Cortex
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Product
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Clinical manifestations
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Dianosis
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Gold
standard
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Other features
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Symptoms
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Signs
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Blood & Urine
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Histopathological
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Imaging
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Others
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Adenoma
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Aldosterone
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- Headache
- Vision problems
- Muscle cramps
- Muscle weakness & cramps
- Numbness
- Temporary paralysis
- Polyuria and polydipsia
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- Hypertension
- Refractory hypertension
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- Hypokalemia
- Alkalosis
- ↑ Plasma aldosterone
- ↓ Plasma Renin
- ↑ ARR
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- Single or multiple nodules
- Encapsulated
- Abundant clear cytoplasm
- Uniforming nuclei
- Histopathology may resemble:
- ZF (large, lipid-laden clear cells)
- ZG (small, compact cells with moderate amount of lipid)
- ZR (lipid-sparse cytoplasm)
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- Adrenal mass or nodule
- Unilateral or bilateral adrenal atrophy
- Hypodense mass (CT)
- Iso and low FDG uptake compared with liver (FDG PET/CT)
- Hyperintense on in-phase and hypointense on oppose-phase (MRI)
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- Fludrocortisone Suppression Testing
- Oral Sodium Loading
- Saline Infusion Testing
- Captopril test
- Adrenal venous sampling
- Posture test
- Genetic testing
- Immunohistochemical staining
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- Fludrocortisone Suppression Testing
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- Glucocorticoid-Remediable Aldosteronism responds to glucocorticoids
- Higher cardiovascular and cerebrovascular morbidity
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Cortisol
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- Weight gain
- Growth retardation
- Headaches
- Amenorrhea
- Virilization (rare)
- Acne
- Violaceous striae
- Acanthosis nigricans
- Sleep disruption
- Mental changes
- Muscular weakneness
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- Hypertension
- Hirsutism
- Hypogonadism
- Growth retardation
- Facial plethora
- Acne
- Striae
- Bruising
- Acanthosis nigricans
- Mental changes
- Muscular weakneness
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- ↑ Plasma cortisol
- ↑ 24 Hour urinary cortisol
- ↓ or inappropriately normal plasma ACTH
- ↑ Blood glucose
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- Yellow fat
- Brown discoloration
- Large cells with increased lipid contetnt (zona fasciculata)
- May contain pigment (lipofuscin)
- Adjacent atrophied cells
- Hemorrhage and calcification (Pre-malignant lesions)
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- Adrenal mass or nodule
- Unilateral or bilateral adrenal atrophy
- ↑ Fat
- Hypodense mass (CT)
- Iso and low FDG uptake compared with liver (FDG PET/CT)
- Hyperintense on in-phase and hypointense on oppose-phase (MRI)
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- Diurnal plasma cortisol variation
- Low dose and high dose dexamethasone suppression test
- Dexamethasone-CRH test
- Adrenal venous sampling
- Genetic testing
- Immunohistochemical staining
- Dual-energy X-ray absorptiometry
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- Associated with Carney complex
- Associated with MEN-1
- Plasma levels of cortisol and ACTH may show false positive and false negative results due to normal diurnal hormonal variation
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Androgens
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- Hirsutism
- Virilization
- Amenorrhea
- Precocious puberty
- Testicular atrophy & diminished libido (male)
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- Clitorimegaly
- Male pattern baldness
- Resistant hypertension
- Gynecomastia
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- ↑ Serum testosterone
- ↑ Serum androstenedione
- ↑ Serum dehydroepiandrosterone sulfate (DHEA-S)
- ↑ urine 17-ketosteroids
- ↑ plasma and urine estrogens
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- Pale tan to brown
- Pseudocapsule or the fibrous capsule
- Nesting, alveolar, cords, trabeculae
- Eosinophilic cytoplasm
- May see clear, vacuolated cytoplasm
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- Well-defined
- Solid mass
- Homogeneous enhancement (CT contrast)
- Hyperintense on in-phase and hypointense on oppose-phase (MRI)
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- FSH, LH, prolactin levels
- Cortisol levels
- FDG PET/CT
- Pelvic Ultrasound
- Adrenal Venous sampling
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- Extremely rare
- Most androgen secreting adenomas are mixed tumors
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Mix
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Carcinoma
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Nodular
Hyperplasia
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