Adrenocortical carcinoma physical examination: Difference between revisions

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__NOTOC__
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{{Adrenocortical carcinoma}}
{{Adrenocortical carcinoma}}
{{CMG}} {{AE}} {{RT}} {{AAM}}
{{CMG}}; {{AE}} {{RT}} {{AAM}} {{MAD}}
==Overview==
==Overview==
Common physical examination findings of Adrenocortical carcinoma include, [[high blood pressure]], [[weakness]], gynecommastia and [[acne]].
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===
* [[Obesity]] with a [[moon like face]] and a buffalo hump on the neck
* [[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>
* Hairsutism
* [[Buffalo hump]]
* Gynecommastia
* 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===
===Vitals===
* [[High blood pressure]]
* [[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===
===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]])
* Fragile and thinning
* 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===
===Head===
* Supraclavicular and dorsocervical fat pads
* [[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]]
* [[Alopecia]]


===Abdomen===
===Abdomen===
* Mass may be found on physical examination
* 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===
===Extremities===
* [[Weakness]]
* [[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


===Neurologic===
===Neurologic===
* [[Confusion]]
* [[Confusion]]
===Genitals===
*[[Clitoromegaly]]


==References==
==References==

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 hypertensionweakness, 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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