With an adrenal tumor, symptoms in women may differ from those in men. clinical picture, especially if the neoplasm contributes to the production of male hormones. Diseases of the adrenal glands are rarely malignant, more often the adrenal glands affect benign formations. Above each kidney are endocrine glands - adrenal glands that produce hormones. Adrenal tumors lead to hormonal imbalance, which leads to failures of various body systems.
The adrenal glands consist of four layers: external, cortical, internal and cerebral, but only in the cortical and cerebral is the synthesis of hormones:

The cortical layer produces:

• glucocorticoids - take part in the distribution of proteins, fats and carbohydrates;
• androsteroids (estrogen, androgen and progesterone) - are responsible for the secondary sexual characteristics of the female or male type;
• mineralocorticoids - maintain water and electrolyte balance in the body.

In the medulla, hormones are produced that transmit nerve impulses and affect metabolic processes, being neurotransmitters:

• dopamine;
• norepinephrine;
• adrenalin.

That is why, with the development of a tumor in a particular layer of the endocrine gland, symptoms can occur in a variety of ways. Tumors, especially hormonally active ones, often cause sexual dysfunction, lead to obesity, diabetes mellitus and hypertension. More often, neoplasms occur in women and occur at an older than average age, but they also occur in children.

The reasons

The exact reasons for the development of neoplasms of the adrenal gland are not fully understood, a genetic predisposition plays a significant role in the appearance, because most often an adrenal tumor occurs in people whose families have already encountered benign or malignant tumors. Factors in the appearance of tumors in the adrenal gland can be:

1. Smoking and alcoholism;
2. Improper nutrition (fast food, food with carcinogens);
3. Tumors of the pituitary gland;
4. Constant stress;
5. Injuries;
6. Hypertension;
7. endocrine disorders.

Secondary malignant neoplasms can occur in the adrenal glands due to metastases from cancer of other organs.

Classification

The classification of tumors of the adrenal glands is very extensive and depends on the structure of the neoplasms, their localization in the layers of the adrenal glands, and the ability to produce hormones. The first thing to highlight is that all tumors are divided into benign and malignant. Benign forms and develops very slowly, its cells do not tend to actively divide and do not metastasize, but can grow into surrounding tissues.

Malignant tumors of the adrenal gland, on the contrary, progress rapidly and metastasize, therefore they are more dangerous. Despite the relative safety of benign neoplasms, they should be removed, as some varieties can produce hormones and become malignant (malignant). Malignant tumors are relatively rare, more often benign neoplasms occur.

By location, there are only two types of tumors:

1. Tumors of the adrenal cortex lead to an imbalance of hormones that are produced in this layer;
2. Neoplasms of the medulla lead to increased production of adrenaline, norepinephrine and dopamine.

All tumors can develop from different tissues. Adenomas, corticoestroms are formed from epithelial cells, lipoma and fibroma - from fibrous tissue cells, neuroblastoma, ganglioma and pheochromocytoma - from brain tissue. There is also a type of tumor that simultaneously affects the cells of the brain tissue and the cortical layer. Such tumors are combined, they include incidentaloma.

Depending on the hormone produced, the tumor may be:

• disrupting sodium metabolism and leading to water-electrolyte imbalance;
• violating material exchange processes;
• leading to secondary male sexual characteristics in female patients;
• leading to secondary sexual characteristics of the female type in men;
• combining common sexual and metabolic disorders.

In most cases (from seventy to ninety percent) a single neoplasm occurs, in ten or fifteen percent one adrenal gland affects several neoplasms at once.

Hormonally active neoplasms

Some tumors simply grow, while others contribute to the production of hormones. Neoplasms of this type are called hormone-producing or hormonally active. Hormonally active adrenal tumors include:

• aldosteroma;
• corticoestroma;
• pheochromocytoma;
• androsteroma;
• corticosteroma.

Most often, hormonal neoplasms are presented in the form of malignant tumors and have increased activity, although some benign neoplasms can also contribute to one degree or another to the production of hormones of the layer in which they were formed. Benign ones include: myoma, lipoma, fibroma. Malignant are: teratoma, melanoma, pyrogenic cancer.

Aldosteroma

The neoplasm is expressed in an increased amount of aldosterone. Aldosteromas develop in the glomerular zone of the cortex and lead to the appearance of Crohn's syndrome (primary aldosteronism). With a high content of this hormone in the body, the arterial pressure, muscle weakness occurs, the level of potassium in the blood drops, alkali rises in the blood and tissues. The malignant type of aldosterone occurs in two or four percent of all tumors in the adrenal glands. When the aldosteroma is removed, blood pressure returns to normal within a few months.

Glucosteroma or corticosteroma

Corticosteromas (glucosteromas) lead to increased production of glucocorticoids. Such neoplasms arise in the beam zone of the cortex and lead to. The main symptoms of this syndrome:

• obesity;
• increased blood pressure;
• earlier puberty;
• earlier development of sexual weakness and the onset of menopause.

A corticosteroma can be a benign adenoma, or it can be a malignant adenocarcinoma or corticoblastoma. This type of adrenal tumors, which are localized in the cortex, is the most common.

Corticoesteroma

Corticoetheroma originates from the adrenal cortex, namely from the reticular and fascicular zones, and contributes to the production of estrogens, which are female sex hormones. This type of neoplasm leads to estrogen-genital syndrome, which causes feminization and sexual weakness in males. Such a tumor is rare, often malignant with pronounced expansive growth. It often occurs in men at a young age.

Androsteroma

Androsteroma leads to the production of androgens and is formed in the retinal cortex or in the ectoric tissue of the adrenal gland. This tissue is located in the fatty tissue of the retroperitoneal space, wide uterine ligament, ovaries, spermatic cords. Tumors lead to androgen-genital syndrome. The pathologies they cause include:

• early puberty in boys;
• pseudohermaphroditism in girls;
• virilization in female patients (the appearance of secondary sexual characteristics characteristic of men).

Half of the androsters are benign, the other half are malignant. The tumor can metastasize to the retroperitoneal space, liver, lungs, and most often affects women from twenty to forty years of age. This type of neoplasm accounts for only one to three percent of all types of adrenal tumors.

Pheochromocytoma

Pheochromocytoma produces catecholamines and in ninety percent of cases is formed in the medulla from chromaffin cells. Less commonly, the formation occurs from neuroendocrine cells. These are tumors that manifest themselves in the form of disorders of the autonomic nervous and vascular system. Vegetative crises develop against the background of compression of nerve plexuses. According to the morphological structure, a tumor of this type is often benign, and only in ten percent of patients the neoplasm becomes malignant. Women aged 30 to 50 are more susceptible to the disease. In ten percent of cases, the pathology is hereditary.

Stages of development

When a tumor of the adrenal glands occurs, the stages of development depend on the size of the neoplasms, the presence of metastases, and germination in the surrounding tissues. For tumors in the adrenal glands, the following staging applies:

1. The first stage has a size of no more than five millimeters and is often benign. The tumor does not give itself away as symptoms and is detected by chance during examination of the gastrointestinal tract.
2. At the second stage, the size of the neoplasm is already more than five millimeters, the tumor can grow into neighboring structures, but does not yet affect lymphatic system, and does not allow metastases.
3. Neoplasms of the third stage in diameter can grow up to five centimeters and metastasize to nearby organs and regional organs. The lymph nodes.
4. The fourth stage is the most severe, during which the neoplasm grows to a large size and can affect any organs and systems, since malignant cells disperse along with the lymph flow and blood flow.

The sooner the pathology is detected, the greater the chance that it will not give complications and will be completely cured.

Symptoms

In men and women, the symptoms of adrenal tumors depend on the production of which hormone the pathology leads to:

• Androsteroma leads to virilism and anabolic syndrome. In children with such a tumor, puberty is noted earlier, rapid physical development, the voice coarsens early, acne appears on the face and body. Women are faced with the development of muscles, the mammary glands, clitoris and uterus atrophy, amenorrhea occurs.
• Corticoestroma in males is manifested in signs of feminization. Atrophy of the testicles and penis occurs, the mammary glands begin to grow (gynecomastia), facial hair growth stops, sexual function suffers. In female patients with such a tumor, there are practically no symptoms, only occasionally estrogens can increase. If a neoplasm occurs in a boy, then puberty is delayed, while in girls, on the contrary, sexual and physical development is too intense.
• Symptoms of corticosteroma are manifested in signs of hypercortisolism (Itsenko-Cushing's syndrome). In such patients, obesity begins, a headache, and constant hypertension occurs. The patient gets tired quickly, his muscle tone weakens, men suffer from erectile dysfunction. An obligatory symptom of corticosteroma is steroid diabetes.

Large blue stretch marks appear on the abdomen, chest and thighs - striae. In men, secondary sexual characteristics appear according to the female type, in women, on the contrary. Patients face osteoporosis, which leads to frequent vertebral compression fractures. Twenty percent of patients develop urolithiasis and pyelonephritis.

• With aldosteroma, there is a frequent pulse and an increase in blood pressure, which is not amenable to therapy and causes visual disturbances. There are failures of the heart rhythm, headaches, hypertrophic, and later dystrophic changes in the myocardium. Renal symptoms also appear - intense thirst, frequent urination, increased daily amount excreted urine, which becomes alkaline. Convulsions, paresthesias and muscle weakness are no exception.
• Pheochromocytoma has dangerous hemodynamics. During it, an adrenaline crisis can occur - pressure rises, it hurts and dizziness, sweating increases, pallor, palpitations and retrosternal pain occur. A person's body temperature rises, tremors and unreasonable vomiting occur, panic attacks are present. The end of the crisis is accompanied by an increase in the volume of urine excreted.

Since tumors have different symptoms, their treatment methods can also be different and are selected by the doctor on an individual basis after a thorough examination.

Diagnostics

To diagnose tumors of the adrenal glands, a number of instrumental studies are carried out, as well as laboratory research in endocrinology, but the diagnosis begins with an external examination, listening to complaints and taking an anamnesis. The doctor notes external signs that may indicate excessive production of a particular hormone, after which he prescribes other examination methods to the patient:

• Ultrasound examination is informative when the size of the adrenal tumor is more than one centimeter. Neoplasms of a smaller diameter cannot be seen using this method.
• Computed or magnetic resonance imaging allows you to examine the neoplasm in more detail, determine its exact location and size.
• Chest x-ray and radioisotropic bone examination help to identify metastases.
• General clinical analysis of urine, as well as the study of urine for hormone levels.
• Phlebography is a blood test taken from the adrenal gland. With the development of pheochromocytoma, this type of study is contraindicated, since it contributes to an increase in blood pressure.
• Fine-needle biopsy of the tumor followed by histological examination to determine the morphological structure of the neoplasm.

After making a diagnosis, the doctor selects the therapy that, in his opinion, will be the most effective.

Treatment

In the treatment of adrenal tumors, it is necessary to take into account the information obtained at the time of diagnosis. The most effective method is surgery. The operation is performed with hormone-producing neoplasms, tumors larger than five centimeters in diameter, as well as malignant pathologies. However, sometimes the operation is contraindicated for the patient, in which case it is necessary to treat the pathology with a conservative method. Contraindications to surgical intervention are:

1. Elderly age;
2. Multiple tumors with a large number of metastases;
3. Severe comorbidities that are a contraindication to anesthesia.

Radiation and chemical therapy are used for oncological neoplasms and are carried out before and after surgery in order to reduce the size of the tumor and eliminate the remnants of malignant cells.

Surgery

The operation is necessarily performed if the tumor is hormonally active and no larger than three centimeters in size. Malignant neoplasms are also surgically removed. The operation can be carried out in two ways:

1. Open access (cavitary surgical intervention);
2. Laparoscopic method (access through several punctures in abdominal cavity).

During surgery, the tumor is removed along with the affected adrenal gland. If the neoplasm is malignant, then the doctor also excised regional lymph nodes. If the nearest organs are affected by metastases, they are also subject to removal.

The most difficult thing is to remove pheochromocytoma, as this can significantly disrupt hemodynamics. To prevent an adrenaline crisis, the patient is carefully prepared for surgery with the help of special preparations. If the crisis nevertheless occurred during the removal of the tumor and the patient began cathetolamine shock, which is accompanied by jumps in blood pressure to critical levels and other dangerous conditions, then the doctors resort to an emergency operation.

Conservative treatment

Together with the operation (before and after it), for malignant neoplasms, radiation and chemical therapy is used, with which you can reduce the tumor and kill its remnants, preventing recurrence. Also, these methods can be self-treatment in cases where surgery is contraindicated. In the postoperative period, the patient is prescribed drugs that help normalize the water-salt balance and prevent mineral homeostasis. Hormone replacement therapy is mandatory and should last a lifetime. Some symptoms after surgery may remain, which requires constant medical supervision.

Forecast and prevention

Predictions after surgery depend on the type of neoplasm, its nature and the therapeutic measures taken. Benign tumors almost never recur, which cannot be said about malignant neoplasms. The sooner the tumor is removed, the better the prognostic data. However, some patients may experience complications and consequences. For example, if an androsteroma was removed and the patient was a child, then he is likely to be stunted. After successful removal of pheochromocytoma, half of the patients develop cardiac disorders within a year.

Thirty percent of patients after removal of an aldosteroma experience moderate hypertension requiring drug treatment throughout life. If the corticosteroma is removed, then the patient recovers after about one and a half or two months. The symptoms that were with cancer gradually disappear - pressure, weight return to normal, sexual function is restored, etc. Metastasized tumors often give a poor prognosis, especially if the pathology is not amenable to surgical treatment. In this case, a person can live up to two years.

Preventive measures include maintaining a healthy lifestyle:

• giving up cigarettes and alcohol;
• proper nutrition;
• avoidance of precipitating factors.

After the treatment, prophylaxis is carried out in order to prevent relapse. The patient is registered and must be examined every six months (and at first more often). After the removal of a malignant tumor, only after five years the person is considered completely cured. When the adrenal gland is removed, the patient is categorically contraindicated in alcohol, sleeping pills, strong physical and psycho-emotional stress.

The adrenal glands are small paired endocrine glands located directly above the kidneys. The shape of the right gland is similar to a pyramid, and the left resembles a crescent. The external difference does not affect the morphological structure and the performance of their main function - the production of a number of hormones that control all vital processes.

The structure of the adrenal glands and the production of hormones

Each adrenal gland (NP) consists of 2 absolutely different types substances - yellow cortical and reddish-brown brain.

yellow cortical layer

The cortical layer consists of 3 zones:

1. Glomerular (external)- produces 3 mineralocorticoid hormones, which are responsible for maintaining the sodium-potassium balance in the kidneys and normal water-salt metabolism in the body.
2. Beam (medium) the zone is responsible for the production of glucocorticoids: cortisone and cortisol. These hormones are responsible for many functions and metabolic processes - they convert fats and some amino acids into glucose, regulate thermogenesis, prevent the growth of connective tissues, increase immunity, muffle inflammatory and allergic reactions; improve the functioning of all sense organs and general resistance to stress.
3. Mesh (internal) the zone, along with the ovaries and testes, secretes 5 androgenic male sex hormones responsible for the development and stability of the manifestation of secondary sexual characteristics. Libido, excitation of the penis and clitoris depend on their level. These hormones further reduce the amount of glucose, cholesterol and lipids in the blood; increase muscle mass and strength.

Reddish brown medulla

The medulla of the NP in borderline psycho-emotional states is the main source of the production of catecholamine hormones, norepinephrine and adrenaline, which:

• responsible for the work of the cardiovascular, respiratory and nervous systems;
• regulate blood sugar levels;
• regulate carbohydrate metabolism.

In addition to catecholamines, the medulla reproduces peptides that play an important role in the regulation of activity gastrointestinal tract, autonomic and central nervous systems.

Like any other organs, the adrenal glands are prone to many diseases:

• hypocriticism - primary (Addison's disease) and secondary adrenal insufficiency in acute or chronic form currents;
• congenital dysfunctions of the NP cortex;
• secondary hyperaldosteronism.

These diseases are caused by a malfunction in the secretion of hormones for unknown reasons. But, in recent times, more and more often, benign and malignant neoplasms of the adrenal glands are diagnosed. According to some reports, it is believed that the NP tumor can be found in 5% of the population.

Classification of NP tumors

Tumors of the adrenal glands can be systematized according to the following parameters:

• By the nature of the injury- benign and malignant. Benign neoplasms are asymptomatic, rarely diagnosed and do not pose a threat to life. Malignant tumors have clear signs of intoxication, are very aggressive and grow rapidly in size. In turn, malignant tumors are divided into primary and secondary - metastatic lesions of NP from other cancerous tumors of internal organs.
• By localization - tumors of the cortex and tumors of the medulla.
• For hormonal addiction- hormonally active (hormone-secreting) and "clinically silent" or hormonally inactive. The latter were called "Insidentalomas" - random. They are asymptomatic and unexpectedly detected during ultrasound diagnostics of other diseases. More common in women (30–60 years) than in men. For the most part, they are left-sided. With the widespread and ubiquitous use of ultrasound machines, the frequency of detection of "silent" adrenalol increased to 10% in all studied patients, and their share in the overall picture of NP tumors reached 20%.

The symptoms of tumors are very diverse and are related to their size, quality, the affected area of ​​the NP (type of hormone) and the level of hormonal activity.

Most NP tumors are small, benign neoplasms, usually affecting a single gland. The most common form of the tumor (about 30%) is a benign cortical adenoma that does not require treatment or surgery. Cysts and pseudocysts are very rarely observed;

• lipomas and myelolipomas;
• lymphomas and vascular tumors of the adrenal glands.

Cancer of the adrenal cortex is extremely rare, poorly curable, occurs in only 2 patients out of 1,000,000 patients with malignant neoplasms of the NP. Statistics show that this cancer occurs mainly in women (40-50 years old) or in children. modern medicine believes that adrenocortical cancer arises from an inherited mutation in TP53.

The clinical manifestations of hormonally active tumors of the adrenal glands deserve the closest attention.

Varieties and symptoms

Each type of tumor has its own symptoms.

Aldosteroma

A small (up to 3 cm), as a rule, benign tumor of the glomerular layer of the NP cortex, which secretes the mineralocorticoid hormone - aldosterone. It is the root cause of Kohn's Syndrome.

The main symptoms of aldosteroma:

• high blood pressure;
• muscle cramps;
• weakness;
• increased excretion of urine;
• intense thirst.

Treatment: removal along with the affected gland, followed by hormone replacement therapy, potassium supplements and a "sodium-free" diet.

Androsteroma

The tumor affects the reticular zone of the NP cortex. Excessively produced by her, the male sex hormone androgen, leads to the virilization of the female body:

• coarsening of the voice, hair growth on the face and body according to the male pattern against the background of baldness;
• change in the muscular type of the figure to the male;
• reduction in breast size and clitoris enlargement,
• violation or disappearance of menstruation (up to infertility);
• uterine atrophy and increased libido.

It is diagnosed in women from 30 to 40 years old. In men, androsteroma is less common and is diagnosed extremely late due to “implicit”, blurred symptoms. Proper diagnosis is facilitated by the increased size of the liver.

Treatment: radical resection of the adrenal gland and hormone therapy.

Corticosteroma (glucosteroma)

Benign (2-6 cm) in 70% and malignant (30 cm and up to 3 kg) in 30% of cases. The most common tumor of the fascicular zone of the NP, producing excessive amounts of cortisol. It is more common in women (20–40 years old) and is characterized by a group of symptoms of Itsenko-Cushing Syndrome:

• the disappearance of the subcutaneous layer of fat on the back of the hand;
• "dysplastic" obesity of the chest, abdomen, neck and head - "moon face";
• the appearance in the region of the VII cervical vertebra of the climacteric hump;
• in women - the redistribution of body fat according to the male type;
• general thinning of the skin and the appearance of striae - purple or purple-red stretch marks on the abdomen, mammary glands, inner thighs and shoulders;
• trophic ulcers on the legs, fungal lesions of the skin and nails;
• atrophy of the muscles of the anterior wall of the abdomen, shoulders and legs;
• "frog belly" and hernias;
• hypertensive syndrome - high blood pressure, headaches, arrhythmias, ascites and edema;
• heterosexual syndrome - in men, libido decreases and the testicles atrophy, and in women, virilization occurs;
• osteoporosis;
• impaired memory and sleep; depressive states; psychopathic reactions or lethargy;
• in 10-20% of cases - steroid diabetes mellitus, in the rest - a persistent metabolic disorder; 65% of patients develop secondary immunodeficiency.

Corticoestroma

A rare and very aggressive malignant tumor that produces estrone and estradiol. Poor treatment. It is characterized by an atypically small volume - only up to 100 g. It most often affects men, causes them to develop secondary sexual characteristics according to the female type (feminization). The first symptom that appears is breast enlargement with growth of glandular tissues.

In women, corticoestroma is not symptomatic and is detected only on ultrasound with confirmation of a blood test for elevated estrogen levels. In girls, this tumor causes premature physical and sexual development, and may cause vaginal bleeding.

The tumor affects the medulla of the NP and produces catecholamines (adrenaline and norepinephrine). In 90% of cases, it is benign, but dangerous with severe complications. The malignant appearance of the tumor is insidious in its atypical location outside the gland. It has been proven that 10% of cases of the disease are hereditary (family) in nature. More often it affects women (30–50 years old) and for the first time makes itself felt by frequent debilitating vegetative crises. The disease can take three forms:

• paroxysmal;
• permanent;
• mixed.

The paroxysmal course is characterized by symptoms of a hypertensive crisis. Appear:

• sudden and abrupt spikes in blood pressure rises up to 300 (and above) mm Hg, which are accompanied by headache and dizziness;
• blanching of the skin (marbling) and increased sweating;
• increased heart rate;
• chest pains;
• jumps in body temperature;
• sudden bouts of vomiting;
• trembling and attacks of causeless panic.

These symptoms may be caused and/or aggravated physical activity, stressful tensions, urination, plentiful food and alcohol.

Paroxysmal attacks can haunt the patient for several months every day for several hours. The end of the attack occurs abruptly, suddenly and is characterized by increased salivation and sweating, sudden reddening of the skin.

The permanent form of pheochromocytoma is characterized by persistent high blood pressure both during crises and between them. The mixed form is recognized by normal blood pressure between crises and sustained elevated blood pressure (without jumps) during them.

Ignoring the symptoms of the paroxysmal form leads to strokes and heart attacks.

Diagnostics

To confirm the diagnosis, a specialist endocrinologist, in addition to the traditional methods of diagnosing a tumor - ultrasound, CT with bolus contrast and MRI; may appoint additional:

• checking the hormonal background - specific blood tests and daily urine;
• clarification of visualization and functional characteristics of the tumor - SPECT technique (single photon emission CT or scintigraphy with non-pharmacological radiolabeled MIBG) and / or PET technique (positron emission tomography with FDG).

Treatment

Rare adrenocortical cancer and malignant pheochromocytoma are poorly treated and fatal unless:

• they were diagnosed on time;
• completely removed;
• received a course of radiation or chemotherapy.

The relief of life-threatening pheochromocytoma seizures is carried out by intravenous administration:

• phentolamine;
• nitroglycerin;
• sodium nitroprusside;
• regitina.

In catecholamine shock, immediate surgery is performed.

Preoperative treatment of some types of tumors is carried out with chemotherapeutic chloditan and lysodren, and pheochromocytoma responds with a decrease in size to the introduction radioactive isotope.

Small, benign and hormonally inactive tumors most often do not require surgery and require only:

• regular monitoring;
• repeated analyses;

In other cases, the neoplasm is completely removed along with the affected adrenal gland (adrenalectomy), followed by permanent hormone replacement treatment and further lifelong monitoring in order to prevent relapses.

The adrenal glands in the human body play an important role in the normalization of metabolic processes and help the body adapt to stressful conditions. It is a paired organ of the endocrine system. They can be exposed to various pathologies and serious diseases, one of which is crayfish.

Tumors of the adrenal glands are pathological uncontrolled growth of cells of the endocrine glands. The growth process is either benign or malignant. The disease is dangerous, it is not easy to diagnose, as it is located in a hard-to-reach area of ​​​​the body, has a small size.

Causes of adrenal tumors

The causes of the disease can be several:

• genetic, hereditary program inherited from parents with chromosomes;
• burn of the body, resulting in a violation of the vital activity of internal organs;
• being under stress for an extended period of time;
• poor malnutrition;
• penetration of pathogenic microbes into the circulatory system;
• increased growth of defective bone marrow cells;
• the effect of toxic substances on the body;
• radiotherapy in the treatment of cancer;
• internal purulent inflammatory process.

In each individual case, the causes of the disease are different, sometimes inexplicable.

Causing factors for the onset of the disease

The adrenal glands consist of cortex and medulla (outer and inner layers). Tumors of the adrenal glands can appear in any of these layers, but outwardly the neoplasms are different. The development of the disease depends on the degree and location of new formations. The most dangerous is a tumor that entails a violation of the activity of biologically active substances affecting psychological and physical health. Many factors are capable of provoking cell proliferation, among them the following are most clearly highlighted:

• congenital change in the system of regulation of the functions of internal organs with the help of hormones (lower cerebral appendage of the pituitary gland, secretory glands);
• close relationship with people who suffered from lung cancer or breast cancer;
• inherited high blood pressure;
• diseases of internal organs (liver, kidneys);
• damage to organs and tissues of the human body (bruises);
• being under prolonged stress and other diseases.

A serious cause of adrenal tumors is an unhealthy, unhealthy lifestyle.

Symptoms of the disease

Difficulty detecting symptoms benign tumors. They are asymptomatic. Malignant neoplasms give external manifestations in the form of:

• fatty formations that have appeared on different parts of the body (neck, hips, etc.);
• sharp weight loss;
• pathology of the skin in the form of thinning, stretch marks;
• convulsive manifestations, spasm and weakness in muscle tissues;
• suffocating pain in the chest and abdomen;
• insulin deficiency ();
• jumps in blood pressure;
• malfunctions of the urinary system;
• decrease in bone density with the risk of fractures (osteoporosis);
• premature maturation of the reproductive system;
• nervous breakdowns, overexcitation.

Symptoms in women are accompanied by an uncharacteristic appearance of facial hair, a violation of the monthly cycle, sometimes its complete cessation, and suppression of sexual desire. In men, in addition to loss of attraction, dysfunction occurs. In people with a tumor, the timbre of the voice changes, there are panic attacks, excitement.

Tumors in the form of myelolipoma of the adrenal glands are composed of adipose tissue, reminiscent of Bone marrow- not malignant. Adrenal pheochromocytoma is a cancer. But a benign tumor or cancer of the adrenal gland is accompanied by the production of hormones that most affect blood pressure for stress responses. The affected medulla of the organ becomes the source of all kinds of indicators of the disease. For example, frequent hypertensive crises may be a consequence of the proliferation of cells in the medulla. Crises in such cases are accompanied by an increase in pressure up to 250/120 mm Hg and even up to 300/150 mm Hg. When the pressure drops sweating profusely, loss of consciousness, involuntary urine output may occur. The danger of the condition lies in the consequences in the form of hemorrhages in the brain. A tumor of the adrenal gland in some cases can be palpated through the abdominal cavity.

The choice of treatment depends on the correctness of determining the degree of oncological disease, which gives real hope for victory over the disease, for a successful outcome. For example, in Germany, on the basis of improved techniques, it is possible to practically defeat cancer in the initial stage. With the transition of cancer to other stages, a special restraining therapy is used, thanks to which the patient returns to a tolerable threshold of life.

Classification of adrenal tumors

An accurate determination of the stage of cancer development is necessary not for classification, but for diagnosis, the correct approach to treatment, and a successful outcome. For example, knowing that a tumor of the right adrenal gland strikes the lymph nodes that are located next to the renal vessels, it is assumed that a kidney tumor may be found here. A tumor of the left adrenal gland threatens to cause an ovarian tumor. Modern pediatrics have to diagnose a tumor of the adrenal glands in children.

The medical literature describes the classification of malignant neoplasms by types according to the histogenetic principle:

• disturbing metabolic processes - corticosteromas;
• the appearance of signs of the second sex - androsteroma;
• violating the water-salt balance in the body - aldosteroma;
• combining andosteric and corticosteromic features - corticoandosteromas;
• developing in children - neuroblastoma;
• affecting the adrenal medulla - pheochromocytomas;
• common type - carcinomas.

