Internal Medicine

P1: SBT

0521779407-02 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:18

74 Adrenal Tumors Adult Optic Neuropathies

follow-up

■Nonfunctioning adrenal adenoma <4 cm: repeat CT in 3 and 12 mo,

then less frequently if radiographically stable

■Functioning adenoma, medical therapy:

➣Electrolytes, PRA, and aldosterone levels for hyperaldosteronism

➣Electrolytes, clinical manifestations, 24-h UFC, and plasma

ACTH for Cushing syndrome

■Adrenocortical carcinoma: 17-KS, other hormone levels if functional,

and serial CT or MRI scans

■Postoperative:

■Suppression of the hypothalamic-pituitary-adrenal axis requiring

glucocorticoid replacement therapy for up to 1 y after resection of

cortisol-producing adenoma

■Transient hyponatremia and hyperkalemia may follow cure of

aldosteronoma; increased dietary sodium and mineralocorticoid

replacement

complications and prognosis

■Benign adrenocortical adenoma: surgery curative

■Adrenocortical carcinoma: poor long-term prognosis; micrometas-

tases common at diagnosis; median survival with surgery, 14–36 mo

Adult Optic Neuropathies...............................

BARRETT KATZ, MD, MBA

history & physical

Optic atrophy is a generic term: proxy statement for histologic integrity

of neural tissue remaining – AXONS of retinal ganglion cells

Any process that affects blood supply to, supporting glia of, or axons

themselves can unfold into

Atrophy

Clinically, must differentiate

■whether the process is bilateral or unilateral

■the nerve head is swollen

■whether atrophy is actually present

Inflammation of the nerve may be demyelinative, immune-related,

infective, idiopathic, due to inflammation of contiguous structures (i.e.,

sinuses, brain, meninges), infiltration (i.e., sarcoid) or shared response

with retina (i.e., neuro-retinitis).