delivery with
stress, asphyxia, and septicemia
Adrenal glands in a neonate are very ______. Neonatal adrenal
glands are proportionally ______ than in an adult.
Sono finding varies, depending on the age of the hemorrhage

neonates
vascular
larger

Adrenal Tumors Sonographic considerations:
Detects ___% of known adrenal masses first detected by
computed tomography (CT). Used to:
Characterize an adrenal mass as cystic or solid
Evaluate the position and patency of the IVC and draining
veins Evaluate tumor invasion into an adjacent
structure Determine the origin of a large retroperitoneal
mass Follow an adrenal mass that is not surgically
removed

90%

Adrenal Adenoma:
Adrenal nodules are usually less than ____ cm. High
incidence of adrenal adenomas exists in older patients with ______
or hypertension. Significant percentage of the malignant
adrenal adenomas may be the result of metastases.

2.5cm
diabetes

Most common primary adrenal tumor.

Adrenal Adenoma

Adrenal Adenomas Sonographic findings:
Nonfunctioning adenomas demonstrate a well-defined, round,
slightly hypoechoic, homogeneous mass. Mass is almost
always detected as an ______ finding. Mass may be so ____
that it compresses adjacent structures.

incidental
large

Adrenal Malignant Tumors:
Primary adrenal carcinomas are _____. May be
hyperfunctional or nonfunctional. Hyperfunctional
malignant tumors are more common in _______.
Adrenal malignant tumors may cause Cushing�s syndrome,
Conn�s syndrome, or adrenogenital syndrome.

rare
women

Adrenal Malignant Tumors:
Functional tumors tend to be _____ than nonfunctional tumors
because they are typically diagnosed earlier. Tumors are
homogeneous with the same echogenicity as the renal _____.
Larger neoplasms tend to be nonfunctional and heterogeneous,
with a central area of ______ and hemorrhage.

smaller
cortex
necrosis

Adrenal Malignant Tumors Sono Findings:
If the mass is _____ (2 to 6 cm), it is well-defined and
homogeneous. Larger masses tend to have _____ with central
hemorrhage and often calcify. In color Doppler, the tumor
is ____vascular with a high incidence of invasion of the
adrenal or renal vein, IVC, hepatic veins, and lymph nodes.

small
necrosis
hypervascular

METs:
Adrenals glands are the _____ most common site in the body for
metastasis, after the lung, liver, and bones. _____
involvement is seen in more than one half of patients.
Metastases to the adrenal gland typically cause adrenal
________.

fourth
Bilateral
insufficiency

METs:
Adrenal glands vary in size and echogenicity.
Metastatic lesions have a nonspecific appearance. Large masses
may contain areas of ________ and hemorrhage.
Differentiating a _______ _______ ________ from a metastatic
lesion can be difficult when no other evidence of metastatic disease
is found and the adrenal mass is unilateral. Often
central necrosis causes sonolucent areas in the tumor.

necrosis
common benign adenoma

Pheochromocytoma:
___________ of the adrenal medulla may produce a tumor called
a pheochromocytoma, which secretes ______ and _______in excessive
quantities. Small percentage of patients have ectopic adrenal
pheochromocytomas rising from the neuroectodermal tissue; these
tumors tend to be _______. Clinical symptoms include
intermittent hypertension, severe headaches, heart palpitations, and
excess perspiration.

Pheochromocytes; epinephrine and norepinephrine
malignant

Pheochromocytoma Sonographic findings:
Homogeneous pattern, weak posterior wall, poor
through-transmission Unilateral May be _____ and
bulky tumors Variety of sonographic patterns: cystic,
solid, and calcified components

large

Adrenal Neuroblastoma:
Well-encapsulated tumor that displaces the kidney _________
and ________ More than ____ of fetal neuroblastomas located
in the adrenal glands; 50% of these have cystic components

inferiorly and laterally
90%

Most common malignancy of the adrenal glands in childhood?

Adrenal Neuroblastoma

Most common tumor of infancy, representing 30% of all neonatal tumors?

