Depending on the localization of adrenal tumors is divided into 2 groups.
The first group includes tumor of the adrenal cortex (androsteroma, corticosteroma, kortikoestroma, adenoma, aldosteronoma and mixed forms).
The second group included tumors that are localized in the adrenal medulla (pheochromocytoma).In most cases, people are faced with a benign lesion, but over time a transition tumor malignancy.
Causes adrenal tumors
No underlying cause of tumors of the adrenal glands, and there are no data on the impact on the occurrence of the disease by environmental factors or a bad way of life.Not marked genetic predisposition.The cause of cancer of the adrenal glands may be the existence of a syndrome of multiple endocrine tumors.In this case basically diagnosed pituitary tumor, parathyroid and pancreas.
Symptoms of adrenal tumors
signs of adrenal tumors depend on the type of hormones synthesized by the tumor.A large tumor may be squeezed surrounding tissue.
Symptoms of adenomas include incr
- stretching of the skin on the abdomen, where the stretch marks are formed;
- weight gain as a result of fat deposits in the abdomen;
- menstrual dysfunction;
- intensive hair growth in women on the chest, face and back;
- development of depression;
- emergence of bone fragility resulting in the development of osteoporosis.
the presence of a tumor, synthesizing sex hormones , in children there is a rapid puberty and adults celebrated sexual dysfunction.In the case of the predominance of androgen increases the clitoris in girls, begin to grow hair on the male pattern.In case of increase of estrogen in boys begin to grow breasts.
If you have a tumor of the adrenal medulla (pheochromocytoma) in the blood periodically thrown adrenaline and noradrenaline, causing characteristic clinical picture: tachycardia, paroxysmal hypertension, vomiting, pain in the heart, shortness of breath, sweating, mood changes, headachespain, thirst, increased urination, fainting.The attack can be triggered by emotional or exercise overexertion.
diagnosis of cancer of the adrenal
for the diagnosis of cancer of the adrenal glands, in addition to carrying out routine laboratory investigations (the general, biochemistry of blood coagulation, urinalysis), provided the execution of tests aimed at to identify the increased production of hormones.
order to identify Cushing's syndrome is dexamethasone suppression test (1 mg) and is determined by the excretion of cortisol in the urine (24 h).If hyperaldosteronism estimated concentration and the ratio of aldosterone and renin;virilization - provides evaluation of serum levels of adrenal androgens (androstenedione, dehydroepiandrosterone sulfate) and testosterone, and 17-ketosteroids excretion in the urine (24 h);feminization - estimated plasma concentrations of estradiol and zstrona.To exclude pheochromocytoma necessary to estimate the daily urinary catecholamines (epinephrine, norepinephrine, dopamine) and their metabolites in urine (in particular, normetanephrine and metanephrine) and serum levels of catecholamines and metanephrine.
The radiological diagnosis include CT or MRI of the abdomen (estimated size and Syntopy primary tumor, metastases are detected), as well as X-ray or CT scan of the chest cavity to detect metastases.Radiological signs of adrenal cancer are tumor size greater than 4 cm, irregular shape, possessing a high density by CT than 20 HU, heterogeneous structure due to hemorrhages, calcifications and necrosis, as well as the invasion of surrounding structures.
the differential diagnosis of adrenal tumors is provided in neuroblastoma and nephroblastoma in children and hamartomas, teratomas, neurofibromatosis, amyloidosis and adrenal granulomas in adults.
treatment of cancer of the adrenal
In most cases, treatment for cancer of the adrenal glands is to remove the tumor surgically.
- When pheochromocytoma absolutely necessary to the operation, during it and after carefully monitor the effect of hormones produced by the adrenal tumor.
- To relieve symptoms and reduce the size of metastases in the body injected metayodbenzilguanidin (MIBG), is associated with pheochromocytoma MIBG for which further provides the ability to connect to a radioactive isotope.
- In the case of metastatic cancer of the adrenal gland has a moderate efficiency mitotane dose of 10-20 g / day.Provided a long course of treatment. If treatment is not brought results mitotanom mode is used, which are based on cisplatin (cisplatin, cyclophosphamide, 5-fluorouracil).
- the treatment of cancer of the adrenal important role belongs to the symptomatic treatment, aimed at to eliminate the symptoms of hormonal endocrine-active tumors.
- If you have Cushing's syndrome monotherapy or in various combinations using mitotane, mifepristone, ketoconazole, and etomidate.Indications for amiloride, spironolactone, triamterene and antihypertensive drugs is the presence of hyperaldosteronism.
- If hyperandrogenism made for the use of steroidal (cyproterone) and nonsteroidal (flutamide), antiandrogens, ketoconazole, spironolactone and cimetidine;hyperestrogenism - anti-oestrogens (clomiphene, tamoxifen, danazol).
- If adrenal insufficiency is necessary to conduct hormone replacement therapy.
- In the case of mixed carcinomas with pheochromocytoma component can be used metayodobenzilguanidina radioactive drugs.
- If increased blood pressure, including in pheochromocytoma, it is an indication to the fact that have been assigned an alpha-blocker followed by the use of beta-blockers (propranolol).