Signs of a malignant adrenal tumor. Adrenal tumors: what they are, causes, symptoms, diagnosis and treatment of adrenal cancer, prognosis. General symptoms of malignant tumors

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Adrenal tumors in most cases are benign neoplasms, which are a proliferation of the cellular structures of these organs. They differ from each other in their method of occurrence, structure and many other factors. The latter determine the nature of the symptoms of tumors in the adrenal glands in women.

The adrenal glands have a rather complex structure, consisting of outer, cortical, inner and medulla layers, and are part of the body’s endocrine system. The synthesis of hormones that provoke the occurrence of neoplasms occurs in the cortex of the organs. However, it has not yet been established exactly why such tumors appear.

Diagnosis of pathology involves the release of the main hormone that provoked the appearance of the disease in question. In cases of adrenal tumors, surgeons are usually involved in treatment, although in some cases (discussed below) doctors limit themselves to corrective hormone therapy.

As already mentioned, doctors are not yet able to identify the specific cause that provokes the onset of the disease. But they know exactly what symptoms and treatment are typical for the problem under consideration. The following patients are at risk for this pathology:

Having a congenital pathology in the structure and functioning of the organs of the endocrine system: the pituitary gland, pancreas and thyroid glands.
Persons whose immediate relatives suffered from a cancerous tumor that arose in the lungs or mammary gland.
With hereditary hypertension.
Having kidney or liver diseases.
Having previously had cancer of any other organs.
Injuries.
Chronic stress.
Arterial hypertension and more.

Diagnosis of the disease determines treatment. In order to facilitate the treatment of the disease in question, several classifications have been adopted in medical practice.

Adrenal tumors are usually divided depending on their location. It is formed from two parts of the organ:

Adrenal cortex. From it arise tumors such as androsteroma, aldosteroma, corticoestromy, corticosteroma, mixed.
Adrenal medulla. These include ganglioneuromas and pheochromocytomas.

The main difference between benign and malignant tumors is that cancer cells divide more actively and, accordingly, attack new tissues faster. The former, in turn, in most cases develop slowly. Moreover, benign tumors in the adrenal glands rarely show symptoms. Therefore, the diagnosis of such diseases is usually carried out as a preventive measure.

Even less commonly, people develop formations from neuroendocrine cells. They develop very slowly. However, at their core they are a type of malignant oncology.

In addition, the type of tumor in question is divided into:

Hormonal. They include such formations as:

pheochromocytes;
corticosteromas;
corticoestroma;
androsteromes;
aldosteromes

Non-hormonal. Characterized by a lack of hormonal activity. Benign formations occur in the form of myomas, fibroids and lipomas; malignant - pyrogenic cancer, teratoma and melanoma.

The classification of pathology is carried out depending on the tissues in which the tumors appeared:

In epithelial (adenoma, cortiestroma and others).
In the connective tissue (fibroma, lipoma, etc.).
In brain tissue (ganglioma, pheochromocytoma, neuroblastoma);
Combined, which simultaneously affected the tissues of the cortical and medulla layers (incidentaloma).

Another classification of the problem is determined depending on the pathology that it provokes:

Imbalance in water-salt and sodium metabolism.
Metabolic disorder.
The emergence of secondary male sexual characteristics in women, manifested in the form of active growth of body hair, deepening of the voice and change in gait.
A similar process occurs in men, manifesting itself in the form of increasing breast size, a decrease in the number of body hairs and a higher voice.
Combination of male sexual characteristics and metabolic disorders in women.

These consequences are caused only by hormonally active tumors, which will be discussed below.

Hormonally active formations

Aldosteroma, originating from the zona glomerulosa of the adrenal glands, produces the hormone of the same name. This neoplasm provokes the development of a disease such as Conn's syndrome. Aldosterone is responsible for regulating water-salt balance in the human body. Accordingly, the appearance of aldosteroma provokes its disruption. Formations of this kind are:

single (occurs in 70-90% of patients);
multiple (10-15% of patients).

Glucosteroma, or corticosteroma, develops from the zona fasciculata. It provokes the appearance of Itsenko-Cushing syndrome, which is characterized by the appearance of obesity, early puberty and other pathologies. It appears quite rarely and mainly affects young people.

Glucosteroma is mainly malignant in nature, and during its course a clear clinical picture arises.

Androsteroma arises from the reticular zone. It produces androgens, the number of which directly determines a person’s sexual development. In approximately 50% of patients diagnosed with androsteroma, it is malignant, metastasizing to the lungs, liver and lymph nodes located in the abdominal part. Most often, the tumor occurs in the female half of the population aged 20-40 years. However, androsteroma is a fairly rare phenomenon. It is detected only in 1-3% of cancer patients.

Pheochromocytoma is characterized by the development of vegetative crises. Basically, it is formed as a benign formation. Cancer cells develop in only 10% of patients aged 30-50 years. Also, in approximately 10% of cases, pheochromocytoma occurs as a hereditary factor.

Stages of development

The prognosis for the development of the disease directly depends on the current stage of its development:

At the first stage, the size of the formation does not exceed 5 mm. In this case, we are usually talking about a benign tumor that is asymptomatic. The problem is discovered accidentally during an examination of the gastrointestinal tract.
At the second stage, the tumor increases in size by more than 5 mm. At the same time, regional lymph nodes remain unchanged.
At the third stage, tumors appear, the diameter of which can reach 5 cm. In the latter case, we are talking about malignant formations that begin to metastasize to nearby tissues.
At the last stage, metastases penetrate to other organs.

If you have an adrenal tumor, symptoms manifest themselves in different ways. The clinical picture, as well as the diagnosis, depends on the type of specific formation affecting a given organ:

Due to a violation of mineral-sodium metabolism, aldosteroma provokes the following symptoms:

hypertension;
weakening of the muscles, as a result of which the limbs regularly spasm and are constrained by cramps;
increased pH level in the blood (alkalosis);
decreased calcium levels (hypokalemia).

Androsteroma.

Androsteroma is characterized by the following symptoms:

pseudohermaphroditism, which occurs in girls who have not reached puberty;
delay or complete cessation of menstruation in mature women, hirsutism, weight loss, infertility (due to shrinkage of the uterus), mammary gland dystrophy;
early sexual development in boys, the appearance of purulent rashes on the skin.