Adrenal Neuroblastoma

Adrenal Neuroblastoma:
Tumor develops within the adrenal ______. Children
are usually asymptomatic. Some have a palpable abdominal mass that
must be differentiated from a neonatal hemorrhage and
hydronephrosis. Spontaneous regression is common before the
age of 1 year. Otherwise, the prognosis is very ____; tumor is
not very responsive to either irradiation or chemotherapy.

medulla
poor

Adrenal Neuroblastoma:
Color Doppler may help demonstrate capsular flow and
___-resistance arterial waveforms. Evaluation of the
surrounding retroperitoneum and liver is conducted to rule out
metastases. When a large, solid, upper abdominal mass is
identified in an infant or young child, the differential diagnosis
should include: Neuroblastoma, Wilms tumor (nephroblastoma), &
Hepatoblastoma

low

Retro Lymphoma:
Sonographic evaluation for abdominal lymphoma is performed to
determine the presence or absence of ________.
Main areas to be evaluated include hepatic and splenic hilum,
origin of celiac and superior mesenteric artery (SMA)
(peripancreatic, mesenteric), and paraaortic and renal hilar
areas.

lymphadenopathy

Most common primary retroperitoneal tumor (PRT)?

Retro Lymphoma

Retro Lymphoma:
Accuracy of sonographic detection is close to 90% when the
lymph nodes are >___cm in diameter. Sonographic
appearance varies from round, hypoechoic masses to anechoic masses
with good posterior enhancement. Color Doppler shows increased
______ vascularity.

2cm
intranodal

Leiomyosarcoma
May originate from smooth muscles of small _____ _______ or
within the gastrointestinal tract and extend into the ________
On sonography, leiomyosarcomas generally present as a
large ______ mass with areas of necrosis and cystic
degeneration.

blood vessels; retroperitoneum
complex

Second most common PRT?

Leiomyosarcoma

Fibrosarcoma and rhabdomyosarcoma:
May be quite invasive, infiltrating widely into muscles and
adjoining soft tissue Often extend across the _____ and
appear very similar to _____ Sonographically, they are
highly reflective tumors.

midline; lymphomas

Germ Cells Tumors:
Benign or malignant
Retroperitoneal space is the _____ most common site (ovaries,
testes, anterior mediastinum, retroperitoneum, and sacrococcygeal
region). Sonographically, tumors are heterogeneous with solid
areas, calcifications, and cystic spaces.

fourth

Teratoma:
Teratomatous tumors may arise within the _____ retroperitoneum
and pelvis. May contain calcified echoes from bones,
cartilage, teeth, and soft-tissue elements Teratomas are
seen more commonly in ______ and are usually located in the
upper-pole of left kidney.

upper
childhood

Secondary Retroperitoneal Tumors:
Most common primary malignancies that spread into the
retroperitoneum are from the breast, lung, testis, or are the
recurrence of previously resected urologic or gynecologic
tumors. Ascitic fluid, along with a retroperitoneal tumor,
usually indicates seeding or invasion of the peritoneal
surface.

...

Secondary Retro Tumors:
Paraaortic region is evaluated for extension to the _____
_____. Liver is evaluated for ______ involvement.

lymph nodes
metastatic

THREE Retro fluid collections?

Urinoma Hemorrhage Abscess

Ormond's Disease:
________ condition characterized by thick sheets of _____
tissue in the retroperitoneal cavity. Fibrosis may encase and
obstruct the ureters and vena cava, with resultant ______.
Also associated with infiltrating neoplasms, acute immune
diseases (Crohn disease), ulcerative colitis, sclerosing
cholangitis, and other conditions

Idiopathic; fibrous; hydronephrosis

Ormond's Disease:
Clinically, the patient may present with abdominal pain,
hypertension, and oligoanuria. Sonography may demonstrate
abnormal hypoechoic tissue surrounding the anterolateral aspect of
the____ and/or the __. Sonography can also be useful in
evaluating the kidneys and to evaluate fibrosis regression in
response to_______.

aorta; IVC
steroids