SU23.1-3,SU24.1-3 | Adrenal and Pancreatic Surgery — Glossary

Acute inflammation of the pancreas caused by autodigestion from prematurely activated enzymes, ranging from mild to life-threatening.

The outer part of the adrenal gland, arranged in three zones (glomerulosa, fasciculata, reticularis) secreting aldosterone, cortisol and androgens respectively.

An adrenal mass discovered incidentally on imaging done for another reason; must be screened for function and assessed for malignancy.

The inner part of the adrenal gland, made of chromaffin cells that secrete the catecholamines adrenaline and noradrenaline.

A secondary deposit in the adrenal gland from a primary cancer elsewhere — commonly lung, breast, kidney or melanoma.

Surgical removal of an adrenal gland, usually performed laparoscopically for benign functioning adenomas.

A benign tumour of the adrenal cortex; the commonest adrenal tumour, which may be functioning (cortisol or aldosterone) or non-functioning.

A malignant tumour of the adrenal cortex, often large and rapidly growing, which may secrete a mixture of cortical hormones or be non-functioning.

A rare, aggressive malignant tumour of the adrenal cortex, usually large at diagnosis and often secreting a mixture of hormones.

The screening test for primary hyperaldosteronism; a high ratio (high aldosterone, suppressed renin) suggests Conn's syndrome.

Pharmacological blockade of alpha-adrenergic receptors (e.g. phenoxybenzamine), the mandatory FIRST step in preparing a phaeochromocytoma patient for surgery.

The central mechanism of pancreatitis: premature intra-pancreatic activation of digestive enzymes so the gland digests itself.

A peptide co-secreted with endogenous insulin; raised in insulinoma and absent from manufactured insulin, so it distinguishes endogenous from exogenous (factitious) insulin.

Progressive, irreversible pancreatic fibrosis (usually from alcohol) causing exocrine insufficiency (steatorrhoea) and endocrine insufficiency (diabetes).

Primary hyperaldosteronism: autonomous aldosterone excess causing hypertension and (often) hypokalaemia.

The rate at which contrast leaves a lesion on CT; good washout favours a benign adenoma, poor washout suggests malignancy or phaeochromocytoma.

The best imaging test to demonstrate and quantify pancreatic necrosis, most informative around 72–96 hours into the illness.

The clinical syndrome of cortisol excess — truncal obesity, moon face, striae, easy bruising, hypertension and diabetes.

A screening test for Cushing's syndrome in which failure of cortisol to suppress after dexamethasone indicates autonomous cortisol secretion.

Surgical removal of a small, superficial, benign tumour (such as an insulinoma) while preserving the surrounding pancreas.

An adrenal tumour that secretes a hormone in excess (cortisol, aldosterone or catecholamines), producing a recognisable clinical syndrome.

A gastrin-secreting PNET causing the Zollinger-Ellison syndrome; often malignant and frequently arising in the 'gastrinoma triangle'.

Mnemonic for causes of pancreatitis: Gallstones, Ethanol, Trauma, Steroids, Mumps/Malignancy, Autoimmune, Scorpion sting, Hyperlipidaemia/Hypercalcaemia/Hypothermia, ERCP, Drugs.

A validated multi-variable severity score for acute pancreatitis stratifying risk from clinical and laboratory values.

A glucagon-secreting PNET causing necrolytic migratory erythema, diabetes and weight loss.

A measure of CT attenuation; a lipid-rich benign adenoma typically shows low attenuation (below about 10 HU) on unenhanced CT.

Secondary infection of necrotic pancreatic tissue; the principal indication for intervention, managed by a step-up approach.

An insulin-secreting PNET causing fasting hypoglycaemia (Whipple's triad); the commonest functioning PNET and usually benign.

The milder, commoner morphological form (revised Atlanta) with an inflamed but viable gland and no necrosis.

Minimally invasive removal of an adrenal gland, the standard approach for benign functioning adenomas.

A pancreatic enzyme more sensitive and specific than amylase that stays elevated longer; a level >3× the upper limit of normal supports the diagnosis.

Multiple endocrine neoplasia type 1, the inherited '3 Ps' syndrome: parathyroid hyperplasia, pituitary adenoma and pancreatic (entero-pancreatic) endocrine tumours.

Catecholamine metabolites measured in plasma or urine as the most sensitive screen for phaeochromocytoma.

An adrenolytic drug used as adjuvant or palliative oncological therapy in adrenocortical carcinoma.

The severe morphological form with death of pancreatic/peripancreatic tissue and a high risk of complications, especially if infected.

An adrenal tumour that does not secrete excess hormone and causes no endocrine syndrome.

Respiratory, cardiovascular or renal dysfunction; persistence beyond 48 hours defines severe acute pancreatitis under the revised Atlanta classification.

A tumour arising from the islet cells of the pancreas, classified as functioning (hormone-secreting) or non-functioning.

A collection of pancreatic fluid enclosed by a non-epithelialised wall, usually maturing over about four weeks after an attack.

An extra-adrenal catecholamine-secreting tumour arising from sympathetic chain chromaffin tissue — the extra-adrenal counterpart of phaeochromocytoma.

A catecholamine-secreting tumour of adrenal medullary chromaffin cells, causing paroxysmal headache, sweating, palpitations and hypertension.

Aldosterone excess arising in the adrenal itself (adenoma or hyperplasia), independent of renin; the cause of Conn's syndrome.

Open en-bloc resection of an adrenal tumour without capsular rupture, used for adrenocortical carcinoma to avoid tumour spillage.

A validated scoring system using parameters at admission and at 48 hours to predict the severity of acute pancreatitis.

The current consensus classification of acute pancreatitis by morphology (interstitial vs necrotising) and severity (mild/moderately severe/severe).

An aide-memoire for phaeochromocytoma: roughly 10% bilateral, 10% extra-adrenal, 10% malignant, 10% familial and 10% in children.

A drug such as octreotide or lanreotide that suppresses hormone secretion and slows growth in receptor-positive neuroendocrine tumours, used in metastatic disease.

Functional imaging (e.g. Ga-68 DOTATATE PET or octreotide scan) that localises receptor-expressing neuroendocrine tumours and detects metastases.

A somatostatin-secreting PNET causing diabetes, gallstones and steatorrhoea.

An escalating strategy for infected necrosis — image-guided drainage first, minimally invasive necrosectomy only if needed — preferred to early open surgery.

The gold-standard test for insulinoma, demonstrating hypoglycaemia with inappropriately elevated insulin and C-peptide.

Active monitoring of a small, non-functioning, imaging-benign adrenal incidentaloma with interval imaging and functional screening instead of surgery.

A PNET secreting vasoactive intestinal peptide, causing profuse watery diarrhoea, hypokalaemia and achlorhydria (WDHA syndrome).

The diagnostic triad of insulinoma: symptoms of hypoglycaemia, a documented low blood glucose during symptoms, and relief of symptoms on giving glucose.

The syndrome of gastrin excess: severe, multiple, recurrent or atypically sited peptic ulcers with diarrhoea due to gastric acid hypersecretion.

The middle cortical zone, which secretes the glucocorticoid cortisol under pituitary ACTH control.

The outermost cortical zone, which secretes the mineralocorticoid aldosterone under renin-angiotensin and potassium control.

The innermost cortical zone, which secretes adrenal androgens.