In the presence of androsteroma in adult men, the clinical picture is quite blurred. Therefore, diagnosing this disease will be difficult.

It provokes a sharp increase in the number of glucocorticoids in the body, resulting in the following manifestations:

earlier puberty (in both sexes);
rapid sexual decline in adult patients, obesity, arterial hypertension and hypertensive crises.

Corticosteroma is one of the most common types of adrenal tumors (occurs in approximately 80% of cases).

Due to the fact that pheochromocytoma develops from the adrenal brain tissue or cells of the neuroendocrine system, it provokes the onset of panic attacks. The latter appear with varying frequency and severity. The prognosis for recovery from pheochromocytoma is positive in most cases.

The main signs indicating the appearance of this tumor include:

causeless vomiting;
trembling in the limbs;
high pressure;
headache and attacks of dizziness;
increased sweating;
pale skin;
pain in the heart;
hyperthermia;
increased diuresis and more.

The course of pheochromocytoma requires special attention, since this pathology develops in three forms and is characterized by different signs:

Occurs in approximately 35-85% of patients. The paroxysmal form is characterized by the following symptoms:

sharp and very high arterial hypertension (pressure increases to 300 mm or more);
dizziness;
headache;
temperature increase.

An exacerbation of this form of the disease occurs with each palpation of the neoplasm, with physical exertion, urination, stress, and overeating. The crisis, as it appears, disappears suddenly, as a result of which the patient’s condition returns to normal. The frequency and duration of attacks varies, but not more than one hour.

This form is characterized by constant high blood pressure.

In the mixed form, crises occur against the background of constant hypertension.

In cases of severe pheochromocytoma, so-called catecholamine shock may occur. This condition is characterized by causeless and frequent changes in high and low blood pressure, hemodynamics that cannot be controlled. In approximately 10% of cases, catecholamine shock is diagnosed in children.

General symptoms

General symptoms common to most types of adrenal glands are divided into:

They appear as:

disturbances in nerve conduction in body tissues;
increased blood pressure, development of persistent hypertension;
nervous overexcitation;
panic caused by fear of death;
pain in the chest and abdominal cavity, of a pressing nature;
frequent urination.

Secondary.

Secondary symptoms are characterized by the appearance of the following pathologies:

renal dysfunction;
diabetes;
sexual dysfunction.

Diagnostics

Modern diagnosis of adrenal tumors allows not only to identify the presence of tumors, but also to establish their type and location. To determine these parameters, the following activities are carried out:

Laboratory examination of urine.

It allows you to determine the functional activity of the tumor. In a urine test, the doctor determines the level of:

aldosterone;
cortisol;
catecholamines;
vanillinmandelic acid;
homovanillic acid.

If during diagnostic procedures the doctor suspects that the patient being examined has developed pheochromocytoma, then urine is collected during the next attack or immediately after its end.

Before collection, the patient is prescribed Captropil or its analogues. A blood test is done to detect certain hormones produced by the tumor.

Blood pressure measurement.

It is performed only after the patient has taken medications that lower or increase blood pressure.

This method involves taking blood from the adrenal glands. Allows you to determine the hormonal picture. Phlebography is contraindicated in case of detection of pheochromocytoma.

Allows you to detect the presence of a tumor only if the size of the latter exceeds 1 cm.

Prescribed to determine the location of the tumor. At the same time, they make it possible to detect tumors measuring at least 0.3-0.5 mm.

X-ray of the lungs and radioisotope bone scan.

They are used to exclude/confirm the presence of metastases in these organs.

It is necessary to treat adrenal tumors based on the information obtained during diagnostic procedures. Basically, pathology therapy involves surgical intervention used for:

hormonally active neoplasms;
tumors larger than 3 cm;
formations with signs of malignancy.

In this case, operations are not prescribed if the following circumstances are identified:

The patient suffers from severe pathologies that prevent surgical intervention.
The patient was diagnosed with many cysts that metastasized to distant organs.
Patient's age.

Absolute indications for surgery include hormonally active neoplasms, the size of which does not exceed three centimeters, and malignant tumors. Often (especially for cancer treatment), chemotherapy is prescribed in addition to surgery. Treatment of pheochromocytoma is complemented by radioisotope therapy, during which a special drug (isotope) is injected intravenously, helping to reduce the size of the tumor and the number of metastases.

When removing tumors, two methods are used:

open, or strip operation;
laparoscopy, performed through small punctures made in the abdominal cavity.

During the operation, both the tumor and the affected adrenal gland are removed. If a malignant neoplasm is diagnosed, nearby lymph nodes are also excised.

Particularly difficult are operations to remove pheochromocytoma. Such activities can lead to severe cases of hemodynamic impairment. To exclude the occurrence of crises, various methods of preparing the patient are used. In particular, appropriate medications are prescribed and special anesthetic treatments are selected. If it was not possible to stop the crisis and catecholamine shock occurred during the procedure to remove the tumor, an emergency operation is prescribed, carried out according to the patient’s vital signs.

At the end of all activities, the patient is prescribed a course of hormones.

If surgery to remove the tumor is performed in a timely manner, the prognosis will be positive. If androsteroma is treated, some patients develop short stature.

Pheochromocytoma, even in the case of a positive outcome of surgical intervention, in approximately half of the cases provokes the onset of moderate tachycardia and hypertension. Both conditions are amenable to drug therapy.

Aldesteroma in approximately 30% provokes the development of moderate hypertension. As in the previous case, the patient is prescribed appropriate medications to maintain the body in a normal state.

Recovery after surgery for corticosteromas is observed after 1.5-2 months. By this time, the main symptoms characteristic of this pathology begin to disappear: body weight and blood pressure normalize, hirsutism decreases, and so on.

In the case of the formation of malignant tumors of the adrenal glands, especially if they have begun to metastasize, the prognosis will be extremely unfavorable.

Prevention

Preventive measures are aimed at eliminating the possibility of relapse of the pathology. At the same time, achieving this goal is quite difficult, since the true reasons that provoke the development of adrenal tumors have not been established.

If the formation has not begun to metastasize, then the patients’ vital functions are restored: previous fertility indicators and other things return. After surgery, patients are recommended to:

exclude the use of sleeping pills and alcohol;
monitor your nervous and physical condition, avoiding overexertion;
follow a diet, limiting the consumption of fatty and spicy foods.

