Above the pole of each kidney is located one adrenal. It is a glandular organ that produces some hormonal substances. In these glands can form tumor processes.
Malignant neoplasms affect the adrenal glands rather rarely, more often the tumors that form in them are benign. Adrenal tumors often produce hormones themselves, which adversely affects the overall organic hormonal status, causing a number of disturbances in the body's activity.
Classification of adrenal tumors
Adrenal tumors are proliferations of adrenal cellular structures of benign or malignant nature.
Adrenal tumors have several classifications. Depending on the location, they are divided into the formation of the adrenal cortex and the tumor of the adrenal medulla.
In turn, the cortical tumors are divided into:
- Mixed Formations.
Tumors of the adrenal medulla are divided into:
All adrenal tumor formations are divided into malignant or benign. Cancerous tumors are characterized by rapid growth and pronounced intoxication symptoms.
Adrenal benign tumors usually do not manifest themselves in any way, they grow slowly and do not reach large sizes, usually they are detected in case of an accidental examination.
In addition, the adrenal formations may be neuroendocrine, i.e., develop from neuroendocrine cellular structures. These tumors are considered quite rare and represent a slow-flowing form of malignant oncology.
Also specialists subdivide adrenal formations into hormonal active and inactive ones.
- Tumors without hormonal activity, usually benign, are formed in the form of myomas, fibroids or limes. Inactive malignant formations are formed in the form of pyrogenic cancer, teratoma or melanoma.
- Hormonal active formations develop in the form of pheochromocytomas, corticosters, corticoestros, androster or aldoster.
There is a classification of adrenal formations by the criteria of pathophysiology:
- Androsteromas - with a masculinizing effect;
- Corticoestromes - possessing the effect of feminization;
- Corticosteroids are tumors that cause metabolic disorders;
- Aldosteromes are formations that disrupt the water-salt balance;
- Corticoandrosteromas - have a combined exchange-viril characteristics.
Adrenal neoplasms are classified and in accordance with the stages:
- The first stage is assigned to tumors less than 5 cm without metastasis, with no regional lymph node enlargement;
- The second stage is the formation of more than 5 cm, also not causing an increase in regional lymph nodes:
- The third stage is assigned to formations of small size( > 5 cm) and large tumors( <5 cm) with metastasis to the lymph node structures of paracaval and para-aortic localization, andalso formations that have a local invasion of adjacent tissues;
- To tumors of the 4th stage are formations of any size, sprouting into neighboring organs, with lymph node lesions. Remote metastasis may occur, but may be absent.
pathology The etiology of adrenal cancer is not yet known, however, there is an assumption of a hereditary role in the development of such tumors.
There are specific factors that can cause tumor formation:
- Family history. The predominant majority of cases of tumors of the adrenal cortex is due to heredity. For example, the Lee-Fraumeni syndrome is a hereditary pathology in which the risk of adrenal cortex formation is high;
- Unhealthy lifestyle. Harmful habits, unhealthy food with carcinogens, an aggressive environment, a polluted atmosphere;
- Age features. Adrenal tumors are most often detected in children and 40-50-year-old patients;
- The presence of multiple endocrine tumor formations, a similar condition is also inherited and can provoke an adrenal tumor;
- Chronic stress conditions;
- Chronic pathologies of the endocrine system;
- Traumatic factors, etc.
Symptoms of adrenal tumor
Clinical manifestations of adrenal formations depend on their pathophysiological affiliation. Androsteroma is characterized by excessive production of testosterone, dehydroepiandrosterone, androstenedione, etc.
Corticoestroma in men flows with feminization, penis and testicles become atrophied, gynecomastia develops, hair ceases to grow on the face, erectile dysfunction develops.
In women, such a tumor is asymptomatic, causing only a slight increase in estrogen. In boys, sexual development is delayed, and girls with cortico-astroma suffer from over-accelerated sexual and physical development.
Adrenal corticosteroids proceed with a clinic similar to hypercorticism, which is also called the Itenko-Cushing syndrome.
- Patients suffer from obesity, often worry about headaches and hypertension, fatigue is increased, muscle tissue is weakened, there is sexual dysfunction, diabetes of the steroid type.
- In the abdomen, hips and chest appear stretch marks and traces of hemorrhages.
- Men acquire female signs, women - male.
- On the background of a tumor, osteoporosis develops, which often causes the vertebral compression fracture. Approximately 25% of patients with corticosteroids suffer from urolithiasis and pyelonephritis.
- There is psychoemotional agitation and depressive states.
Aldosteromas are accompanied by unresponsive hypertension, cardiac irregularities, headaches, hypertrophic, and then dystrophic changes in the heart muscle.
Constantly increased pressure causes pathological changes in the fundus, which provokes visual disturbances. There are also kidney symptoms like severe thirst, increased diuresis, alkaline urine reaction and frequent nighttime urination. Patients also note the presence of seizures, paresthesias and muscle weakness.
In about 10% of patients with aldosteroma, the tumor develops latently.
Pheochromocytoma is characterized by dangerous hemodynamics and in most cases manifests itself:
- Increased pressure;
- Headaches and dizziness;
- Hyperpotency and pallor;
- Palpitation and retrosternal soreness;
- Panic attacks;
- With a shiver and uncaused vomiting;
- Increased diuresis, etc.
Any tumors can lead to dangerous complications, some benign formations can be malignant, therefore, for proper treatment, a qualified diagnosis is necessary.
Diagnosis of the disease
When suspected of adrenal neoplasms, the following tests are carried out:
- Laboratory diagnosis of blood, urine, coagulogram and specialized tests for hormone level detection;
- MRI or CT;
- Radiography of the chest cell region;
- Ultrasound examination;
- Radioisotope scanning of bone structures;
- Phlebographic diagnosis( prohibited with pheochromocytoma).
The diagnosis and the survival of the patient depend on the skill and timeliness of the diagnosis( for malignant tumors).
Tactics of treatment
Treatment of adrenal tumors is carried out only in an operative way. Operations may be contraindicated if:
- There are severe pathologies that categorically exclude any instrumental intervention;
- There are cystic tumors with multiple distant metastasis.
Some tumors are perfectly amenable to chemotherapeutic treatment with drugs such as Lysodrenum, Mitotana or Chloditane. In the treatment with pheochromocytomas, radioisotope therapy is sometimes used, when a radioactive isotope is injected intravenously, which leads to a decrease in the size of the tumor and the number of metastases.
Surgery to remove
Absolute indications for surgical treatment of adrenal tumor are:
- Tumor size <3 cm;
- Actively growing education;
- Hormonal active tumors;
- Education with malignant symptoms.
The open method involves removing the tumor through the incisions on the abdomen, after which unattractive scars remain. Laparoscopic surgery is carried out through small punctures( not more than a centimeter), necessary for inserting instruments and extracting the tumor.
Completely removed the affected adrenal gland, if the tumor has a malignant character, then the nearest adrenal lymph nodes are removed. Because of the high risk of complications, surgical interventions with pheochromocytomas are most difficult.
After surgery, the endocrinologist, as a rule, appoints a lifelong hormone replacement therapy for adrenal hormones to the patient.
With the timely elimination of a tumor of the adrenal glands of a benign nature, the predictions are only favorable.
After removal of the androsteroma tumor, a characteristic short stature may remain.
After removal of pheochromocytoma formations, such phenomena as hypertension and tachycardia can be preserved, which are eliminated by appropriate therapy.
With a benign corticosteroid, the appearance of the patient begins to change after a month, the weight decreases, the stretch marks turn pale, the sexual function is restored, etc.
If the formations are malignant and metastasize, the predictions are very negative.
Regarding prevention of adrenal formations, it is not definitively defined, therefore, the main direction of prevention is monitoring the patient's condition in order to prevent relapses.
If there was no metastasis, then after the removal of education the patient completely recovers.
At the previous level, fertility returns, menstruation is restored, other manifestations disappear.
After removal of the adrenal gland, patients should not take sleeping pills, drink alcohol, monitor physical and mental stress. It is necessary to visit the endocrinologist on a regular basis, and in case of any changes in the condition it is necessary to consult a doctor.
Symptomatic therapy of hormone-producing adrenal tumors, is described in this video: