Adrenal Tumors

There are benign and malignant tumors of the adrenal gland arising from the cortex and medulla. Adenomas with increased secretion of glucocorticoids or aldosterone are localized in the adrenal cortex, and pheochromocytoma, which produces adrenaline and norepinephrine, is located in the medulla. Malignant tumors (corticosteroma, pheochromoblastoma, neuroblastoma), as well as adenomas, can be secreting or non-secreting.

In the diagnosis of adrenal tumors, along with a thorough medical history, biochemical and endocrinological studies, ultrasound and computed tomography, angiography are important. It is difficult to distinguish a benign tumor from a malignant one even with morphological analysis. In both variants, the tumor has a capsule.

Signs of malignancy: invasion of the capsule and blood vessels, large tumor size, perverted reaction to the dexamethasone test. Malignant tumors are prone to recurrence, metastases appear in the para-aortic lymph nodes, lungs, liver, and bones.

Adenoma and cancer of the adrenal cortex cause Cushing's syndrome. There is a high level of cortisol in the blood, and significant excretion of ketosteroids in the urine. In case of cancer, the tumor is large, the secretion of cortisol is slightly suppressed after taking dexamethasone.

Aldosteroma is a small tumor (less than 2 cm), manifested by potassium loss and sodium retention, increased blood pressure, thirst, polyuria, and muscle weakness. Malignant aldosteroma is rare and is usually larger than 3-4 cm.

Pheochromocytoma is manifested by increased blood pressure with severe crises and rapidly developing complications (retinopathy, cerebral hemorrhage, etc.). The level of adrenaline, norepinephrine in the blood and their metabolites in the urine is high. In 10-15% of cases, pheochromocytoma develops on both sides.

Treatment.

The main treatment method for patients with adrenal tumors is surgery. After removal of the secreting tumor, dynamic laboratory monitoring is necessary. Detection of a new increase in the level of hormones or other active substances helps in the early detection of tumor recurrence and timely reoperation.

For malignant corticosteroma, objective and symptomatic improvement is achieved by using o,p-DDD [1,1-dichlorochlorophenylethane 6-10 g/day, aminoglutethemide 500-1500 mg/day; Replacement therapy is carried out with cortisone acetate.