It is also necessary to visit an endocrinologist every six months in order to correct restorative therapy and prevent relapses. If any problems arise, you should consult your doctor promptly.

Stages of the oncological process

Oncologists classify formations into 4 stages:

Tumors smaller than 5 centimeters. The process does not affect other organs, regional lymph nodes are not enlarged.
New growths are larger than 5 centimeters, otherwise similar to the first stage.
Formations of any size that have metastases to the paracaval and para-aortic lymph nodes or invade surrounding tissues.
Tumors accompanied by involvement of other organs and lymph nodes, possibly with distant metastases.

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Hormonally active neoplasms

Aldosteroma

It releases aldosterone, and therefore causes mineral-salt imbalance. Also, hyperproduction of the hormone contributes to increased blood pressure, resistant to antihypertensive therapy, alkalosis, decreased blood sugar levels, and muscle atrophy. With a sharp release of aldosterone, a crisis occurs, which is characterized by vomiting, tachypnea, headache, and visual disturbances. More often, in 96% of cases, the tumor has a benign course with a single focus. Diagnostics reveals hypokalemia.

Glucosteroma or corticosteroma

The product of this tumor is a glucocorticoid. Symptoms of the neoplasm are early puberty in children or decreased libido in adults, increased blood pressure, weight gain, Itsenko-Cushing syndrome, weakness, and rapid fatigue. This is the most common pathology of the cortex. Such patients often experience depression and neurosis.

Corticoesteroma

The secret of the neoplasm is estrogens, which leads to disorder of sexual function, atrophy of the genital organs, hypospermia, and the appearance of compaction in the mammary glands in men. In women, the pathology leads to changes in hormonal levels according to the male type, and in girls, to an acceleration of the development of sexual characteristics. Basically, the tumor is malignant and grows rapidly. It occurs more often in young guys.

Androsteroma

Oncopathology releases androgen in large volumes, which is why men experience rapid puberty, but sometimes the process does not reveal itself. The female sex is characterized by masculinization, hypotrophy of the breasts and uterus, or pseudohermaphroditism in children. In more than 50% of cases, the formation has a malignant course, characterized by early metastasis to the liver and lymph nodes. More often diagnosed in young women.

Pheochromocytoma

90% of tumors are benign; there is a genetic predisposition, more pronounced than with other neoplasms. Mainly affects women 30-50 years old. There are three types of flow:

Constant - stable hypertension.
Paroxysmal - characterized by sharp rises in blood pressure. A surge in pressure is accompanied by tachycardia, headache, tremor, anxiety, and hyperthermia. Symptoms are present for a couple of hours and suddenly go away.
Mixed - hypertension combined with crises.

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Causes of the disease

The etiology remains completely unexplored; the main theory is that heredity is the main factor in the occurrence of neoplasms. But, although the causes of the pathology have not been fully identified, a number of circumstances have been identified that support the development of the tumor process:

The causes of adrenal tumors include stress, bad habits, trauma, and genetics.

cases of such diseases in the family - most of the formations arise on the basis of genetic predisposition;
bad habits - smoking, drinking alcohol and fast food, food with carcinogens;
age range - children and patients aged 40-50 years are more susceptible to the disease;
multiple endocrine oncological processes;
prolonged stress;
hypertonic disease;
disorders of the endocrine organ system;
injuries.

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Symptoms of manifestation

Symptoms for adrenal tumors can vary depending on the structure and hormonal activity of the tumor. Malignant tumors manifest themselves as weight loss, pain in different locations, and digestive disorders. Hormonal symptoms of formations include weight gain, weakness, and decreased mood. However, each tumor on the adrenal gland will have its own distinctive features depending on the hormone produced. All common signs of oncological pathology are divided into primary and secondary.

disruption of nerve impulse transmission in muscles;
attacks of hypertension or persistently elevated blood pressure;
anxiety;
phobia of death;
pressing pain in the chest and epigastrium;
frequent urination.

sexual dysfunction;
kidney dysfunction;
diabetes.

Complications

Pheochromocytoma may be accompanied by catecholamine shock. Its symptoms are similar to a crisis, but in addition to this, uncontrolled surges in pressure occur that are resistant to therapy. The complication is more typical for children, occurring in 10% of patients. The course of benign formations is aggravated by malignancy or malignancy. A malignant neoplasm on the adrenal gland is prone to metastases, mainly through the blood, due to the large number of vessels with thin walls in the formation itself and suppression of the immune system. Therefore, the oncological process spreads to the liver, uterus, lungs, and bones.

Another possibility of spread is through lymph flow. The regional lymph nodes for the organ are located behind the aorta at the level of the 11th–12th thoracic vertebra. The lymph nodes of the left adrenal gland are located at the level of the vessels of the ovaries (testicles), therefore, if affected, there is a higher risk that an ovarian tumor will subsequently occur. A tumor of the right adrenal gland affects the lymph nodes near the renal vessels, that is, a kidney tumor is often among the complications.

Diagnostics

The following methods are used to detect adrenal gland formation:

On ultrasound, the tumor is detected as a hypoechoic formation. However, the organ is inconveniently localized for this method, so the size of the formation must be more than 1 cm in order for it to be detected.
CT is one of the main and most accurate research methods, the invention of which belongs to Henry Hounsfield. The native density of the lesion found is important for the doctor - only by this indicator can one assume that the patient has a cyst, angiomyolipoma or myelolipoma of the adrenal gland.
MRI diagnostics can even detect a tumor of the medial adrenal peduncle: a hypodense formation with clear edges; hypodense areas may be observed in the center.
X-ray of the lungs, radioisotope study of bones - to exclude metastases.
A urine test to determine the level of a hormone that interests the therapist based on the course of the patient’s disease. If pheochromocytoma is suspected, the procedure is performed during or after a pressure surge.
When performing phlebography, blood is taken for hormonal tests from the vessels of the adrenal glands. This diagnostic method is prohibited for pheochromocytoma due to a possible increase in blood pressure.
If the testosterone norm is exceeded several times, this indicates a tumor of the ovaries or adrenal glands.
A biopsy is used to study a solid formation, its structure and finally determine the diagnosis.

