The adrenal cortex can be affected by various tumor diseases, both hormone-releasing hormones and hormone-active ones.
Among the hormone producing tumor formations is quite common aldosterome. This adrenal tumor, capable of producing hormones and damaging the cortex of the organ. A similar disease is the cause of primary aldosteronism or Conn's disease.
In fact, aldosteroma is an aldosterone secreting adrenal adenoma, which is characterized by the symptoms of Conn's syndrome. Usually, such tumors are of a benign nature, however, in about 5% of cases they are formed by malignant ones.
Aldosteromas are more typical for women, in whom they are detected three times more often than in male patients. The most preferable age of patients is 30-50 years. In single cases, the tumor affects the children's population.
Causes of the pathology of
The aetiological field of aldosterome has not been sufficiently studied to date, but most scientists hold the theory that the hereditary factor plays a leading role in the development of aldosteroma.
The formed aldosterome produces an excessive amount of the aldosterone hormone, which takes an active part in real-exchange processes, exerting a significant influence on their course.
As a result, a number of changes occur:
- The sodium content increases;
- A persistent increase in pressure is formed;
- Blood volume circulating through blood vessels and veins increases;
- The body loses a significant amount of hydrogen, magnesium and potassium in the urine, which leads to dysfunctional disorders of organic structures;
- Glomerular activity is suppressed, resulting in a deficiency of renin, a specific renal enzyme that regulates blood pressure;
- The increased content of aldosterone hormone leads to hypertrophic changes in the structure of the myocardium, damage to vascular tissues and kidney structures.
Aldosteromas of benign origin usually differ in small sizes( not more than 3 cm), such tumors have a yellowish-brownish hue and a capsule of connective tissue structures.
Malignant tumor forms of aldosteroma are formed from the adrenal cortex's own tissues. Such formations are characterized by rapid development and growth, and already with small tumor sizes metastases can occur.
Symptoms of adrenal aldosteroma
Adrenal aldosteroma is manifested by three characteristic syndromes: renal, cardiovascular and neuromuscular.
Neuromuscular syndrome develops under the influence of potassium-magnesium deficiency and is manifested by such signs as:
- Excessive fatigue;
- Frequent cases of constipation;
- Convulsive muscle contraction;
- Muscular dystrophy or weakness;
- Somatic disorders in the limbs;
- Paralysis.
Cardiovascular syndrome develops as a result of fluid retention and sodium and manifests itself with symptoms like:
- Intensive headaches;
- Hypertensive disease;
- Spotting irregularities;
- Left ventricular dysfunction of the myocardium.
Renal Syndrome manifests itself:
- Nicturia - when nocturnal urination becomes too frequent;
- Isostenuria - when the density of urine is too low;
- Increased urination;
- Violations of concentration renal function;
- Permanent thirst, etc.
If aldosteroma is of a malignant nature, then other signs such as hyperthermia, painful sensations in the abdominal area and other intoxication can be added to the main triad of syndromes. And only 10% aldosteromas differ asymptomatic course.
Tumor Diagnostics
Confirming the diagnosis requires a lot of research. This includes laboratory tests of urine, blood, all kinds of tests with hypothiazide, spironolactone, march test, etc.
In addition, in the diagnosis of aldosteroma, ultrasound, scintigraphy, magnetic resonance imaging and computed tomography are necessary.
It should be noted that radiological diagnostics of aldosterome like adrenal angiography or pneumosuprenorrhoea may be insufficiently informative due to poor vascularization and because of the small size of the tumor.
Treatment of aldosterome
Therapeutic measures for aldosterome are based on surgical treatment.
The adrenalectomy is shown, during which the affected adrenal is removed along with the tumor tissues.
- Surgery is performed with thoracolumbar or lumbar access, if the exact location of the aldosterome is known.
- If the exact location is not known, then the operation is performed over-the-air.
- The most applicable is retroperitoneoscopic access, when surgical intervention is performed through one 3-cm cut or three punctures in the back area. Such access is considered the least traumatic, it requires me a long rehabilitation and does not leave cosmetically unpleasant scars.
- Performing an operation openly or laparoscopically is the most traumatic.
After surgery, retroperitoneoscopically, patients can take some types of food in the evening, and on the second-third day after the intervention the patient can be discharged.
The success of surgical intervention is significantly increased when specialized preoperative preparation of the patient is carried out. To do this, about a couple of weeks before the intervention requires a salt-free diet with increased intake of potassium-containing products.
To reduce the excessive content of hormones, shows the reception of drugs like Veroshpirona. And after the operation, in order to avoid complications, the patient is shown Cortisone's intake, control over the level of sodium and potassium.
If there is a bilateral adrenal lesion, then in some cases conservative therapy with the use of drugs like Veroshpyrona, antihypertensive drugs, potassium-containing medicines, etc.
If one adrenal gland significantly increases the functionality, or conservative treatment is useless, then doctors consider the possibility of a one-sidedadrenalectomy.
Forecast
After removal of the diseased adrenal gland and tumor, pressure normalization occurs, and patient predictions are favorable. Normalization of pressure is observed in about 60-70% of cases.
If elevated blood pressure levels persist after adrenalectomy, then corrective antihypertensive therapy is indicated. Usually this phenomenon occurs in about 25% of patients.
Video about the aldosterome: