May 1, 2017 Vrach

A neoplasm such as an adrenal tumor can be benign or malignant. They are formed from various cells of the body and can have different symptoms. Most often, the manifestations are paroxysmal and represent an adrenal crisis. Possible impaired renal function, hormonal changes. For treatment, mainly surgical methods are used.

The adrenal glands are a paired organ, they are endocrine glands, each of which consists of a cortex and a medulla. The main function of the adrenal glands is the production of hormones necessary for the normal functioning of the body. This organ produces a fairly large amount of hormones, so a violation of its functions always quickly affects the state of the body and general well-being.

Hormones produced in the adrenal glands:

• Mineralocorticoids that regulate water and mineral metabolism.
• Glucocorticoids that provide protein-carbohydrate metabolism.
• Androsteroids responsible for secondary sexual characteristics.
• Catecholamines, which are neurotransmitters and regulators of metabolic processes.

Each layer of the adrenal glands is “responsible” for the production of certain hormones, therefore, with the development of tumors, the symptoms and manifestations depend on which part of the organ is affected.

Classification of tumors

This pathology is classified depending on the signs:

1. by localization - formed from the medulla of the adrenal glands or the cortex of the organ;
2. by activity - hormone-producing and hormonally inactive;
3. by nature - benign and malignant.

Classification according to the place of localization distinguishes two groups of tumors, which are very different from each other. This is due to the functions of the layers of the organ and the fact that they produce different groups of hormones. Tumors of the adrenal cortex are less common than neoplasms of the medulla. Both of them can be malignant and benign. The latter, as a rule, are small in size and do not disturb patients. They are discovered incidentally during a kidney exam for some other reason. Adrenal cancer is different rapid growth and severe symptoms.

As for the hormonal activity of neoplasms, inactive ones are most often found among benign ones. It is a fibroma, lipoma or myoma. Hormonally active tumors always lead to severe symptoms due to an excess of one or another hormone. It is they who bring the greatest number of problems and are most often malignant.

Hormone-producing tumors

Each type of hormone-producing tumors has its own characteristics and manifestations associated with the area from which they originate.

Types of tumors that produce hormones:

• Aldosteroma;
• Corticosteroma;
• Corticoestroma;
• Androsteroma;
• Pheochromocytoma.

Aldosteroma is a neoplasm in the glomerular zone of the adrenal cortex. It produces aldosterone, as a result, the amount of this hormone in the body increases. Since this hormone regulates mineral-salt metabolism, it is this process that is disrupted. In the body, the concentration of potassium increases, alkalization of the blood occurs, hypertension is observed, and muscle tone decreases.

Corticosteroma is formed in the area of ​​the cortex that produces glucocorticosteroids. It is the most common among all tumors of the adrenal cortex, it can have both benign and malignant course. With an excess of glucocorticosteroids, the processes of sexual development are disturbed, in particular, earlier maturation is observed in children, and in adults, an earlier extinction of sexual functions. Obesity, hypertension are frequent companions of corticosteroma.

Corticoestroma produces estrogens, it is formed in the reticular and fascicular zones of the adrenal cortex. Estrogens are female sex hormones, so their excess leads to an increase in female sexual characteristics - feminization. Corticoestroma occurs quite rarely, mainly in young men. This tumor in most cases is malignant and quite aggressive.

Androsteroma produces male sex hormones - androgens. It develops in the reticular zone of the cortex or ectopic tissue. The formation of such a tumor leads to early puberty in boys, the appearance of signs of masculinity in girls and women. Most often, androsteroma occurs in women of active age, in half of the cases it is malignant. In general, this neoplasm accounts for no more than 3% of all adrenal neoplasms.

Pheochromocytoma in most cases is benign. It is accompanied by vegetative crises, as it comes from chromaffin cells in the brain tissue and produces catecholamines.

Symptoms and manifestations

An adrenal tumor gives a very diverse clinical picture, since the symptoms are associated with the structure of the neoplasm, with its localization and hormonal activity. All symptoms can be divided into two groups: general and hormonal. General symptoms are characteristic mainly of malignant tumors and are associated with tissue destruction, intoxication and the spread of metastases.

General symptoms of malignant tumors

• Deterioration of well-being;
• Decreased performance;
• emotional lability;
• Violation of the functions of the affected organs;
• Nausea;
• digestive problems;
• Weight loss.

Hormonal symptoms depend on which hormone is produced by the tumor.

Most Common Symptoms

• Obesity;
• hypertension;
• Decreased muscle tone;
• Osteoporosis;
• Violations in the sexual sphere.

A fairly common symptom is arterial hypertension, which can be constant or manifest in the form of attacks. Specific symptoms in women are observed with androsteroma, when the concentration of male sex hormones increases. They may appear to varying degrees.

Symptoms of androsteroma in women

• Reduction of the subcutaneous fat layer;
• Increase in muscle mass;
• Increased hair growth on the body;
• Lowering the timbre of the voice;
• Possible reduction or atrophy of the mammary glands;
• Violation of the menstrual cycle.

With corticoestroma, an increase in the concentration of female sex hormones occurs. More susceptible to this disease are young men, whose body undergoes changes according to the female type. Symptoms in men manifest themselves in varying degrees, which is associated with the amount of estrogens secreted by the tumor.

Symptoms of corticoestroma

• Enlargement of the mammary glands;
• Increase in the subcutaneous fat layer;
• Increasing the timbre of the voice;
• Cessation of hair growth on the face;
• Decreased or even loss of potency.

Diagnosis and treatment

If a tumor of the adrenal gland is suspected, it is required to undergo diagnostic procedures that will make it possible to identify the neoplasm and determine its nature, as well as assess the danger to the patient.

Diagnostic measures

• Collection of anamnesis;
• Computed tomography, including with the use of contrast;
• Scintigraphy;
• Positron emission tomography;

Not all patients require a complete set diagnostic procedures. Which ones are necessary, the attending physician decides in each case. In addition to the above studies, it is necessary to perform an analysis of daily urine for metanephrines and cortisol, a special hormonal blood test.

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Based on the diagnostic results, conclusions are drawn about the need for treatment and specific methods are selected.

Treatment depends on the size, activity of the tumor and signs of its malignancy. Neoplasms that do not cause concern and have dimensions of no more than 3 cm require dynamic observation. In other cases, the treatment is mainly surgical.

Indications for surgical treatment

• The size of the tumor is more than 3 cm;
• Hormonal activity;
• Malignant character.

The operation consists in removing the entire affected adrenal gland. Cancer may also require the removal of nearby lymph nodes. In some cases, chemotherapy is effective. Courses of chemotherapy and radiation therapy are carried out after the removal of malignant tumors to destroy the remaining cancer cells and prevention of recurrence and metastasis.

With timely detection of pathology and adequate treatment, in most cases it is possible to achieve the cessation of symptoms and a significant improvement in the patient's condition. However, hormone replacement therapy is often required after removal of the adrenal gland.

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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 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.

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

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, the rest have a persistent metabolic disorder; 65% of patients develop secondary immunodeficiency.

Corticoestroma

Rare and very aggressive malignant tumor producing 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.

Tumors of the adrenal gland have recently become more common - due to the wide availability of ultrasound and computed tomography, tumor formations of the adrenal gland are detected in 2-3% of patients. There is evidence that a tumor of the adrenal gland can be found with a thorough examination in 5% of the inhabitants of our planet.

At present, the situation with the diagnosis and treatment of adrenal tumors resembles the situation with the diagnosis and treatment of thyroid nodules, which was created about 10-15 years ago. At the end of the 20th century, following the widespread use of thyroid ultrasound, thyroid nodules began to be detected in 20-30% of the inhabitants of the Earth, after which the number of thyroid operations began to grow exponentially. In some medical centers there was an almost 10-fold increase in the number of thyroid surgeries! It took several years of efforts by leading Russian specialists, thousands of lectures for doctors, books for patients, information sites - and only after all this work was it possible to explain to doctors that among all thyroid nodules, only 5% are malignant, and all the rest are completely harmless benign formations that never "degenerate" into cancer. Now the leading specialized centers of the world operate only on patients with malignant thyroid nodules, or with benign nodules that reduce the patient's quality of life - i.e. work strictly according to indications, avoiding operations on all other nodes.

The situation with tumors of the adrenal glands is in many ways similar to the situation with thyroid nodules, only for the adrenal glands, computed and magnetic resonance imaging were the “catalyst” for the increase in the number of operations. These studies appeared later than ultrasound, and they are performed less often, so the “wave” of operations on the adrenal glands also appeared later.

Often with CT or MRI abdominal cavity doctors radiodiagnosis accidentally notice a tumor of the adrenal gland. For such accidentally detected tumors, they even came up with a special name - "incidentaloma" (from incidental - random). It is important to understand that an accidentally detected tumor of the adrenal gland is by no means a reason for a mandatory operation. A thorough examination is required, in which the diagnosis will be clarified, and indications for surgery will be determined (or it will become clear that there are no indications for surgery).

Symptoms of an adrenal tumor

There are few diseases in humans that have such a diverse clinical picture as an adrenal tumor. Symptoms of this disease can be associated both with the structure of the tumor (benign or malignant), and with the presence or absence of hormonal activity in the tumor.

If the symptoms of adrenal tumor malignancy are quite typical for all malignant tumors (weight loss, pain, digestive disorders, vascular dysfunction, etc.), then the hormonal symptoms of such tumors depend only on which hormone the tumor produces (cortisol, aldosterone). , sex hormones, adrenaline, norepinephrine).

Hormonal symptoms of an adrenal tumor may include the appearance of obesity, muscle weakness, the development of osteoporosis, depression, sprains on the skin (with a cortisol-producing tumor of the adrenal cortex), crisis or permanent increase blood pressure(with pheochromocytoma - a tumor that produces adrenaline or noradrenaline; with aldosterone - a tumor that produces aldosterone), the development of a number of male sexual characteristics (pronounced muscles, hairiness, rough voice) with a virilizing adrenal adenoma (androsterome), which produces sex hormones.

Fortunately, malignant tumors of the adrenal glands (adrenocortical cancer, malignant pheochromocytoma) are quite rare - in 1-2% of all tumors. In most cases, by the time of detection, these tumors are of considerable size (more than 4 cm) and are often accompanied by regional metastases (in the lymph nodes) or distant metastases (in the lungs, bones). Malignant tumors of the adrenal gland require rapid and radical treatment.

Diagnosis of adrenal tumors

The following imaging modalities are used to evaluate a patient with a suspected adrenal tumor:

Ultrasound of the adrenal glands (a safe, cheap and affordable method; its disadvantages are low information content, especially in overweight patients);

Computed tomography (optimally - with intravenous administration of a contrast agent, which allows drawing conclusions about the structure of the tumor);

Magnetic resonance imaging.

In some cases, radionuclide diagnostic methods can be used:

Adrenal scintigraphy with metaiodobenzylguanidine (MIBG);

Positron emission tomography with 18-FDG.

Among hormonal studies for adrenal tumors, the following can be used:

Analysis of daily urine for cortisol;

Analysis of daily urine for metanephrines;

Blood test for ACTH, cortisol, chromogranin A, renin, aldosterone, calcitonin, blood ions (potassium, calcium, chlorine, sodium), parathyroid hormone.

The choice of a specific examination method is determined by the endocrinologist or endocrinologist surgeon who conducts the diagnosis.

Tumors of the adrenal glands - treatment

Some benign tumors of the adrenal glands may not require treatment at all. This applies to small tumors that do not produce hormones, for which there is no information about their malignant structure. Such benign tumors of the adrenal glands require only regular examination, periodic repetition of hormonal tests and repeated computed tomography. The prognosis for such tumors is favorable.

If a malignant tumor of the adrenal gland is suspected, it must be removed. Surgery for an adrenal gland tumor should be performed in a specialized endocrine surgery center with sufficient experience in the field of adrenal surgery. Surgery for a tumor of the adrenal gland can be performed both with an exclusively low-traumatic approach (lumbar endoscopic extraperitoneal approach), and with a traumatic open approach, accompanied by transection of the muscles of the anterior abdominal wall, chest wall and diaphragm. In the North-Western Center of Endocrinology, the leader of Russian endocrine surgery, which performs more than 100 operations on the adrenal glands annually, the vast majority of operations for adrenal tumors are performed endoscopically through the lower back with the formation of a small and cosmetic suture.

An operation to remove a tumor of the adrenal gland requires the use of modern equipment. The operating room of the Northwestern Endocrinology Center is equipped with endoscopic equipment manufactured by Karl Storz (Germany), an Ethicon Ultracision ultrasonic harmonic scalpel (USA), and an endoscopic electrocoagulator with Ligasure feedback (USA). All this allows the removal of the adrenal tumor with minimal trauma to the patient.

Adrenal Tumor Prognosis

With timely diagnosis and proper treatment, an adrenal tumor can be cured completely and forever. This applies to both benign and malignant tumors of the adrenal glands. Of course, in this case, not only the discipline and attentiveness of the patient, but also the experience of the doctor conducting the examination and treatment is of paramount importance.

In the North-Western Center of Endocrinology, examination of patients with adrenal tumors is carried out by endocrinologists with significant experience in the field of endocrine surgery and who have specialized in leading clinics in Europe, the USA, and Japan.

You can sign up for an examination for an adrenal tumor by calling the center's branches:

Petrograd branch (Kronverksky pr., 31, 200 meters from Gorkovskaya metro station, tel. 498-10-30 from 7.30 to 20.00 seven days a week);

Primorsky branch (Savushkina St., 124, building 1, tel. 344-0-344, from 7.00 to 21.00 on weekdays, from 7.00 to 19.00 on weekends).

Consultations of patients with tumors of the adrenal glands are carried out:

	Sleptsov Ilya Valerievich, surgeon-endocrinologist, doctor medical sciences, Professor of the Department of Surgery with a course in Surgical Endocrinology, Member of the European Association of Endocrine Surgeons
	Surgeon-endocrinologist of the highest qualification category, Candidate of Medical Sciences, specialist of the North-Western Center of Endocrinology. One of the most experienced surgeons in Russia performing operations on the adrenal glands. Operations are performed with a minimally traumatic retroperitoneoscopic approach through lumbar punctures, without incisions.
	Surgeon-endocrinologist, oncologist, candidate of medical sciences, member of the European Thyroid Association (ETA). Performs endoscopic surgeries on the adrenal glands. Retroperitoneoscopic approach. More than 350 surgical interventions per year, half of which are endoscopic.

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  Virilism syndrome (virilism) - a symptom complex characterized by the appearance in females of secondary sexual characteristics characteristic of the male body

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• Corticosteroma

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• Analyzes in St. Petersburg

  One of the most important stages of the diagnostic process is the performance of laboratory tests. Most often, patients have to perform a blood test and urinalysis, but often the object laboratory research are other biological materials.

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  Information for patients requiring adrenal surgery (adrenal gland removal, adrenal resection)

A tumor of the adrenal glands is a serious pathology, the symptoms in women are acute, manifested by disruptions in the functioning of all body systems. The insidiousness of the disease is that it disguises itself as others and, because of this, is diagnosed late.

What is an adrenal tumor?

The adrenal glands are a paired organ that performs an endocrine function. They are located above the upper points of the kidneys, produce several hormones, regulate all processes in the human body. Participate in water-salt, protein, carbohydrate metabolism, determine the development of sexual characteristics, promote the synthesis of adrenaline and norepinephrine. Organs have two layers: inner (brain) and cortical (outer).

Violate the work of such important organs various tumors- neoplasms that appear within the boundaries of one or both adrenal glands are diagnosed in every fifth person.

Classification of tumors

Tumors of the adrenal glands in women differ in location, method of formation, nature and hormonal activity.

By the nature of the neoplasm are:

• benign;
• malignant.

Benign ones are distinguished by their small size, the absence of symptoms (myoma, fibroma, lipoma). Malignant ones are characterized by rapid development, pronounced manifestations. Malignant include: teratoma, melanoma, pyrogenic cancer.

Malignant is divided into primary (formed directly in the adrenal gland) and secondary (which are metastases of cancer of other organs).

Depending on the place where the tumor has formed, there are:

• Tumors of the cortex.
• Tumors of the brain.

In the adrenal cortex:

• Corticosteroma.
• Androsteroma.
• Aldosteroma.

In the medulla:

• Ganglioneuroma.
• Pheochromocytoma.

According to hormonal dependence, formations are distinguished:

• Hormonally active.
• Hormonally inactive.

The former are usually cancerous, the latter are benign in nature. Tumors diagnosed in women are often inactive.

Malignant tumors have four stages of development:

1. The tumor is less than 0.5 cm and has no symptoms. Discovered by chance during an ultrasound scan.
2. Education grows more than 1 cm, does not affect other organs.
3. The tumor increases in size, becomes more than 5 cm. The patient develops symptoms of intoxication. Metastases occur in nearby lymph nodes.
4. Education grows, metastases affect distant organs. Most often light and spinal cord. At this stage, the tumor is considered inoperable.

The adrenal glands are an endocrine gland that has a paired structure. Pairs or lobes of the adrenal glands are fixed in the upper part of the right and left kidneys.

The structure of the adrenal glands has a complex structure, therefore, two layers are distinguished in them: the outer one is the cortical one, and the inner one is the brain one.

Regardless of what provokes tumors of the adrenal glands, they can be located in any of the layers, but the external manifestations of tumors located in the cortical layer and tumors located in the medulla differ significantly from each other. So why do adrenal tumors occur? Symptoms, diagnosis, treatment of adrenal cancer - read on.

Scientists have not yet been able to single out a certain pattern of the occurrence of pathology with a clearly traceable causality. However, it is known for sure that the risk group this disease patients include:

• With congenital pathologies of the thyroid and pancreas, pituitary gland, endocrine neoplasia of all types.
• People whose next of kin have been diagnosed with lung or breast cancer.
• Patients with hereditary hypertension, diseases and pathologies of the structure of the kidneys and / or liver.
• The maximum risk of rapid development of a tumor of the adrenal glands in persons who have independently undergone oncological diseases of any organs. This is due to the spread of cancer cells from the affected tissues through the blood and lymph of the body.

Classification of tumors

In the focus of pathological growth of new tissues, both malignant (10%) and benign (90%) cells can be found.

In the vast majority of cases, growths of a benign nature are diagnosed. The frequency of detection of malignant structures does not exceed 2% of cases in adults, and 1.5% of cases in children.

Tumors of the adrenal glands are classified according to the tissues within which they originated:

• in epithelial tissue adrenal cortex - aldosteroma, androsteroma, adenoma, corticoestroma and carcinoma;
• in the connective tissue between the cortical and cerebellar layers - fibroma, lipoma, myeloma, angioma;
• in the tissue of the medulla - ganglionoma, ganglionevroma, pheochromocytoma (the most common type of tumor), sympathogonioma, neuroblastoma;
• combined, that is, located in the tissues of the cortical and medulla layers - incidentalomas.

In any of these tumors, a benign or malignant structure can be found.

Signs of a benign tumor:

• small size - diameter up to 5 cm;
• absence of external manifestations (symptoms);
• discovered incidentally during ultrasound examination of the gastrointestinal tract.

Signs of a malignant tumor (cancer of the adrenal glands):

• large size - 5–15 cm in diameter;
• rapid growth and rapid growth;
• pronounced symptomatic manifestations, provoked by an excess of the hormone produced by the affected tissues.

Additionally, malignant tumors can be classified as primary, that is, consisting of the organ's own tissue, and secondary, that is, resulting from the penetration of metastases from other organs.

There is a more detailed classification of primary tumors - they can be hormonally inactive and hormonally active.

Hormonally inactive or clinically “silent” (not manifesting external symptoms) are mostly benign, the most common are fibroids and fibromas in women, and lipomas in men.

May occur at any age, as an element that accompanies chronic obesity, hypertension, type II diabetes mellitus.

Among malignant hormonally inactive tumors, the most common are: pyrogenic cancer, teranoma, melanoma.

Hormonally active, that is, producing increased daily doses of hormones and having vivid clinical symptoms:

• arising in the cortical layer - corticosteroma, aldosteroma, corticoestroma, androsteroma;
• arising in the medulla - pheochromocytoma.

The adrenal glands control the fat reserve of the body, help to adapt to stressful situations, that is, it is a very important organ in the human body. Here you can learn how to check the work of the adrenal glands and diagnose possible pathologies in time.

Classification according to the physiological pathologies they cause

• Imbalance of water-salt and sodium metabolism - aldosteroma.
• Acceleration or slowdown of metabolic processes - corticosteromas.
• The manifestation of secondary male sexual characteristics in women (pathological growth of body hair, male-type hair growth, change in gait, coarsening of the voice) - androsteromas.
• The manifestation of secondary female sexual characteristics in men (breast growth, hair loss, increased voice timbre - corticoestroms.
• The manifestation of male sexual characteristics in combination with metabolic disorders in women - corticoandrosteroma.

Hormonally inactive benign tumors often do not require surgical removal or corrective hormone therapy. People in whom they were found can continue their usual lifestyle, but they need to be examined by an endocrinologist every 6 months and turn to him with a sharp change in well-being.

Hormonally active tumors, regardless of nature, require surgical removal and subsequent hormone therapy, which must be constantly adjusted under medical supervision.

The only right decision in each case can only be made by a specialized medical specialist.

Pathogenesis and symptoms of the most common hormonally active types of tumors

Aldosteroma

Aldosteroma is a tumor that grows in the tissues of the adrenal cortex and causes a pathological excess of the hormone aldosterone. Its development is manifested by Conn's syndrome, which includes such disorders of mineral-sodium metabolism:

• development of hypertension;
• weakening of muscle tissue, periodic spasms and convulsions;
• alkalosis - an increase in the level of blood ph above normal (7.45 units per milliliter of blood);
• hypokalemia - a decrease in the calcium content below the minimum normal limit (3.5 units per milliliter of blood fluid).

Aldosteromas are found in such varieties: single, multiple, bilateral or unilateral.

Malignant variants among them found no more than 4%.

Androsteroma

Androsteroma - can be located in the zone of the adrenal cortex and in their ectopic tissue. Outwardly, it reveals itself as an androgenital syndrome, which has the following symptoms:

• In girls who have not reached puberty - pseudohermaphroditism.
• In mature women - hirsutism, delayed menstruation, sometimes their complete cessation. Rapid loss of total body weight, dystrophy of mammary gland tissues, a decrease in the volume of the uterus, resulting in infertility.
• In boys who have not reached the age of puberty - untimely early sexual development, purulent acne on the skin of the whole body.
• In men, the symptomatic picture is erased, the diagnosis of this tumor in them is usually accidental.

Most often, androsteroma occurs in children under adolescence and women 20-40 years old. In more than 50% of cases, this tumor is malignant in nature and can quickly metastasize to life-supporting organs: lungs, liver, lymphatic system and blood cells.

However, androsteroma is a rare tumor, its share of the total percentage of tumors that occur in the adrenal glands is no more than 3%.

Corticosteroma

Corticosteroma is a tumor that grows in the adrenal cortex, causing an increase in the secretion of glucocorticoids.

The presence of corticosteroma reveals itself as a rapidly developing Itsenko-Cushing's syndrome:

• in children of both sexes - early puberty;
• in adults of both sexes - earlier sexual extinction, obesity, hypertensive crises, arterial hypertension.

Corticosteromas are the most common type of tumors of the adrenal cortex, which in 80% of cases are benign.

Corticoesteroma

Corticoesteroma is a rapidly growing, in most cases, malignant tumor in the adrenal cortex.

Manifested by estrogen-genital syndrome:

• development of female sexual characteristics in men;
• male sexual dysfunction (decreased libido, lack of erection).

It most often occurs in mature men under 35 years of age, progresses rapidly. A favorable prognosis is only after surgical removal of the tumor at the earliest stages of its occurrence.

Pheochromocytoma

Pheochromocytoma is a tumor lurking in the adrenal medulla or affecting cells of the neuroendocrine system (ganglia, sympathetic and solar plexuses).

Expressed panic attacks varying degrees of severity and frequency.

In 90% of cases, pheochromocytoma is benign, in 10% of them the hereditary nature of the disease can be traced.

The most common occurrence of pheochromocytoma are women 30-50 years old. In the vast majority of cases, the outcome of the disease is positive.

Common symptoms of adrenal tumors

Primary:

• violation of nerve conduction in muscle tissues;
• paroxysmal increase in blood pressure or the development of persistent hypertension;
• nervous excitement;
• panic fear of death;
• pressing pains in the chest and abdomen;
• increased urine output.

Secondary:

• diabetes;
• impaired renal function;
• sexual dysfunction.

Diagnostics

1. To determine the functional activity of adrenal tumors, depending on the clinical picture, a urine test is performed to determine the level of aldosterone, cortisol or free catecholamines in it, as well as vanillinmandelic and homovanillic acid. If the doctor suspects pheochromocytoma, and in clinical picture the patient is present with sharp jumps in pressure, urine is taken during a hypertensive crisis or after it.
2. Blood sampling with special tests for hormones is carried out after taking Captopril and identical drugs.
3. Measurement of blood pressure is carried out after taking drugs that increase and decrease blood pressure: Itropafen, Clonidine, Tyramine.
4. Phlebography - blood sampling from the adrenal veins to determine the hormonal picture in it. But it is contraindicated in femochromocytoma, as it can cause a sharp rise in blood pressure!
5. Ultrasound can only detect tumors larger than 1 cm in diameter.
6. CT and MRI can determine the location and size of even the smallest formations with a diameter of 0.3-0.5 cm.
7. X-rays of the lungs and radioisotope images of the bones of the skeleton can be used to detect metastases in nearby organs.

Treatment

Surgical removal of the tumor can be performed both with open abdominal surgery and laparoscopically (through small punctures in the anterior wall of the peritoneum).

The body of the adrenal gland and the lymph nodes closest to it may be subject to removal.

To stop the growth of pheochromocytoma, injections of a radioactive isotope are used, which ensure the death of tumor cells and metastasis.

In some cases, chemotherapy may be performed.

The decision on the choice of a method of fighting a tumor should be entrusted to endocrinologists practicing in endocrine surgery centers.

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