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Treatment of pathology

Identified adrenal tumors are an indication for surgical intervention. This is the only radical type of therapy, regardless of the type of cancer process. Space-occupying lesions should still be treated surgically. The operation is prohibited for patients with serious chronic diseases and distant metastasis. Removal of an adrenal tumor is performed under endotracheal anesthesia. Treatment at the postoperative stage includes prevention of deficiency, hormonal therapy, normalization of water and electrolyte balance and disturbances of mineral homeostasis. Chemotherapy is used for advanced processes or the subsequent occurrence of metastases after surgery. Radiation therapy is used only as a palliative method.

Disease prognosis

The prognosis is much better with a benign course of the process. In this case, timely surgery promotes recovery, but complications still appear. After removal of an adrenal tumor in children, they slow down in growth or, if a pheochromocytoma is excised, within six months, in such patients, cardiac dysfunction is first detected.

Treatment of malignant tumors is less effective - the symptoms do not go away in a couple of months, as in the first case, especially if metastases have developed, and the prognosis is much worse.

Preventive actions

The etiology of formation in the adrenal glands still remains unknown, therefore at the preventive stage one should concentrate on preventing relapses and the most likely complications. Patients are recommended to visit an endocrinologist every six months, who changes treatment based on the results of diagnostic procedures and the patients’ well-being. Doctors advise patients after surgery to avoid exercise and stress, and stop using sleeping pills and alcoholic beverages.

Adrenal tumors

Adrenal tumors

Adrenal tumors– benign or malignant focal growths of adrenal cells. They can originate from the cortical or medulla layers and have different histological, morphological structures and clinical manifestations. More often they manifest themselves paroxysmally in the form of adrenal crises: muscle tremors, increased blood pressure, tachycardia, agitation, a feeling of fear of death, pain in the abdomen and chest, copious discharge of urine. In the future, it is possible to develop diabetes mellitus, kidney problems, and sexual dysfunction. Treatment is always surgical.

The adrenal glands are endocrine glands complex in histological structure and hormonal function, formed by two morphologically and embryologically different layers - the outer, cortical and inner, medulla.

The adrenal cortex synthesizes various steroid hormones:

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

The inner medulla layer 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 adrenal tumors, endocrine pathology is determined by damage to one or another layer of glands and the peculiarities of the action of the excessively secreted hormone.

Classification of adrenal tumors

Based on their location, adrenal tumors are divided into two large groups, 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 chromaffin or nervous tissue arise from the inner medulla of the adrenal glands: pheochromocytoma (develops more often) and ganglioneuroma. Adrenal tumors arising from the medulla and cortex can be benign or malignant.

Benign tumors of the adrenal glands are usually small in size, without pronounced clinical manifestations and are random findings during examination. With malignant tumors of the adrenal glands, a rapid increase in the size of the tumors and pronounced symptoms of intoxication are observed. There are primary malignant tumors of the adrenal glands, arising from the organ’s own elements, and secondary ones, metastasizing from other locations.

In addition, primary adrenal tumors can be hormonally inactive (incidentalomas or “clinically silent” tumors) or overproducing any adrenal hormone, i.e., hormonally active. Hormonally inactive tumors of the adrenal glands are often benign (lipoma, fibroma, fibroids), develop with equal frequency in women and men of any age group, and usually accompany the course of obesity, hypertension, and diabetes mellitus. Malignant hormonally inactive adrenal tumors (melanoma, teratoma, pyrogenic cancer) are less common.

Hormonally active tumors of the adrenal cortex are aldosteroma, androsteroma, corticoestroma and corticosteroma; medulla - pheochromocytoma. According to pathophysiological criteria, adrenal tumors are divided into:

causing disturbances in water-salt metabolism - aldosteromas;
causing metabolic disorders - corticosteromas;
neoplasms that have a masculinizing effect - androsteromes;
neoplasms that have a feminizing effect - corticoestroma;
neoplasms with mixed metabolic-virile symptoms - corticoandrosteromas.

Hormone-secreting adrenal tumors are of greatest clinical importance.

Hormone-active adrenal tumors

Aldosteroma is an aldosterone-producing adrenal tumor arising from the zona glomerulosa cortex and causing 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 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.

Glucosteroma (corticosteroma) is a glucocorticoid-producing tumor of the adrenal gland, emanating from the zona fasciculata of the cortex and causing the development of Itsenko-Cushing syndrome (obesity, arterial hypertension, early puberty in children and early decline of sexual function in adults). Corticosteromas can have a benign course (adenomas) and a malignant course (adenocarcinomas, corticoblastomas). Corticosteromas are the most common tumors of the adrenal cortex.

Corticoesteroma is an estrogen-producing tumor of the adrenal gland, emanating from the zona fasciculata and reticularis of the cortex and causing the development of estrogen-genital syndrome (feminization and sexual weakness in men). It develops rarely, usually in young men, and is often malignant in nature and has pronounced expansive growth.

Androsteroma is an androgen-producing tumor of the adrenal glands, originating from the reticular zone of the cortex or ectopic adrenal tissue (retroperitoneal fatty tissue, ovaries, broad ligament of the uterus, spermatic cords, etc.) and causing the development of androgen-genital syndrome (early puberty in boys, pseudohermaphroditism in girls , symptoms of virilization in women). In half of the cases, androsteromas are malignant, metastasizing 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.

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

Symptoms of adrenal tumors

Aldosteromas manifest themselves in three groups of symptoms: cardiovascular, renal and neuromuscular. Persistent arterial hypertension that is not amenable to antihypertensive therapy, headaches, shortness of breath, heart failure, hypertrophy, and then myocardial dystrophy are noted. Persistent hypertension leads to changes in the fundus of the eye (from vasospasm to retinopathy, hemorrhages, degenerative changes and papilledema).

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

Neuromuscular manifestations of aldosteroma: muscle weakness of varying severity, paresthesia and convulsions are caused by 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.

The clinical picture of corticosteroma corresponds to the manifestations of hypercortisolism (Itsenko-Cushing syndrome). Cushingoid type obesity, hypertension, headache, increased muscle weakness and fatigue, steroid diabetes, and sexual dysfunction develop. Striae and petechial hemorrhages appear on the abdomen, mammary glands, and inner thighs. Men develop signs of feminization - gynecomastia, testicular hypoplasia, decreased potency; In women, on the contrary, there are signs of virilization - male type of hair growth, deepening of the voice, hypertrophy of the clitoris.

Developing osteoporosis causes compression fractures of the vertebral bodies. A quarter of patients with this adrenal tumor have pyelonephritis and urolithiasis. Mental dysfunction is often observed: depression or agitation.

Manifestations of corticoesteroma in girls are associated with accelerated 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 delayed 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 adrenal tumor does not manifest itself symptomatically and is only accompanied by an increase in the concentration of estrogen in the blood. Purely feminizing adrenal tumors are quite rare; more often they are of a mixed nature.

Androsteromas, characterized by excessive production of androgens by tumor cells (testosterone, androstenedione, dehydroepiandrosterone, etc.), cause the development of anabolic and virile syndromes. With androsteroma in children, accelerated physical and sexual development is observed - rapid growth and muscle development, deepening of the timbre of the voice, the appearance of acne on the torso and face. With the development of androsteroma in women, signs of virilization appear - cessation of menstruation, hirsutism, decreased voice, hypotrophy of the uterus and mammary glands, clitoral hypertrophy, reduction of the subcutaneous fat layer, increased libido. In men, the 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 hypercortisolism.

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

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

Adrenal tumors that occur without symptoms of hyperaldosteronism, hypercortisolism, feminization or virilization, or vegetative crises develop asymptomatically. As a rule, they are detected incidentally during an MRI, CT scan of the kidneys, or ultrasound of the abdominal cavity and retroperitoneal space performed for other diseases.

Complications of adrenal tumors

Among the complications of benign adrenal tumors is their malignancy. Malignant tumors of the adrenal glands metastasize to the lungs, liver, and bones.

In severe cases, pheochromocytoma crisis is complicated by catecholamine shock - uncontrolled hemodynamics, erratic changes in high and low blood pressure levels that are not amenable to conservative therapy. Catecholamine shock develops in 10% of cases, more often in pediatric patients.

Diagnosis of adrenal tumors

Modern endocrinology has diagnostic methods that not only make it possible to diagnose adrenal tumors, but also to establish their type and location. 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 is suspected and blood pressure rises in crisis, urine and blood are taken for catecholamines immediately after an attack or during it. Special tests for adrenal tumors involve 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 venography - radiopaque catheterization of the adrenal veins, followed by blood sampling and determination of hormone levels in it. The study is contraindicated for pheochromocytoma, as it may provoke the development of a crisis. The size and location of the adrenal tumor and the presence of distant metastases are assessed based on 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 adrenal tumors, 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 monitoring of the development of an adrenal tumor is possible. Surgeries for adrenal tumors are performed through open or laparoscopic access. The entire affected adrenal gland must be removed (adrenalectomy—removal of the adrenal gland), and in the case of a malignant tumor, the adrenal gland along with nearby lymph nodes.

Surgeries for pheochromocytoma are the most difficult due to the high likelihood 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. Pheochromocytomas are also treated with intravenous administration of a radioactive isotope, which causes a reduction 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, emergency surgery is indicated for life-saving reasons. After surgical removal of the tumor along with the adrenal gland, the endocrinologist prescribes constant replacement therapy with adrenal hormones.

Prognosis for adrenal tumors

Timely removal of benign adrenal tumors is accompanied by a favorable prognosis for life. However, after androsteroma removal, patients often experience short stature. Half of the patients who underwent surgery for pheochromocytoma still have moderate tachycardia and hypertension (permanent or transient), which can be corrected with medication. When the aldosteroma is removed, blood pressure returns to normal in 70% of patients; in 30% of cases, moderate hypertension remains, responding well to antihypertensive therapy.

After removal of a benign corticosteroma, regression of symptoms is noted within 1.5-2 months: the patient’s appearance changes, blood pressure and metabolic processes return to normal, stretch marks fade, 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 have an extremely unfavorable prognosis.

Prevention for adrenal tumors

Since the causes of the development of adrenal tumors have not been fully established, prevention comes down to preventing recurrences of removed tumors and possible complications. After adrenalectomy, control examinations of patients by an endocrinologist are necessary once every 6 months. with subsequent adjustment of therapy depending on well-being and research results.

For patients after adrenalectomy for adrenal tumors, physical and mental stress, the use of sleeping pills and alcohol are contraindicated.

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An adrenal tumor is a serious pathology; the symptoms in women are acute and manifest as disruptions in the functioning of all body systems. The insidiousness of the disease is that it disguises itself as others and because of this it 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, and regulate all processes in the human body. They participate in water-salt, protein, and carbohydrate metabolism, determine the development of sexual characteristics, and promote the synthesis of adrenaline and norepinephrine. Organs have two layers: internal (brain) and cortical (external).

Various organs interfere with the functioning of such important organs. tumors- neoplasms that appear within the boundaries of one or both adrenal glands are diagnosed in every fifth person.

Classification of tumors

Adrenal tumors in women vary in location, method of formation, nature and hormonal activity.

According to the nature of the neoplasm there are:

benign;
malignant.

Benign ones are small in size and lack symptoms (fibroids, fibroids, lipomas). Malignant ones are characterized by rapid development and pronounced manifestations. Malignant ones include: teratoma, melanoma, pyrogenic cancer.

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

Depending on the location where the tumor formed, there are:

Cortical tumors.
Brain tumors.

In the adrenal cortex:

Corticosteroma.
Androsteroma.
Aldosteroma.

In the medulla:

Ganglioneuroma.
Pheochromocytoma.

Based on 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 formations have four stages of development:

The tumor is less than 0.5 cm and has no symptoms. It is discovered accidentally during an ultrasound.
The formation grows more than 1 cm and does not affect other organs.
The tumor increases in size and becomes more than 5 cm. The patient develops symptoms of intoxication. Metastases occur in nearby lymph nodes.
The formation grows, metastases affect distant organs. Most often the lungs and spinal cord. At this stage, the tumor is considered inoperable.

May 1, 2017 Doctor

A neoplasm such as an adrenal tumor can be benign or malignant. They are formed from different cells of the organ and can have different symptoms. Most often, manifestations are paroxysmal and represent an adrenal crisis. Possible renal dysfunction and hormonal changes. Surgical methods are mainly used for treatment.

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 disruption of its functions always quickly affects the state of the body and overall well-being.

Hormones produced in the adrenal glands:

Mineralocorticoids, which regulate water-mineral metabolism.
Glucocorticoids that ensure 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, when tumors develop, symptoms and manifestations depend on which part of the organ is affected.

Classification of tumors

This pathology is classified depending on the symptoms:

by localization - formed from the adrenal medulla or the organ cortex;
according to activity – hormone-producing and hormonally inactive;
by nature – benign and malignant.

Classification by location 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 can be malignant or benign. The latter, as a rule, are small in size and do not bother patients. They are discovered by chance during a kidney test for some other reason. Adrenal cancer is characterized by rapid growth and severe symptoms.

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

Hormone-producing tumors

Each type of hormone-producing tumors has its own characteristics and manifestations related to the zone from which they originate.

Types of tumors that produce hormones:

Aldosteroma;
Corticosteroma;
Corticoestroma;
Androsteroma;
Pheochromocytoma.

Aldosteroma is a neoplasm in the zona glomerulosa 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. The concentration of potassium in the body increases, the blood becomes alkalized, hypertension is observed, and muscle tone decreases.

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

Corticoestroma produces estrogens and is formed in the zona reticularis and zona fasciculata of the adrenal cortex. Estrogens are female sex hormones, so their excess leads to increased female sexual characteristics - feminization. Corticoestroma occurs quite rarely, mainly in young men. This tumor is in most cases 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 and the appearance of signs of masculinity in girls and women. Androsteroma occurs most often 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 is benign in most cases. It is accompanied by vegetative crises, as it comes from chromaffin cells in the brain tissue and produces catecholamines.

Symptoms and manifestations

A tumor of the adrenal gland gives a very diverse clinical picture, since the symptoms are related to the structure of the tumor, its location 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 in health;
Decreased performance;
Emotional lability;
Dysfunction 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;
Sexual disorders.

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

Symptoms of androsteroma in women

Reduction of subcutaneous fat layer;
Increased muscle mass;
Increased body hair growth;
Lowering the timbre of the voice;
Possible reduction or atrophy of the mammary glands;
Menstrual irregularities.

With corticoestroma, there is an increase in the concentration of female sex hormones. Young men, whose bodies undergo female-type changes, are more susceptible to this disease. Symptoms in men appear to varying degrees, which is associated with the amount of estrogen secreted by the tumor.

Symptoms of corticoestroma

Enlargement of the mammary glands;
Increase in subcutaneous fat layer;
Raising the timbre of the voice;
Stopping facial hair growth;
Decreased or even loss of potency.

Diagnosis and treatment

If an adrenal tumor is suspected, it is necessary to undergo diagnostic procedures that will make it possible to identify the tumor and determine its nature, as well as assess the danger to the patient.

Diagnostic measures

Taking anamnesis;
Computed tomography, including the use of contrast;
Scintigraphy;
Positron emission tomography;

Not all patients require a full range of diagnostic procedures. Which ones are necessary is decided by the attending physician in each specific case. In addition to the above studies, it is necessary to perform a 24-hour urine test for metanephrines and cortisol, and 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 malignancy. Neoplasms that do not cause concern and are no more than 3 cm in size require dynamic monitoring. In other cases, treatment is mainly surgical.

Indications for surgical treatment

Tumor size more than 3 cm;
Hormonal activity;
Malignant nature.

The operation involves removing the entire affected adrenal gland. If you have cancer, it may also be necessary to remove nearby lymph nodes. In some cases, chemotherapy is effective. Courses of chemotherapy and radiation therapy are carried out after removal of malignant tumors to destroy remaining cancer cells and prevent relapse and metastasis.

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

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

Adrenal tumors represent pathological uncontrolled growth of endocrine gland cells. The growth process is either benign or malignant. The disease is dangerous and not easy to diagnose, as it is located in a hard-to-reach area of the body and is small in size.

Causes of adrenal tumors

There may be several causes of the disease:

genetic, hereditary program inherited from parents with chromosomes;
body burn resulting in disruption of the vital functions of internal organs;
being in a stressful state for a long period of time;
poor nutritional status;
penetration of pathogenic microbes into the circulatory system;
increased growth of defective bone marrow cells;
exposure to toxic substances on the body;
radiation therapy in the treatment of cancer;
internal purulent inflammatory process.

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

Provoking factors for the occurrence of the disease

The adrenal glands consist of a cortex and medulla (outer and inner layers). Adrenal tumors can appear in any of these layers, but the appearance of the tumors is different. The development of the disease depends on the extent and location of new formations. The most dangerous is a tumor, which entails disruption of the activity of biologically active substances that affect the psychological and physical state of health. Many factors can provoke cell proliferation, among them the following are most clearly highlighted:

congenital changes in the system of regulation of the functions of internal organs with the help of hormones (lower medullary appendage of the pituitary gland, secretory glands);
close relationship with people who have 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 illnesses.

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

Symptoms of the disease

It is difficult to detect symptoms of the development of benign tumors. They are asymptomatic. Malignant neoplasms give external manifestations in the form of:

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

Symptoms in women are accompanied by the uncharacteristic appearance of facial hair, disruption of the monthly cycle, sometimes its complete cessation, and suppression of sexual desire. In men, in addition to loss of desire, dysfunction occurs. People with a tumor change the timbre of their voice, experience panic attacks, and become overexcited.

Tumors in the form of adrenal myelolipoma consist of adipose tissue and resemble bone marrow - not malignant. Adrenal pheochromocytoma is an oncological disease. But a benign tumor or cancer of the adrenal gland is accompanied by the production of hormones that have the greatest effect on blood pressure and stress reactions. The affected medulla of the organ becomes the source of various 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 sweat is released profusely, loss of consciousness and weak urine discharge may occur. The danger of the condition lies in the consequences in the form of hemorrhages in the brain. An adrenal tumor can in some cases be palpated through the abdominal cavity.

The choice of treatment, which gives real hope for victory over the disease and a successful outcome, depends on the correct determination of the degree of cancer. For example, in Germany, based on improved techniques, it is possible to practically defeat cancer in the initial stage. As cancer progresses to other stages, special restraining therapy is used, thanks to which patients return to a tolerable threshold of life.

Classification of adrenal tumors

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 affects the lymph nodes, which 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 the development of an ovarian tumor. Modern pediatrics has to diagnose adrenal tumors in children.

The medical literature outlines the classification of malignant neoplasms by type according to the histogenetic principle:

disrupting metabolic processes - corticosteromas;
the appearance of signs of the second sex - androsteromas;
disturbing the water-salt balance in the body - aldosteromes;
combining andosterome and corticosterome features - corticoandosteromas;
developing in children – neuroblastomas;
affecting the adrenal medulla - pheochromocytomas;
the generally established type is carcinoma.

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

Stage I – tumor size does not exceed 5 cm;
Stage II – tumor larger than 5 cm, but without invasion;
Stage III – tumors of various sizes with local invasion without penetration into neighboring organs;
Stage IV – tumors have invaded 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 T – tumor, N – nodes (lymphatic), M – movement. In general, the TNM formula denotes a tumor of any size with or without metastases, with or without invasion of other organs. Numbers from 0 to 4 indicate the degree of organ damage and tumor spread. At the end of the formula the name of the diseased body is indicated.

In addition to these TNM formulas, the diagnostic basis (an encrypted explanation) is indicated to confirm the validity of the diagnosis. For example, a record of type C4 T1N1M0 means stage 1 of tumor development and penetration of metastases into the lymph nodes, and the conclusion is based on data from studying the pathology of objects obtained surgically. This diagnosis is trustworthy and considered final.

The final diagnosis is important when prescribing subsequent treatment:

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

Each type of neoplasm can be noncancerous or cancerous.

Diagnostics

A patient suspected of having an adrenal tumor is given a medical examination using all possible methods. Of the visual inspection methods, reliable, achievable and inexpensive is ultrasonography. CT scan allows us to draw conclusions about the structure of a given tumor. Data MRI complement the patient examination process.

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 and metanephrines;
blood for adrenocorticotropic hormone.

In each individual case, the choice of a specific examination technique 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 gentle.

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

Treatment of an adrenal tumor begins after a thorough examination of the condition of the body and the development of the formation. Benign new adrenal tissue does not require treatment or any invasion. Finely focal neoplasms that do not produce hormones require only regular examination, repeated over a certain period of time. As a rule, such tumors have a favorable prognosis.

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

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

Drug treatment

The most common method of treatment and preventive measures is drug therapy. With the help of medications, the hormonal secretion of newly formed cells is regulated and their growth is inhibited. Drugs are prescribed in cases where it is impossible to operate on adrenal glands with metastases, as well as when the oncological tumor has been partially removed. Recognized as the main medicine Mitotane, which can be combined with chemotherapy procedures. The medicine is capable of destroying cancer formations. Other remedies are also prescribed ( Hydrocortisone, Prednisolone, Dexamethasone).

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

Radioisotope therapy and drug treatment require regular monitoring of the blood condition regarding indications of the presence of hormones.

Common chemicals to help a patient in the late stages of tumor treatment:

Cisplatin;
Doxorubicin;
Etoposide;
streptozocin;
Vincristine.

Chemical therapy gives a 35% chance of successfully completing treatment.

Surgery

Adrenal cancer is a serious medical finding; in such a situation, surgical intervention is required. The operation is carried out in a specialized medical center. The existing competence in this surgical field is important.

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

Treatment methods at home

Our body works smoothly and normally when the activity of internal organs is regulated. This 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. In both cases, the body needs help. 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, and select the right products. The concept of proper nutrition means consumption vegetables, fruits. The balance of proteins, carbohydrates and fats should combine lean fish and meats, dairy products and food greens.

Fatty and fried foods are allowed in minimal quantities. Dried fruits, legumes and nuts should be treated with great caution 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 natural gifts, citrus fruits, apples, garden berries and rose hips will be necessary in the diet. In addition, we should not forget about wheat products with the addition of bran and beef liver.

Traditional medicine recipes

Traditional medicine recipes contain various herbal preparations that help normalize hormonal levels and improve people’s well-being. An example of such a collection:

take horsetail herb - 50 g,
nettle and knotweed herbs - 100g each,
annual plant called common pikulnik – 75 g,
add dry Icelandic moss - 40 g.

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

Important! The broth should be fresh every day.

Recipes made from affordable blackcurrants are noteworthy. The aromatic berry has a special effect on the human body. Leaves in the form of a decoction and juice from berries are equally useful. Regular consumption of black currant as a food product improves the activity of the endocrine glands and relieves painful symptoms.

For currant broth:

For 400 ml of boiling water, take 20 g of dried leaves and infuse for 3 hours;
Drink the strained decoction 100 ml after meals 4 times a day.

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

Forecast

Timely treatment of adrenal tumors results in a favorable life prognosis in the future. However, one must be prepared for the fact that adrenal cancer will bring a lot of suffering to the patient.

In patients who have surgically removed pheochromocytoma, tachycardia remains, persistent hypertension remains, requiring drug correction, 70% of patients who have had aldosteromas removed live with normal blood pressure, in the other 30% of cases hypertension is observed, which responds well to drug therapy.

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

blood pressure normalizes;
positive changes occur in appearance;
reproductive function returns to normal;
insulin levels are normalized;
the person's body weight decreases.

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

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With an adrenal tumor, symptoms in women may differ from the male clinical picture, especially if the tumor 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, which produce hormones. Adrenal tumors lead to hormonal imbalance, which leads to malfunctions of various body systems.
The adrenal glands consist of four layers: outer, cortical, inner and medulla, but only in the cortex and medulla does the synthesis of hormones occur:

The cortex produces:

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

The medulla produces hormones that transmit nerve impulses and influence metabolic processes, being neurotransmitters:

dopamine;
norepinephrine;
adrenalin.

That is why, when a tumor develops in one or another layer of the endocrine gland, a wide variety of symptoms can occur. Tumors, especially hormonally active ones, often cause sexual dysfunction, lead to obesity, diabetes mellitus and hypertension. Neoplasms are more common in women and occur at older than average ages, but they also occur in children.

Causes

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

Smoking and alcoholism;
Unhealthy diet (fast food, food with carcinogens);
Pituitary tumors;
Constant stress;
Injuries;
Hypertension;
Endocrine disorders.

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

Classification

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

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

Based on location, there are only two types of tumors:

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

All tumors can develop from different tissues. Adenomas and corticoestromas 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 brain tissue cells and the cortex. Such tumors are combined, including incidentoloma.

Depending on the hormone produced, the tumor may be:

disrupting sodium metabolism and leading to water-electrolyte imbalance;
disrupting material exchange processes;
leading to secondary male sexual characteristics in female patients;
leading to secondary sexual characteristics of the female type in men;
combining general 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 produce 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, to one degree or another, contribute to the production of hormones of the layer in which they were formed. Benign ones include: fibroids, lipomas, fibromas. Malignant ones are: teratoma, melanoma, pyrogenic cancer.

Aldosteroma

The neoplasm is expressed in an increased amount of aldosterone. Aldosteromas develop in the zona glomerulosa cortex and lead to the appearance of Crohn's syndrome (primary aldosteronism). When the level of this hormone in the body is high, blood pressure drops, muscle weakness occurs, potassium levels in the blood drop, and alkali increases in the blood and tissues. The malignant type of aldosterome occurs in two to 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 zona fasciculata of the cortex and lead to. The main symptoms of this syndrome:

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

Corticosteroma can be a benign adenoma or a malignant adenocarcinoma or corticoblastoma. This type of adrenal tumor, which is localized in the cortex, is the most common.

Corticoesteroma

Corticoetheroma originates from the adrenal cortex, namely the zona reticularis and zona fasciculata, and promotes 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 occurs more often in young men.

Androsteroma

Androsteroma leads to the production of androgens and is formed in the retinal cortex or in the ectonic tissue of the adrenal gland. This tissue is found in the fatty tissue of the retroperitoneum, broad uterine ligament, ovaries, and 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 androsteres are benign, the other half are malignant. The tumor can metastasize to the retroperitoneum, liver, lungs, and most often affects women from twenty to forty years of age. This type of tumor 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, formation occurs from neuroendocrine cells. These are tumors that manifest themselves in the form of disturbances in the functioning of the autonomic nervous and vascular systems. Autonomic crises develop against the background of compression of nerve networks. 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 years are more susceptible to the disease. In ten percent of cases, the pathology is hereditary.

Stages of development

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

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

The earlier the pathology is identified, the greater the chance that it will not cause 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. Children with such a tumor experience early puberty, rapid physical development, early coarsening of the voice, and acne appearing on the face and body. Women experience muscle development, the mammary glands, clitoris and uterus atrophy, and amenorrhea occurs.
Corticoestroma in males manifests itself in signs of feminization. Atrophy of the testicles and penis occurs, the mammary glands begin to enlarge (gynecomastia), facial hair growth stops, and sexual function suffers. In female patients with such a tumor, symptoms are practically absent, only occasionally estrogen levels may increase. If a neoplasm occurs in a boy, then puberty is delayed; in girls, on the contrary, sexual and physical development occurs too intensively.
Symptoms of corticosteroma manifest themselves in signs of hypercortisolism (Itsenko-Cushing syndrome). Such patients become obese, have headaches, and develop constant hypertension. The patient gets tired quickly, his muscle tone is weakened, and men suffer from erectile dysfunction. A mandatory sign of corticosteroma is steroid diabetes.

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

With aldosteroma, there is a rapid pulse and increased blood pressure, which cannot be treated and causes visual disturbances. Heart rhythm disturbances, headaches, hypertrophic and later dystrophic changes in the myocardium occur. Kidney symptoms also appear - extreme thirst, frequent urination, an increase in the daily amount of urine excreted, which becomes alkaline. Convulsions, paresthesia and muscle weakness are no exception.
Pheochromocytoma has dangerous hemodynamics. During this, an adrenaline crisis may occur - blood pressure rises, headaches and dizziness occur, sweating increases, pallor, palpitations and chest pain occur. A person’s body temperature rises, trembling and causeless vomiting occur, and panic attacks occur. 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 individually after a thorough examination.

Diagnostics

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

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

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

Treatment

When treating adrenal tumors, it is important to take into account the information obtained at the time of diagnosis. The most effective method is surgery. The operation is performed for hormone-producing neoplasms, tumors larger than five centimeters in diameter, as well as malignant pathologies. However, sometimes surgery is contraindicated for the patient, in which case the pathology must be treated using a conservative method. Contraindications to surgery are:

Elderly age;
Multiple tumors with a large number of metastases;
Severe concomitant pathologies that are a contraindication to anesthesia.

Radiation and chemical therapy are used for cancer tumors and are carried out before and after surgery to reduce the size of the tumor and eliminate the remains of malignant cells.

Surgery

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

Open access (abdominal surgery);
Laparoscopic method (access through several punctures in the abdominal cavity).

During surgery, the tumor is removed along with the affected adrenal gland. If the neoplasm is malignant, the doctor also excises regional lymph nodes. If nearby organs are affected by metastases, they must also be removed.

It is most difficult to remove a pheochromocytoma, as this can significantly impair hemodynamics. To prevent an adrenaline crisis, the patient is carefully prepared for surgery using special medications. If a crisis nevertheless occurs during the removal of the tumor and the patient begins to experience cahetolamine shock, which is accompanied by surges in blood pressure to critical levels and other dangerous conditions, then doctors resort to emergency surgery.

Conservative treatment

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

Prognosis and prevention

Prognosis after surgery depends on the type of tumor, its nature and the treatment measures taken. Benign tumors almost never recur, which is not the case with malignant tumors. The sooner the tumor is removed, the more favorable the prognostic data. However, some patients may experience complications and consequences. For example, if an androsterome was removed and the patient was a child, the child will most likely be stunted. After successful removal of pheochromocytoma, half of the patients develop cardiac disorders within a year.

Thirty percent of patients who have their aldosteroma removed experience moderate hypertension that requires lifelong medication. If the corticosteroma is removed, the patient recovers after about one and a half to two months. The symptoms that were present during cancer gradually go away - blood pressure, weight return to normal, sexual function is restored, etc. Metastatic tumors often give a poor prognosis, especially if the pathology cannot be treated with surgery. 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 provoking factors.

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