Adrenocortical carcinoma physical examination: Difference between revisions

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{{CMG}}; {{AE}} {{RT}} {{AAM}} {{MAD}}
{{CMG}}; {{AE}} {{RT}} {{AAM}} {{MAD}}
==Overview==
==Overview==
Common physical examination findings of Adrenocortical carcinoma include [[Cushing's syndrome]] findings such as [[hypertension]], [[weakness]], gynecomastia, and [[acne]]. Hyperandrogenic cases may show findings such as [[clitoromegaly]] and [[hirsuitism|hirsutism]]. 
Common physical examination findings of adrenocortical carcinoma include findings of [[Cushing's syndrome]] such as [[hypertension]], [[weakness]], [[gynecomastia]], and [[acne]]. Hyperandrogenic cases may show findings such as [[clitoromegaly]] and [[hirsuitism|hirsutism]]. 
==Physical Examination==
==Physical Examination==
===Appearance of the patient===
===Appearance of the patient===
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* [[Buffalo hump]]
* [[Buffalo hump]]
* Patients may appear [[Flushing|flushed]] due to the associated increase in [[erythropoietin]] secretion.<ref name="pmid12923403">{{cite journal| author=La Batide-Alanore A, Chatellier G, Plouin PF| title=Diabetes as a marker of pheochromocytoma in hypertensive patients. | journal=J Hypertens | year= 2003 | volume= 21 | issue= 9 | pages= 1703-7 | pmid=12923403 | doi=10.1097/01.hjh.0000084729.53355.ce | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12923403  }}</ref>
* Patients may appear [[Flushing|flushed]] due to the associated increase in [[erythropoietin]] secretion.<ref name="pmid12923403">{{cite journal| author=La Batide-Alanore A, Chatellier G, Plouin PF| title=Diabetes as a marker of pheochromocytoma in hypertensive patients. | journal=J Hypertens | year= 2003 | volume= 21 | issue= 9 | pages= 1703-7 | pmid=12923403 | doi=10.1097/01.hjh.0000084729.53355.ce | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12923403  }}</ref>
* Patients may appear [[obese]] due to associated type2 [[diabetes mellitus]] and [[Cushing's syndrome]].<ref name="pmid7567437">{{cite journal| author=Drénou B, Le Tulzo Y, Caulet-Maugendre S, Le Guerrier A, Leclercq C, Guilhem I et al.| title=Pheochromocytoma and secondary erythrocytosis: role of tumour erythropoietin secretion. | journal=Nouv Rev Fr Hematol | year= 1995 | volume= 37 | issue= 3 | pages= 197-9 | pmid=7567437 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7567437  }}</ref>
* Patients may appear [[obese]] due to associated type 2 [[diabetes mellitus]] and [[Cushing's syndrome]].<ref name="pmid7567437">{{cite journal| author=Drénou B, Le Tulzo Y, Caulet-Maugendre S, Le Guerrier A, Leclercq C, Guilhem I et al.| title=Pheochromocytoma and secondary erythrocytosis: role of tumour erythropoietin secretion. | journal=Nouv Rev Fr Hematol | year= 1995 | volume= 37 | issue= 3 | pages= 197-9 | pmid=7567437 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7567437  }}</ref>
===Vitals===
===Vitals===
* [[Hypotension]] occurs due to fluid contraction
* [[Hypotension]] occurs due to fluid contraction
* [[Hypertension|Hypertension due to]] [[Cortisol|cortisol's]] enhancement of [[epinephrine]]'s [[vasoconstrictive]] effect
* [[Hypertension|Hypertension due to]] [[Cortisol|cortisol's]] enhancement of [[epinephrine]]'s [[vasoconstrictive]] effect
* [[Tachypnea]] if [[malignant]] secondaries are found in the [[lung]]. [[Dyspnea]] occurs in patients with complicated [[heart failure]] and [[cardiomyopathy]]
* [[Tachypnea]] if [[malignant]] secondaries are found in the [[lung]]
* [[Dyspnea]] occurs in patients with complicated [[heart failure]] and [[cardiomyopathy]]