For the convenience of conducting clinical events, a classification by stages is used:

• Stage I - the size of the tumor does not exceed 5 cm;
• Stage II - the tumor is larger than 5 cm, but without invasion;
• Stage III - tumors of different sizes with local invasion without penetration into neighboring organs;
• Stage IV - tumors invade other organs, regardless of size.

There is an international system for determining the stage of malignant neoplasms, which is based on three components of TNM. The symbols T, N and M correspond to the meaning of T - tumor, N - nodes (lymphatic), M - displacement. In general, the TNM formula denotes a tumor of any size with or without metastases, with or without invasion to other organs. Numbers from 0 to 4 indicate the degree of damage to the organ, the spread of the tumor. At the end of the formula, the name of the sick body is indicated.

In addition to these TNM formulas, a diagnosis base (encrypted explanation) is indicated to confirm the validity of the diagnosis. For example, a record of the form C4 T1N1M0 means stage 1 of tumor development and penetration of metastases into the lymph nodes, and the conclusion is based on data from a study of the pathology of objects that were obtained surgically. This diagnosis is trustworthy and is recognized as final.

The final diagnosis is important when prescribing further treatment:

• chemical therapy;
• irradiation techniques;
• immune or hormonal therapy and other methods.

Each type of neoplasm can be non-cancerous and cancerous.

Diagnostics

A patient who is suspected of having an adrenal tumor is given a medical examination by all possible means. Of the visual examination routes, reliable, achievable and inexpensive is ultrasound procedure. CT scan allows you to make a conclusion about the structure of this tumor. Data MRI supplement the process of examination of the patient.

Radionuclide diagnostic methods are also used:

• radiological diagnostics;
• PET (positron or two photon emission tomography) with 18-FDG.

Hormonal studies are carried out:

• urine tests for the presence of cortisol, for metanephrines;
• blood for adrenocorticotropic hormone.

In each individual case, the choice of a specific examination method is made by a diagnostician.

Therapeutic measures

Symptoms and treatment regarding the adrenal glands are closely related.

Modern medicine knows different practices:

• innovative and conservative
• radical and forgiving.

But medical solidarity lies in the fact that in any case it is necessary.

Treatment of a tumor of the adrenal glands begins after a thorough study of the state of the body, the development of education. Benign newly formed tissues of the adrenal glands do not need treatment and any invasion. Small-focal neoplasms that do not produce hormones need only regular examination, repeated at a certain period of time. As a rule, such tumors have a favorable prognosis.

Modern medicine has several methods of treatment, in some cases it is used complex treatment. The most common way is the surgical removal of the focus of the disease.

The method of irradiation of cancer of the adrenal cortex is used to prevent the introduction of cancer cells into bone tissue. The method is ineffective without direct irradiation of the immediate tumor.

Medical treatment

The most common method of treatment and preventive measures is drug therapy. By using medicines hormonal secretion of newly formed cells is regulated, their growth is inhibited. Drugs are prescribed in cases where it is impossible to operate on the adrenal glands with metastases, as well as when the oncological formation is partially removed. Recognized as the main drug Mitotan which can be combined with chemotherapeutic procedures. The drug can destroy cancers. Other means are also assigned ( Hydrocortisone, Prednisolone, Dexamethasone).

Of the new generation drugs, it is considered effective Medrol which is recommended in combination with other medicines in cases of insufficiency of the functions of the adrenal cortex. Another medicine called Polcortolon contains the hormone Glucocorticoid necessary for the body, and Cortef.

radioisotope therapy and drug treatment requires regular examination of the state of the blood regarding the indications of the presence of hormones.

Chemical preparations are common to help the patient in the later stages of tumor treatment:

• Cisplatin;
• doxorubicin;
• Etoposide;
• Streptozocin;
• Vincristine.

Chemotherapy gives a 35% chance of successful completion of therapeutic measures.

Surgery

Adrenal cancer is a serious medical report, in such a situation, the intervention of a surgeon is required. The operation is carried out in a specialized medical center. At the same time, the existing competence in this surgical field is important.

Surgical practice has been enriched by the method laparoscopy, in which adrenal cancer of 1-3 stages is extracted through special punctures in the peritoneal cavity. An undesirable point in this type of treatment is the possibility of recurrence of the disease. Micro metastases can persist during operations, and then grow throughout the body. Under such circumstances, repeated surgical intervention is required.

Treatment methods at home

Our body works smoothly and normally when the activity of internal organs is regulated. Such a kind of regulator is the hormonal system, which is controlled by endocrine cells. The adrenal glands play an important role in this harmonious combination. The right one looks like a triangle, the left one looks like a crescent. And together they produce the necessary hormones.

However, too much production of them causes a disease - Cushing's syndrome (photo below).

Cushing's syndrome

Insufficient hormonal production leads to Addison's disease. And in one, and in another option, help is required for the body. Folk remedies - herbal medicine can help, for example:

• snowdrop tincture;
• infusion of horsetail herb.

A stimulant for the adrenal glands, as folk practice shows, is geranium.

In restoring the body, it is important to establish proper nutrition, provide vitamins, pick up desired products. Under the concept proper nutrition consumption must be taken into account. vegetables, fruits. The balance of proteins, carbohydrates and fats should combine low-fat varieties of fish and meat, dairy products and food greens.

Fatty and fried foods are allowed in minimal quantities. With great care, dried fruits, legumes and nuts should be considered due to their excess potassium content.

The diet of a sick person is supplemented vitamins B1 and ascorbic acid. Since these vitamins are present in nature's gifts, citrus fruits, apples, garden berries, and rose hips will be essential in the diet. In addition, we should not forget about wheat products with the addition of bran and beef liver.

Traditional medicine recipes

In recipes traditional medicine there are various herbal preparations that contribute to the normalization of hormonal levels, improve people's well-being. An example of such a collection:

• take herbs field horsetail - 50 g,
• nettle and knotweed herbs - 100g each,
• annual with the name common pikulnik - 75 g,
• add dry Icelandic moss - 40 g.

For a medicinal decoction, 2 tablespoons are taken herbal collection. This mixture must be poured with water in a volume of 500 ml and boiled over a fire for 10 minutes. After cooling the broth, you need to strain it. It is recommended to drink the resulting decoction 2 hours after eating 4 times a day, 100 ml for 2 weeks.

Important! The decoction should be fresh every day.

Noteworthy are recipes from affordable blackcurrant. Fragrant berry has a special effect on the human body. Leaves in the form of a decoction and juice from berries are equally useful. Regular use of blackcurrant as a food product improves the activity of the endocrine glands, relieves painful symptoms.

For currant broth:

• 20 g of dried leaves are taken per 400 ml of boiling water and infused for 3 hours;
• strained broth to drink 100 ml after meals 4 times a day.

Hormonal imbalance contributes to the reproduction of cells, the appearance of a disease with the terrible name of adrenal cancer. Therefore, any attempt to use alternative medicine can only be resorted to after consultation with specialists. It is possible to treat the disease with herbal remedies only with the approval of specialists and within reasonable limits.

Forecast

Timely treatment of a tumor of the adrenal glands responds in the future with a favorable life prognosis. However, one must be prepared for the fact that adrenal cancer will bring the patient a lot of suffering.

In patients who got rid of pheochromocytoma by surgery, tachycardia remains, persistent hypertension that needs drug correction persists, 70% of patients who have removed aldosteromas live with normal blood pressure, in the other 30% of cases hypertension is observed, which responds well to drug therapy.

