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Tumors of adrenal glands

Tumors of adrenal glands – good-quality or malignant focal growths of cells of adrenal glands. Can proceed from cortical or brain layers, have different histologic, morphological structure and clinical manifestations. Prove pristupoobrazno in the form of adrenalovy crises more often: trembling of muscles, increase HELL, tachycardia, excitement, sensation of fear of death, belly-ache and breast, plentiful office of urine. Further development of diabetes, violations of work of kidneys, violation of sexual functions is possible. Treatment is always quick.

Tumors of adrenal glands

Tumors of adrenal glands – good-quality or malignant focal growths of cells of adrenal glands. Can proceed from cortical or brain layers, have different histologic, morphological structure and clinical manifestations. Prove pristupoobrazno in the form of adrenalovy crises more often: trembling of muscles, increase HELL, tachycardia, excitement, sensation of fear of death, belly-ache and breast, plentiful office of urine. Further development of diabetes, violations of work of kidneys, violation of sexual functions is possible. Treatment is always quick.

Adrenal glands – the endocrine glands, complex on a histologic structure and hormonal function, formed by two various layers in the morphological and embryological relation – external, cortical and internal, brain.

Bark of adrenal glands synthesizes various steroid hormones:

  • the mineralokortikoida participating in water-salt exchange (, 18-, );
  • the glucocorticoids participating in proteinaceous and carbohydrate exchange (, cortisol, 11-, 11-);
  • the androsteroida causing development of secondary sexual characteristics on women's (feminization) or men's (virilization) to types (estrogen, androgens and progesterone in small amounts).

The inside, brain layer of adrenal glands develops catecholamines: the dopamine, noradrenaline and adrenaline serving as the neurotransmitters transferring nervous impulses, and influencing exchange processes. At development of tumors of adrenal glands endocrine pathology is defined by defeat of this or that layer of glands and features of action is superfluous sekretiruyemy hormone.

Classification of tumors of adrenal glands

On localization of a new growth of adrenal glands are divided into two big groups essentially different from each other: tumors of bark of adrenal glands and tumor of brain substance of adrenal glands. Tumors of an external kortikalny layer of adrenal glands - an aldosterom, a kortikosteroma, a kortikoestrom, an androsterom and the mixed forms – are observed rather seldom. Tumors of chromaffine or nervous tissue proceed from an inside brain layer of adrenal glands: a feokhromotsitoma (develops more often) and a ganglionevroma. The tumors of adrenal glands proceeding from a brain and cortical layer can be good-quality or malignant.

Good-quality new growths of adrenal glands, as a rule, of the small sizes, without the expressed clinical manifestations are also casual finds at inspection. At malignant tumors of adrenal glands bystry increase in the sizes of new growths and the expressed intoxication symptoms is observed. Primary malignant tumors of adrenal glands proceeding from own elements of body, and secondary, spreading from other localizations meet.

Besides, primary tumors of adrenal glands can be hormonal and inactive (intsidentaloma or "clinically mute" tumors) or producing many any hormone of an adrenal gland, i.e. hormonal and active. Hormonal and inactive new growths of adrenal glands are more often good-quality (a lipoma, fibroma, myoma), with an identical frequency develop at women and men of any age groups, usually accompany the course of obesity, hypertensia, diabetes. Less often malignant hormonal and inactive tumors of adrenal glands (a melanoma, a teratoma, pyrogene cancer) meet.

Hormonal and active tumors of a cortical layer of adrenal glands are an aldosteroma, an androsteroma, a kortikoestroma and a kortikosteroma; a brain layer – a feokhromotsitom. By pathophysiological criterion of a tumor of adrenal glands are subdivided on:

  • defiant violations of water-salt exchange – an aldosteroma;
  • defiant metabolic violations – kortikosteroma;
  • the new growths having maskuliniziruyushchy effect – androsteroma;
  • the new growths having the feminizing effect – kortikoestroma;
  • new growths with the symptomatology mixed exchange – kortikoandrosteroma.

Gormonosekretiruyushchy tumors of adrenal glands have the greatest clinical value.

Hormonal and active tumors of adrenal glands

Aldosteroma – the tumor of adrenal glands producing proceeding from a glomerular zone of bark and causing development of primary aldosteronizm (Conn's syndrome). Aldosteron carries out regulation of mineral and salt exchange in an organism. Surplus of an aldosteron causes hypertensia, muscular weakness, (alkalization of blood and fabrics) and a gipokaliyemiya. Aldosteroma can be single (in 70-90% of cases) and multiple (10-15%), one - or bilateral. Malignant aldosteroma occur at 2-4% of patients.

Glyukosterom (kortikosterom) – the tumor of adrenal glands producing glucocorticoids proceeding from a puchkovy zone of bark and causing development of a syndrome of Itsenko-Cushing (obesity, arterial hypertension, early puberty at children and early fading of sexual function at adults). Kortikosteroma can have a good-quality current (adenomas) and malignant (adenocarcinomas, kortikoblastoma). Kortikosteroma – the most widespread tumors of bark of adrenal glands.

Kortikoesteroma – the tumor of adrenal glands producing estrogen proceeding from puchkovy and mesh zones of bark and causing development estrogen - a genital syndrome (feminization and sexual weakness at men). Develops seldom, usually at young men, has malignant character and the expressed expansive growth more often.

Androsteroma – the tumor of adrenal glands producing androgens proceeding their mesh zone of bark or ektopichesky nadpochechnikovy fabric (zabryushinny fatty cellulose, ovaries, a wide ligament of a uterus, seed kanatik, etc.) and causing development an androgen - a genital syndrome (early puberty at boys, a pseudo-hermaphroditism at girls, virilization symptoms at women). In half of zlokachestvenna androsteroma cases, spread in lungs, a liver, zabryushinny lymph nodes. At women develops twice more often, usually in the age range from 20 to 40 years. Androsteroma are rare pathology and make from 1 to 3% of all tumors.

Feokhromotsitoma – the tumor of adrenal glands producing catecholamines proceeding from chromaffine cells of brain tissue of adrenal glands (in 90%) or neuroendocrine system (sympathetic textures and , a solar plexus etc.) and followed by vegetative crises. Morphologically more often the feokhromotsitoma carries a good-quality current, its ozlokachestvleniye is observed at 10% of patients, usually with vnenadpochechnikovy localization of a tumor. Feokhromotsitoma meets at women a little more often, mainly aged from 30 up to 50 years. 10% of this type of tumors of adrenal glands have family character.

Symptoms of tumors of adrenal glands

Aldosteroma are shown by three groups of symptoms: cardiovascular, kidney and neuromuscular. Are noted the persistent arterial hypertension which is not giving in to hypotensive therapy, headaches, short wind, interruptions in heart, a hypertrophy, and then myocardium dystrophy. Persistent hypertensia leads to changes of an eye bottom (from an angiospazm to a retinopathy, to hemorrhages, degenerate changes and hypostasis of a disk of an optic nerve).

At sharp emission of an aldosteron the crisis which is shown vomiting, the most severe headache, a sharp myopathy, the superficial respiratory movements, sight violation can develop, it is possible - development of sluggish paralysis or an attack of a tetaniya. Sharp coronary insufficiency, a stroke can serve as complications of crisis. Kidney symptoms of an aldosteroma develop at sharply expressed gipokaliyemiya: there are a thirst, a polyuria, a nikturiya, alkaline reaction of urine.

Neuromuscular manifestations of an aldosteroma: muscular weakness of various degree of expressiveness, a paresteziya and a spasm - are caused by a gipokaliyemiya, development of intracellular acidosis and dystrophy of muscular and nervous tissue. The asymptomatic current of an aldosteroma occurs at 6-10% of patients with this type of tumors of adrenal glands.

The clinic of a kortikosteroma corresponds to manifestations of a giperkortitsizm (Itsenko-Cushing's syndrome). Obesity on kushingoidny type, hypertensia, a headache, the increased muscular weakness and fatigue, steroid diabetes, sexual dysfunction develops. On a stomach, mammary glands, the internal surfaces of hips emergence of striya and petekhialny hemorrhages is noted. At men feminization signs - a ginekomastiya, a hypoplasia of testicles, decrease in a potentiality develop; women have, on the contrary, virilization signs – men's type of pilosis, decrease in a timbre of a voice, a clitoris hypertrophy.

The developing osteoporosis serves as the reason of a compression fracture of bodies of vertebras. At a quarter of patients with this tumor of adrenal glands pyelonephritis and an urolithic disease comes to light. Violation of mental functions is quite often noted: depression or excitement.

Manifestations of a kortikoesteroma at girls are connected with acceleration of physical and sexual development (increase in genitalia and mammary glands, pubis pilosis, acceleration of growth and premature maturing of a skeleton, vaginal bleedings), at boys – with a delay of sexual development. At adult men feminization signs – a bilateral ginekomastiya, an atrophy of a penis and testicles, lack of growth of hair in the person, a high timbre of a voice, distribution of fatty deposits on a body on female type, an oligospermiya, decrease or loss of a potentiality develop. At female patients this tumor of adrenal glands symptomatic does not prove in any way and is followed only by increase in concentration in blood of estrogen. Purely feminizing tumors of adrenal glands are quite rare, more often they have the mixed character.

Androsteroma, characterized by excess production of androgens tumor cells (testosterone, an androstendion, a degidroepiandrosteron, etc.), cause development of anabolic and virilny syndromes. At an androsteroma at children the accelerated physical and sexual development – rapid growth and muscular development, voice timbre coarsening, emergence of acne rash on a trunk and a face is noted. At development of an androsteroma in women virilization signs – the termination of periods, a girsutizm, decrease in a timbre of a voice, a hypotrophy of a uterus and mammary glands, a clitoris hypertrophy, reduction of a hypodermic and fatty layer, increase in a libido appear. At men of manifestation of a virilizm are expressed less therefore these tumors of adrenal glands often are casual finds. Secretion androsteromy and glucocorticoids is possible that it is shown by clinic of a giperkortitsizm.

Development of a feokhromotsitoma is followed by dangerous haemo dynamic violations and can proceed in three forms: paroksizmalny, constant and mixed. The current of the most frequent paroksizmalny form (from 35 to 85%) is shown by sudden, excessively high arterial hypertension (to 300 and higher than a mm of mercury.) with dizziness, a headache, a mramornost or pallor of integuments, heartbeat, perspiration, zagrudinny pains, vomiting, a shiver, feeling of panic, a polyuria, rise in body temperature. The attack of a paroxysm is provoked by the physical tension, a tumor palpation, plentiful food, alcohol, an urination, stressful situations (injuries, operation, childbirth, etc.).

Paroksizmalny crisis can last till several o'clock, repeatability of crises – from 1 within several months to several in day. Crisis stops quickly and suddenly, arterial pressure comes to initial size, pallor is replaced by reddening of integuments, plentiful sweating and secretion of saliva are observed. At a constant form of a feokhromotsitoma it is noted the increased arterial pressure is resistant. At the mixed form of this tumor of adrenal glands feokhromotsitomny crises develop against the background of constant arterial hypertension.

The tumors of adrenal glands proceeding without the phenomena of a giperaldosteronizm, a giperkortitsizm, feminization or a virilization of vegetative crises develop asymptomatically. As a rule, they come to light incidentally when performing MPT, KT of kidneys or the ultrasonography of an abdominal cavity and retroperitoneal space which are carried out concerning other diseases.

Complications of tumors of adrenal glands

Their malignization occurs among complications of benign tumors of adrenal glands. Malignant tumors of adrenal glands spread in lungs, a liver, bones.

At a heavy current feokhromotsitomny crisis is complicated by katekholaminovy shock – uncontrollable haemo dynamics, chaotic change of the high and low rates HELL which are not giving in to conservative therapy. Katekholaminovy shock develops in 10% of cases, is more often at patients of children's age.

Diagnosis of tumors of adrenal glands

The modern endocrinology has such methods of diagnostics which not only allow to diagnose adrenal gland tumors, but also to establish their look and localization. Functional activity of tumors of adrenal glands is determined by the content in daily urine of an aldosteron, free cortisol, catecholamines, gomovanilinovy and vanililmindalny acid.

At suspicion on feokhromotsity and krizovy rises I wet HELL and blood on catecholamines is taken away right after an attack or during it. Special tests at tumors of adrenal glands provide blood sampling on hormones before drug intake (test with captopril, etc.) or measurement HELL before administration of drugs (test with a clonidine, tiraminy and tropafeny).

Hormonal activity of a tumor of adrenal glands can be estimated, using a selective nadpochechnikovy flebografiya – a X-ray contrast kateterization of nadpochechnikovy veins with the subsequent blood sampling and determination of the level of hormones in it. The research is contraindicated at a feokhromotsitoma since can provoke development of crisis. The sizes and localization of a tumor of adrenal glands, existence of the remote metastasises are estimated by results of ultrasonography of adrenal glands, KT or MPT. These diagnostic methods allow to reveal tumors - intsidentaloma with a diameter from 0,5 to 6 cm.

Treatment of tumors of adrenal glands

Hormonal and active tumors of adrenal glands, and also the novobrazovaniye with a diameter more than 3 cm which are not showing functional activity and tumors with signs of a malignization are treated surgically. In other cases dynamic control of development of a tumor of an adrenal gland is possible. Operations for tumors of adrenal glands are performed from open or laparoscopic access. All affected adrenal gland (an adrenalektomiya - removal of an adrenal gland) is subject to removal, and at a malignant tumor – an adrenal gland together with blizraspolozhenny lymph nodes.

The greatest complexity is represented by operations at a feokhromotsitoma because of a high probability of development of heavy violations of haemo dynamics. In these cases much attention is paid to preoperative training of the patient and the choice of an anesteziologichesky grant, the feokhromotsitomny crises directed to knocking over. At feokhromotsitoma also treatment by means of intravenous administration of the radioactive isotope causing reduction in sizes of a tumor of an adrenal gland and the available metastasises is applied.

Treatment of some types of tumors of adrenal glands well gives in chemotherapy (mitotany). Knocking over of feokhromotsitomny crisis is carried out by intravenous infusion of phentolamine, nitroglycerine, sodium of a nitroprussid. At impossibility of knocking over of crisis and development of katekholaminovy shock the emergency transaction of vital indications is shown. After expeditious removal of a tumor together with an adrenal gland the doctor-endocrinologist appoints continuous replacement therapy of a gomonama of adrenal glands.

The forecast at tumors of adrenal glands

Timely removal of benign tumors of adrenal glands is followed by the forecast, favorable for life. However after removal of an androsteroma at patients low-tallness is quite often noted. At a half of the patients who underwent an operation for a feokhromotsitoma the moderate tachycardia, hypertensia (constant or tranzitorny) which are giving in to medicinal correction remain. During removal of an aldosteroma arterial pressure returns to normal at 70% of patients, in 30% of cases the moderate hypertension which is well responding to hypotensive therapy remains.

After removal of a good-quality kortikosteroma regress of symptomatology is noted in 1,5-2 months: appearance of the patient changes, return to normal HELL and exchange processes, striya turn pale, sexual function is normalized, displays of steroid diabetes disappear, body weight decreases, the girsutizm decreases and disappears. Malignant tumors of adrenal glands and their metastasis predictively are extremely adverse.

Prevention at tumors of adrenal glands

As the reasons of development of tumors of adrenal glands are up to the end not established, prevention comes down to the prevention of a recurrence of remote tumors and possible complications. After an adrenalektomiya control inspections of patients by the endocrinologist of 1 times in 6 months with the subsequent correction of therapy depending on health and results of researches are necessary.

Physical and mental activities, the use of sleeping medicines and alcohol are contraindicated to patients after an adrenalektomiya concerning tumors of adrenal glands.

Tumors of adrenal glands - treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!

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