===Chest===
===Chest===
* [[Gynecomastia]]
* [[Gynecomastia]]
===Skin===
===Skin===
* The skin may be fragile and thin.<ref name="pmid261569702">{{cite journal| author=Nieman LK| title=Cushing's syndrome: update on signs, symptoms and biochemical screening. | journal=Eur J Endocrinol | year= 2015 | volume= 173 | issue= 4 | pages= M33-8 | pmid=26156970 | doi=10.1530/EJE-15-0464 | pmc=4553096 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26156970  }}</ref>
* The [[skin]] may be fragile and thin <ref name="pmid261569702">{{cite journal| author=Nieman LK| title=Cushing's syndrome: update on signs, symptoms and biochemical screening. | journal=Eur J Endocrinol | year= 2015 | volume= 173 | issue= 4 | pages= M33-8 | pmid=26156970 | doi=10.1530/EJE-15-0464 | pmc=4553096 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26156970  }}</ref>
* [[Jaundice]] secondary to deranged [[liver]] function in case of [[metastasis]] to the [[liver]]
* [[Jaundice]] secondary to deranged [[liver]] function in case of [[metastasis]] to the [[liver]]
* [[Hyperpigmentation]] - this is due to [[melanocyte-stimulating hormone]] production as a byproduct of [[Adrenocorticotropic hormone|ACTH]] synthesis from [[Proopiomelanocortin|Proopiomelanocortin (POMC)]]
* [[Hyperpigmentation]] - this is due to [[melanocyte-stimulating hormone]] production as a byproduct of [[Adrenocorticotropic hormone|ACTH]] synthesis from [[Proopiomelanocortin|Proopiomelanocortin (POMC)]]
* [[Telangiectasia]] (dilation of [[capillaries]])
* [[Telangiectasia]] (dilation of [[capillaries]])
* Thinning of the [[skin]] (which causes [[easy bruising]])
* Thinning of the [[skin]] (which causes [[easy bruising]])
* Purple or red [[striae]] (the weight gain in [[Cushing's syndrome|Cushing's]] stretches the skin, which is thin and weakened, causing it to [[hemorrhage]]) on the trunk, buttocks, arms, legs or breasts, and proximal [[muscle weakness]]
* Purple or red [[striae]] (the weight gain in [[Cushing's syndrome|Cushing's]] stretches the skin, which is thin and weakened, causing it to [[hemorrhage|bleed]]) on the [[trunk]], [[buttocks]], arms, legs or [[breasts]], and [[proximal]] [[muscle weakness]]
* [[Hirsutism]]
* [[Hirsutism]]
* [[Dehydration]] caused by [[gastrointestinal]] secretion of fluid and [[Electrolyte|electrolytes]]


===Head===
===Head===
* [[Alopecia|Facial flushing]]<ref name="pmid23285767">{{cite journal| author=Simonenko VB, Makanin MA, Dulin PA, Vasilchenko MI, Lesovik VS| title=[About the signs of malignant pheochromocytoma]. | journal=Klin Med (Mosk) | year= 2012 | volume= 90 | issue= 10 | pages= 64-8 | pmid=23285767 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23285767  }}</ref>
* [[Alopecia|Facial flushing]] <ref name="pmid23285767">{{cite journal| author=Simonenko VB, Makanin MA, Dulin PA, Vasilchenko MI, Lesovik VS| title=[About the signs of malignant pheochromocytoma]. | journal=Klin Med (Mosk) | year= 2012 | volume= 90 | issue= 10 | pages= 64-8 | pmid=23285767 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23285767  }}</ref>
* [[Icterus|Scleral icterus]] in case of [[metastasis]] to the [[liver]]
* [[Icterus|Scleral icterus]] in case of [[metastasis]] to the [[liver]]
* [[Moon face|Moon-face]] is a medical sign where the face swells up into a rounded shape. It is often associated with [[Cushing's syndrome]], which has led to it being known as [[Cushingoid appearance|Cushingoid facies]], or [[steroid]] treatment<ref name="pmid261569702" />
* [[Moon face|Moon-face]]  is often associated with [[Cushing's syndrome]], also known as [[Cushingoid appearance|Cushingoid facies]] <ref name="pmid261569702" />
* [[Alopecia]]
* [[Alopecia]]