After removal of the corticosteroma, recovery begins in 1.5-2 months:

• pressure normalizes;
• there are positive changes in appearance;
• childbearing function returns to normal;
• the content of insulin is normalized;
• the body weight decreases.

In the future, it is necessary to establish a diet, healthy lifestyle life and go for examinations to the doctor.

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- benign or malignant focal growths of adrenal cells. They can come from the cortical or medulla, have different histological, morphological structure and clinical manifestations. More often they manifest themselves paroxysmal in the form of adrenal crises: muscle trembling, increased blood pressure, tachycardia, agitation, fear of death, pain in the abdomen and chest, copious urine. In the future, it is possible to develop diabetes, disorders of the kidneys, violation of sexual functions. Treatment is always prompt.

General information

Tumors of the adrenal glands are benign or malignant focal growths of cells of the adrenal glands. They can come from the cortical or medulla, have different histological, morphological structure and clinical manifestations. More often they manifest themselves paroxysmal in the form of adrenal crises: muscle trembling, increased blood pressure, tachycardia, agitation, fear of death, pain in the abdomen and chest, copious urine. In the future, the development of diabetes mellitus, impaired renal function, and impaired sexual function is possible. Treatment is always prompt.

Pathoanatomy

Adrenal glands are complex endocrine glands in terms of histological structure and hormonal function, formed by two layers that are different in morphological and embryological terms - the outer, cortical and inner, cerebral.

The adrenal cortex synthesizes various steroid hormones:

• mineralocorticoids involved in water-salt metabolism (aldosterone, 18-oxycorticosterone, deoxycorticosterone);
• glucocorticoids involved in protein-carbohydrate metabolism (corticosterone, cortisol, 11-dehydrocorticosterone, 11-deoxycortisol);
• androsteroids, which cause the development of secondary sexual characteristics according to female (feminization) or male (virilization) types (estrogens, androgens and progesterone in small quantities).

The inner medulla of the adrenal glands produces catecholamines: dopamine, norepinephrine and adrenaline, which serve as neurotransmitters that transmit nerve impulses and affect metabolic processes. With the development of tumors of the adrenal glands, endocrine pathology is determined by the defeat of one or another layer of the glands and the peculiarities of the action of the excess secreted hormone.

Classification

Adrenal neoplasms are divided into two large groups according to localization, which are fundamentally different from each other: tumors of the adrenal cortex and tumors of the adrenal medulla. Tumors of the outer cortical layer of the adrenal glands - aldosteroma, corticosteroma, corticoestroma, androsteroma and mixed forms - are observed quite rarely. Tumors of the chromaffin or nervous tissue originate from the inner medulla of the adrenal glands: pheochromocytoma (develops more often) and ganglioneuroma. Tumors of the adrenal glands originating from the medulla and cortex can be benign or malignant.

Benign neoplasms of the adrenal glands, as a rule, are small in size, without pronounced clinical manifestations and are incidental findings during the examination. In malignant tumors of the adrenal glands, a rapid increase in the size of the neoplasms and pronounced symptoms of intoxication are observed. There are primary malignant tumors of the adrenal glands, emanating from the body's own elements, and secondary, metastasizing from other localizations.

In addition, primary adrenal tumors can be hormonally inactive (incidentalomas or "clinically silent" tumors) or producing an excess of any adrenal hormone, i.e., hormonally active.

1. Hormonally inactive neoplasms of the adrenal glands are often benign (lipoma, fibroma, fibroids), develop with the same frequency in women and men of any age group, usually accompany the course of obesity, hypertension, diabetes mellitus. Less common are malignant hormonally inactive tumors of the adrenal glands (melanoma, teratoma, pyrogenic cancer).
2. Hormonally active adrenal cortical tumors are aldosteroma, androsteroma, corticoestroma and corticosteroma; medulla - pheochromocytoma. According to the pathophysiological criterion, adrenal tumors are divided into:

• causing violations of water-salt metabolism - aldosteroma;
• causing metabolic disorders - corticosteromas;
• neoplasms that have a masculinizing effect - androsteromas;
• neoplasms that have a feminizing effect - corticoestroms;
• neoplasms with mixed metabolic-virilic symptoms - corticoandrosteromas.

Greatest clinical significance have hormone-secreting tumors of the adrenal glands.

Symptoms of adrenal tumors

Tumors of the adrenal glands that occur without the phenomena of hyperaldosteronism, hypercortisolism, feminization or virilization, autonomic crises develop asymptomatically. They are usually found incidentally on MRI, renal CT, or abdominal and retroperitoneal ultrasonography performed for other conditions.

Aldosteroma

An aldosterone-producing adrenal tumor that originates from the glomerular cortex and causes the development of primary aldosteronism (Conn's syndrome). Aldosterone regulates mineral-salt metabolism in the body. Excess aldosterone causes hypertension, muscle weakness, alkalosis (alkalinization of the blood and tissues), and hypokalemia. Aldosteromas can be single (in 70-90% of cases) and multiple (10-15%), unilateral or bilateral. Malignant aldosteromas occur in 2-4% of patients.

Aldosteromas present with three sets of symptoms: cardiovascular, renal, and neuromuscular. Persistent arterial hypertension, not amenable to antihypertensive therapy, headaches, shortness of breath, interruptions in the heart, hypertrophy, and then myocardial dystrophy are noted. Persistent hypertension leads to changes in the fundus (from angiospasm to retinopathy, hemorrhages, degenerative changes and papilledema).

With a sharp release of aldosterone, a crisis may develop, manifested by vomiting, severe headache, severe myopathy, superficial respiratory movements, visual impairment, possibly the development of flaccid paralysis or an attack of tetany. Complications of the crisis can be acute coronary insufficiency, stroke. Renal symptoms of aldosteroma develop with pronounced hypokalemia: thirst, polyuria, nocturia, and alkaline urine appear.

Neuromuscular manifestations of aldosteroma: muscle weakness of varying severity, paresthesia and convulsions - due to hypokalemia, the development of intracellular acidosis and degeneration of muscle and nervous tissue. Asymptomatic aldosteroma occurs in 6-10% of patients with this type of adrenal tumor.

Glucosteroma

Glucosteroma, or corticosteroma, is a glucocorticoid-producing adrenal tumor that originates from the fascicular cortex and causes the development of Itsenko-Cushing's syndrome (obesity, arterial hypertension, early puberty in children and early extinction of sexual function in adults). Corticosteromas can be benign (adenomas) and malignant (adenocarcinomas, corticoblastomas). Corticosteromas are the most common tumors of the adrenal cortex.

The clinic of corticosteroma corresponds to the manifestations of hypercortisolism (Itsenko-Cushing's syndrome). Obesity develops according to the Cushingoid type, hypertension, headache, increased muscle weakness and fatigue, steroid diabetes, sexual dysfunction. On the abdomen, mammary glands, inner surfaces of the thighs, the appearance of striae and petechial hemorrhages is noted. Men develop signs of feminization - gynecomastia, testicular hypoplasia, decreased potency; in women, on the contrary, signs of virilization - male type of hair growth, lowering the timbre of the voice, hypertrophy of the clitoris.

Developing osteoporosis causes a compression fracture of the vertebral bodies. In a quarter of patients with this tumor of the adrenal glands, pyelonephritis and urolithiasis are detected. Often there is a violation of mental functions: depression or agitation.

Corticoesteroma

An estrogen-producing adrenal tumor that originates from the fascicular and reticular cortex and causes the development of estrogen-genital syndrome (feminization and sexual weakness in men). It develops rarely, usually in young men, is more often malignant and has a pronounced expansive growth.

Manifestations of corticoesteroma in girls are associated with an acceleration of physical and sexual development (enlargement of the external genitalia and mammary glands, pubic hair growth, accelerated growth and premature maturation of the skeleton, vaginal bleeding), in boys - with a delay in sexual development. In adult men, signs of feminization develop - bilateral gynecomastia, atrophy of the penis and testicles, lack of facial hair growth, high timbre of voice, distribution of body fat according to the female type, oligospermia, decrease or loss of potency. In female patients, this tumor of the adrenal glands does not manifest itself symptomatically and is accompanied only by an increase in the concentration of estrogens in the blood. Purely feminizing tumors of the adrenal glands are quite rare, more often they are mixed.

Androsteroma

An androgen-producing tumor of the adrenal glands that originates from the reticular zone of the cortex or ectopic adrenal tissue (retroperitoneal fatty tissue, ovaries, broad ligament of the uterus, spermatic cords, etc.) and causes the development of androgen-genital syndrome (early puberty in boys, pseudohermaphroditism in girls, symptoms virilization in women). In half of the cases, androsteromas are malignant, metastasize to the lungs, liver, and retroperitoneal lymph nodes. In women, it develops 2 times more often, usually in the age range from 20 to 40 years. Androsteromas are a rare pathology and account for 1 to 3% of all tumors.

Androsteromas, characterized by excessive production of androgens by tumor cells (testosterone, androstenedione, dehydroepiandrosterone, etc.), cause the development of anabolic and viril syndrome. With androsteroma in children, accelerated physical and sexual development is noted - rapid growth and muscle development, coarsening of the voice timbre, the appearance of acne on the trunk and face. With the development of androsteroma in women, signs of virilization appear - the cessation of menstruation, hirsutism, a decrease in the timbre of the voice, hypotrophy of the uterus and mammary glands, clitoral hypertrophy, a decrease in the subcutaneous fat layer, and an increase in libido. In men, manifestations of virilism are less pronounced, so these adrenal tumors are often incidental findings. Secretion of androsteroma and glucocorticoids is possible, which is manifested by the clinic of hypercorticism.

Pheochromocytoma

A catecholamine-producing tumor of the adrenal glands, originating from chromaffin cells of the adrenal medulla (in 90%) or the neuroendocrine system (sympathetic plexuses and ganglia, solar plexus, etc.) and accompanied by autonomic crises. Morphologically, pheochromocytoma is more often benign, its malignancy is observed in 10% of patients, usually with extra-adrenal localization of the tumor. Pheochromocytoma occurs more frequently in women, predominantly between the ages of 30 and 50. 10% of this type of adrenal tumors are familial.

The development of pheochromocytoma is accompanied by dangerous hemodynamic disorders and can occur in three forms: paroxysmal, permanent and mixed. The course of the most frequent paroxysmal form (from 35 to 85%) is manifested by sudden, excessively high arterial hypertension (up to 300 and above mm Hg) with dizziness, headache, marbling or pallor of the skin, palpitations, sweating, retrosternal pain, vomiting , trembling, feeling of panic, polyuria, rise in body temperature. An attack of paroxysm is provoked by physical stress, palpation of the tumor, abundant food, alcohol, urination, stressful situations (injuries, surgery, childbirth, etc.).

A paroxysmal crisis can last up to several hours, the frequency of crises is from 1 for several months to several per day. The crisis stops quickly and suddenly, blood pressure returns to its original value, pallor is replaced by reddening of the skin, profuse sweating and saliva secretion are observed. With a permanent form of pheochromocytoma, persistently elevated blood pressure is noted. With a mixed form of this tumor of the adrenal glands, pheochromocytoma crises develop against the background of constant arterial hypertension.

Complications

Among the complications of benign tumors of the adrenal glands is their malignancy. Malignant tumors of the adrenal glands metastasize to the lungs, liver, bones. In severe cases, the pheochromocytoma crisis is complicated by catecholamine shock - uncontrolled hemodynamics, a random change in high and low blood pressure values ​​that are not amenable to conservative therapy. Catecholamine shock develops in 10% of cases, more often in patients childhood.

Diagnostics

Modern endocrinology has such diagnostic methods that not only allow diagnosing adrenal tumors, but also establish their type and localization. The functional activity of adrenal tumors is determined by the content of aldosterone, free cortisol, catecholamines, homovanillic and vanillylmandelic acid in daily urine.

If pheochromocytoma and crisis rises in blood pressure are suspected, urine and blood for catecholamines are taken immediately after an attack or during it. Special tests for adrenal tumors include taking blood for hormones before and after taking medications (test with captopril, etc.) or measuring blood pressure before and after taking drugs (tests with clonidine, tyramine and tropafen).

The hormonal activity of an adrenal tumor can be assessed using selective adrenal phlebography - radiopaque catheterization of the adrenal veins, followed by blood sampling and determination of the level of hormones in it. The study is contraindicated in pheochromocytoma, since it can provoke the development of a crisis. The size and localization of the adrenal tumor, the presence of distant metastases are assessed by the results of ultrasound of the adrenal glands, CT or MRI. These diagnostic methods make it possible to detect incidentaloma tumors with a diameter of 0.5 to 6 cm.

Treatment of adrenal tumors

Hormonally active tumors of the adrenal glands, as well as neoplasms with a diameter of more than 3 cm that do not show functional activity, and tumors with signs of malignancy are treated surgically. In other cases, dynamic control over the development of an adrenal tumor is possible. Operations for tumors of the adrenal glands are performed from an open or laparoscopic approach. The entire affected adrenal gland is subject to removal (adrenalectomy - removal of the adrenal gland), and in case of a malignant tumor, the adrenal gland along with nearby lymph nodes.

Operations for pheochromocytoma are the most difficult due to the high probability of developing severe hemodynamic disorders. In these cases, much attention is paid to the preoperative preparation of the patient and the choice of anesthesia, aimed at stopping pheochromocytoma crises. In pheochromocytomas, treatment is also used with intravenous administration of a radioactive isotope, which causes a decrease in the size of the adrenal tumor and existing metastases.

Some types of adrenal tumors respond well to chemotherapy (mitotane). Relief of pheochromocytoma crisis is carried out by intravenous infusion of phentolamine, nitroglycerin, sodium nitroprusside. If it is impossible to stop the crisis and the development of catecholamine shock, an emergency operation is indicated for health reasons. After surgical removal of the tumor along with the adrenal gland, the endocrinologist prescribes permanent replacement therapy with adrenal hormones.

Forecast

Timely removal of benign tumors of the adrenal glands is accompanied by a favorable prognosis for life. However, after removal of androsteroma, patients often have short stature. In half of the patients who underwent surgery for pheochromocytoma, moderate tachycardia, hypertension (permanent or transient), amenable to drug correction, remain. When the aldosteroma is removed, blood pressure returns to normal in 70% of patients, in 30% of cases moderate hypertension remains, which responds well to antihypertensive therapy.

After removal of a benign corticosteroma, regression of symptoms is noted already after 1.5-2 months: the patient's appearance changes, blood pressure and metabolic processes return to normal, striae turn pale, sexual function normalizes, manifestations of steroid diabetes mellitus disappear, body weight decreases, hirsutism decreases and disappears . Malignant tumors of the adrenal glands and their metastasis are extremely unfavorable prognostically.

Prevention

Since the causes of the development of tumors of the adrenal glands are not fully established, prevention is reduced to the prevention of recurrence of removed tumors and possible complications. After adrenalectomy, control examinations of patients by an endocrinologist are necessary once every 6 months. with subsequent correction of therapy depending on the state of health and research results.

Patients after adrenalectomy for tumors of the adrenal glands are contraindicated in physical and mental stress, the use of hypnotics and alcohol.

Neuroblastoma in children often affects the kidney tissue. Neuroblastoma of the right adrenal gland, as well as the left one, can metastasize along blood vessels, affect the lymph nodes, internal organs (for example, the liver) and affect the cells of the skin. This kind malignant neoplasm has unique characteristics and an aggressive form of development.

Description and features

An adrenal gland tumor occurs during embryonic development and, as a rule, manifests itself at an early age. Development occurs due to pathological changes in immature embryonic nerve cells. Cells mutate and do not mature to a full-fledged level, while continuing to divide and form a tumor.

Adrenal neuroblastoma in children has a unique feature - in some cases it disappears on its own.

A negative characteristic of neuroblastoma of the left and right adrenal glands in children is its aggressive and rapid development. Such a pathology of the adrenal glands in childhood is extremely rare and manifests itself up to 5 years. It occupies a fairly large space in the abdominal region of the child. At the first stages of development, a malignant formation is quite difficult to detect, this is possible only when conducting a set of studies.

Neuroblastoma of the adrenal glands in the fetus and newborn

Children with adrenal neuroblastoma do not have any symptoms of the disease. More often, the tumor is discovered incidentally during examination by a pediatrician or during x-ray and ultrasound. The malignancy is characterized rapid growth and in a short time can affect the canal of the spinal cord.

In the fetus, the development of adrenal neuroblastoma is extremely rare. When conducting an ultrasound examination of the fetus, neuroblastoma can be detected at the end of the 2nd trimester of pregnancy, most early diagnosis the tumor was fixed at the 26th week. In the fetus, the tumor is usually localized on one side. It is almost impossible to predict the further development of the tumor after the diagnosis is made - the course ranges from independent regression to the active spread of metastases.

Causes

The etiology and causes of the formation of neuroblastoma of the adrenal gland in embryonic and childhood have not yet been elucidated. In the vast majority of recorded cases, the tumor occurs for no apparent reason. In more rare cases, this hereditary disease. Adrenal neuroblastoma, a hereditary form of cancer, is found in newborns and infants under the age of 1 year.

Pathology occurs when the healthy maturation of embryonic cells changes. Mutation at the cellular level leads to incomplete maturation of nerve cells, but they continue to divide, forming a malignant tumor. If the disease occurs before the year, there is a chance that the tumor will independently flow into a benign form and disappear over time.

Symptoms of the disease

At the first stages of development of neuroblastoma of the adrenal glands, no characteristic symptoms are found in children. For childhood, minor malaise is considered as signs of other diseases characteristic of this period of life. The primary site of tumor localization, as a rule, is located in the adrenal glands. The child may have bluish or red spots on the skin. This indicates damage by metastases of skin cells. The main characteristic symptoms in the presence of adrenal neuroblastoma in children:

• constant fatigue, drowsiness;
• increased sweating;
• an increase in body temperature for no apparent reason;
• enlarged lymph nodes, seals in the neck and abdomen;
• abdominal pain, stool disorder;
• poor appetite, persistent nausea, weight loss;
• pain in the bones.

Cancer cells produce hormones and cause pressure on the organs. An overgrown malignant formation in the retroperitoneal space can adversely affect the functioning of the gastrointestinal tract. If metastases have reached the bone marrow, the child becomes sickly and weak. Cuts, even minor ones, cause heavy bleeding that is difficult to stop.

Stages of development of adrenal neuroblastoma in children

The course of development of neuroblastoma of the adrenal gland has conditional stages. This division of the development of the disease makes it possible to determine the most effective methods treatment. Stage 1 is characterized by a single tumor, the size of which (no more than 5 centimeters) allows for surgery. Metastases and lesions of the lymph nodes are absent. Stage 2A - a malignant neoplasm is localized, part of it is operable. There are no metastases at all or there are no signs of distant metastases. Stage 2 - the development of metastases that affect the lymph nodes.

Stage 3 - a bilateral tumor appears. Stage 3 neuroblastoma is divided in turn into several classifications: with degrees T1 and T2 - single tumors are not more than 5 centimeters and from 5 to 10 centimeters. N1 - lymph nodes are affected by metastases. M0 - no distant metastases. With a diagnosis of N, it is impossible to determine the presence or absence of metastases.

Stage 4 - a malignant tumor increases in size, metastasizes to the bone marrow, internal organs and lymph nodes. Stage 4A has a tumor no more than 10 centimeters, sometimes it is impossible to determine the presence or absence of metastases. Stage 4B has many synchronous tumors. It is impossible to determine the defeat of the lymph nodes, as well as to assess the presence of distant metastases.

Diagnostics

If you suspect the presence of neuroblastoma in a child, you should immediately consult a doctor and go through all the necessary examination procedures. Diagnostic methods for detecting adrenal neuroblastoma:

• urinalysis for the presence of tumor markers and catecholamines;
• general and detailed blood test;
• radiography;
• ultrasound procedure;
• positron emission tomography;
• CT scan;
• biopsy of tumor tissue and bone marrow.

Primary diagnosis is carried out using urine and blood tests. If the suspicion of neuroblastoma is confirmed, additional studies are assigned to detect the location of its localization, the number of metastases, the size and nature of the tumor. Based on the results of the tests, the doctor prescribes the necessary treatment procedure.

Treatment Methods

Methods for the treatment of neuroblastoma of the adrenal glands in children are divided into 3 types: chemotherapy, radiation therapy and surgery. The choice of method depends on the stage of development of a malignant neoplasm. In stages 1 and 2A, formations are usually removed by surgery. If stage 2 B, a course of chemotherapy is prescribed after the operation. Stage 4S neuroblastoma often disappears on its own.

The 3rd stage of a malignant formation is inoperable due to its large size. In this case, the neuroblastoma is reduced with chemotherapy and then the necessary surgery is performed. After the operation, the child must undergo a course of radiation therapy. Unfortunately, the 4th degree of tumor development is difficult to treat and there is a high risk of death.

Prognosis and life expectancy

On the initial stages The development of neuroblastoma of the adrenal glands in children is treatable in all cases. 3rd stage during proper treatment has a favorable prognosis - more than 65% of sick children successfully got rid of the tumor. Life expectancy after a complete cure also has a favorable prognosis - the child can fully develop and live long years. Stage 4S in 75% of cases is successfully defeated by the child's body. When diagnosed with stage 4 neuroblastoma, the prognosis is disappointing - no more than 20% of children live longer than 5 years after the treatment.