Adrenocortical carcinoma physical examination: Difference between revisions

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Latest revision as of 19:00, 30 October 2017

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

Moon-like face^[1]
Buffalo hump
Patients may appear flushed due to the associated increase in erythropoietin secretion.^[2]
Patients may appear obese due to associated type 2 diabetes mellitus and Cushing's syndrome.^[3]

Vitals

Hypotension occurs due to fluid contraction
Hypertension due to 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

Chest

Gynecomastia

Skin

The skin may be fragile and thin ^[4]
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 ACTH synthesis from Proopiomelanocortin (POMC)
Telangiectasia (dilation of capillaries)
Thinning of the skin (which causes easy bruising)
Purple or red striae (the weight gain in Cushing's stretches the skin, which is thin and weakened, causing it to bleed) on the trunk, buttocks, arms, legs or breasts, and proximal muscle weakness
Hirsutism
Dehydration caused by gastrointestinal secretion of fluid and electrolytes

Head

Facial flushing ^[5]
Scleral icterus in case of metastasis to the liver
Moon-face is often associated with Cushing's syndrome, also known as Cushingoid facies ^[4]
Alopecia

Abdomen

A palpable abdominal mass in the lower abdominal quadrant ^[5]
Guarding may be present
Hepatomegaly if malignant secondaries found in liver
flushing in medullary thyroid cancer patients

Extremities

Clubbing
Cyanosis
Pitting/non-pitting edema of the upper/lower extremities ^[6]
Muscle atrophy
Fasciculations in the upper/lower extremity

Neurologic

Confusion

Genitals

Clitoromegaly

References

↑ 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.
↑ 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.
↑ 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.
↑ ^4.0 ^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.
↑ ^5.0 ^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.
↑ Brunaud L, Duh QY (2002). "Aldosteronoma". Curr Treat Options Oncol. 3 (4): 327–33. PMID 12074769.

Template:WikiDoc Sources

[pmid26156970-1] 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.

[pmid12923403-2] 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.

[pmid7567437-3] 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.

[pmid261569702-4] 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.

[pmid23285767-5] 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.

[pmid12074769-6] Brunaud L, Duh QY (2002). "Aldosteronoma". Curr Treat Options Oncol. 3 (4): 327–33. PMID 12074769.

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@@ Line 1: / Line 1: @@
+__NOTOC__
 {{Adrenocortical carcinoma}}
-{{CMG}}; {{AE}} {{RT}}
+{{CMG}}; {{AE}} {{RT}} {{AAM}} {{MAD}}
 ==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 [[hirsuitism|hirsutism]].
+==Physical Examination==
 ===Appearance of the patient===
-* Patient may be [[obese]] with a moon like face.
+* [[Moon like face|Moon-like face]]<ref name="pmid26156970">{{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>
+* [[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 [[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===
+* [[Hypotension]] occurs due to fluid contraction
+* [[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]]
+===Chest===
+* [[Gynecomastia]]
 ===Skin===
-* Purple striae can be seen on the skin of the abdomen in Cushing's syndrome.
+* 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>
-* Delayed wound healing
+* [[Jaundice]] secondary to deranged [[liver]] function in case of [[metastasis]] to the [[liver]]
-* Discoloration
+* [[Hyperpigmentation]] - this is due to [[melanocyte-stimulating hormone]] production as a byproduct of [[Adrenocorticotropic hormone|ACTH]] synthesis from [[Proopiomelanocortin|Proopiomelanocortin (POMC)]]
-* [[Acne]]
+* [[Telangiectasia]] (dilation of [[capillaries]])
-* [[Malar flush]]
+* 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|bleed]]) on the [[trunk]], [[buttocks]], arms, legs or [[breasts]], and [[proximal]] [[muscle weakness]]
+* [[Hirsutism]]
+* [[Dehydration]] caused by [[gastrointestinal]] secretion of fluid and [[Electrolyte|electrolytes]]
+===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>
+* [[Icterus|Scleral icterus]] in case of [[metastasis]] to the [[liver]]
+* [[Moon face|Moon-face]]  is often associated with [[Cushing's syndrome]], also known as [[Cushingoid appearance|Cushingoid facies]] <ref name="pmid261569702" />
+* [[Alopecia]]
+===Abdomen===
+* A palpable [[abdominal mass]] in the lower [[abdominal]] quadrant <ref name="pmid23285767" />
+* [[Abdominal guarding|Guarding]] may be present
+* [[Hepatomegaly]] if [[malignant]] secondaries found in [[liver]]
+* [[flushing]] in [[medullary thyroid cancer]] patients
+===Extremities===
+* [[Clubbing]]
+* [[Cyanosis]]
+* [[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]]
+* [[Fasciculations]] in the upper/lower extremity
-===Head===
+===Neurologic===
+* [[Confusion]]
+===Genitals===
+*[[Clitoromegaly]]
 ==References==
 {{reflist|2}}
+[[Category:Endocrinology]]
+[[Category:Types of cancer]]
+[[Category:Disease]]
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