===Abdomen===
===Abdomen===
* A palpable [[abdominal mass]] in the lower [[abdominal]] quadrant<ref name="pmid23285767" />
* A palpable [[abdominal mass]] in the lower [[abdominal]] quadrant <ref name="pmid23285767" />
* [[Abdominal guarding|Guarding]] may be present.
* [[Abdominal guarding|Guarding]] may be present
* [[Hepatomegaly]] if [[malignant]] secondaries found in [[liver]]
* [[Hepatomegaly]] if [[malignant]] secondaries found in [[liver]]
* [[Diarrhea]] caused by [[gastrointestinal]] secretion of fluid and [[Electrolyte|electrolytes]], and [[flushing]] in [[medullary thyroid cancer]] patients
* [[flushing]] in [[medullary thyroid cancer]] patients


===Extremities===
===Extremities===
* [[Clubbing]]
* [[Clubbing]]
* [[Cyanosis]]
* [[Cyanosis]]
* Pitting/non-pitting [[edema]] of the upper/lower extremities<ref name="pmid12074769">{{cite journal| author=Brunaud L, Duh QY| title=Aldosteronoma. | journal=Curr Treat Options Oncol | year= 2002 | volume= 3 | issue= 4 | pages= 327-33 | pmid=12074769 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12074769  }}</ref>
* [[Pitting edema|Pitting]]/non-pitting [[edema]] of the upper/lower [[extremities]] <ref name="pmid12074769">{{cite journal| author=Brunaud L, Duh QY| title=Aldosteronoma. | journal=Curr Treat Options Oncol | year= 2002 | volume= 3 | issue= 4 | pages= 327-33 | pmid=12074769 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12074769  }}</ref>
* [[Muscle atrophy]]
* [[Muscle atrophy]]
* [[Fasciculations]] in the upper/lower extremity
* [[Fasciculations]] in the upper/lower extremity

Latest revision as of 19:00, 30 October 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2] Ahmad Al Maradni, M.D. [3] Mohammed Abdelwahed M.D[4]

Overview

Common physical examination findings of adrenocortical carcinoma include findings of Cushing's syndrome such as hypertension, weakness, gynecomastia, and acne. Hyperandrogenic cases may show findings such as clitoromegaly and hirsutism. 

Physical Examination

Appearance of the patient

Vitals

Chest

Skin

Head

Abdomen

Extremities

Neurologic

Genitals

References

  1. ↑ Nieman LK (2015). "Cushing's syndrome: update on signs, symptoms and biochemical screening". Eur J Endocrinol. 173 (4): M33–8. doi:10.1530/EJE-15-0464. PMC 4553096. PMID 26156970.
  2. ↑ La Batide-Alanore A, Chatellier G, Plouin PF (2003). "Diabetes as a marker of pheochromocytoma in hypertensive patients". J Hypertens. 21 (9): 1703–7. doi:10.1097/01.hjh.0000084729.53355.ce. PMID 12923403.
  3. ↑ Drénou B, Le Tulzo Y, Caulet-Maugendre S, Le Guerrier A, Leclercq C, Guilhem I; et al. (1995). "Pheochromocytoma and secondary erythrocytosis: role of tumour erythropoietin secretion". Nouv Rev Fr Hematol. 37 (3): 197–9. PMID 7567437.
  4. ↑ 4.0 4.1 Nieman LK (2015). "Cushing's syndrome: update on signs, symptoms and biochemical screening". Eur J Endocrinol. 173 (4): M33–8. doi:10.1530/EJE-15-0464. PMC 4553096. PMID 26156970.
  5. ↑ 5.0 5.1 Simonenko VB, Makanin MA, Dulin PA, Vasilchenko MI, Lesovik VS (2012). "[About the signs of malignant pheochromocytoma]". Klin Med (Mosk). 90 (10): 64–8. PMID 23285767.
  6. ↑ Brunaud L, Duh QY (2002). "Aldosteronoma". Curr Treat Options Oncol. 3 (4): 327–33. PMID 12074769.

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