Tumors of the adrenal gland
Tumors of the adrenal gland. Distinguish benign and malignant tumors of the adrenal gland, emanating from the cortical and medullary layer. In the adrenal cortex, adenomas with increased secretion of glucocorticoids or aldosterone are localized, in the cerebral layer - pheochromocytoma, producing adrenaline and norepinephrine. Malignant tumors (corticosteroma, pheochromoblastoma, neuroblastoma), as well as adenomas, can be secreting or non-secretive.
In the diagnosis of adrenal gland tumors, along with a thorough history, biochemical and endocrinological studies, ultrasound and computed tomography, angiography, are of great importance.
It is difficult to distinguish a benign tumor from a malignant one even with morphological analysis. In both cases, the tumor has a capsule. Signs of malignancy: invasion of the capsule and vessels, a large tumor size, a perverse reaction to the dexamethasone test. Malignant tumors are prone to recurrence, metastases appear in para-aortic lymph nodes, lungs, liver, bones.
Adenoma and cancer of the adrenal cortex cause Ku-shing syndrome. In the blood - a high level of cortisol, in the urine - a significant excretion of ketosteroid. In cancer, a large tumor, secretion of cortisol is slightly inhibited after taking dexamethasone.
Aldosteroma-a small tumor (less than 2 cm), manifested by loss of potassium and sodium retention, increased blood pressure, thirst, polyuria, muscle weakness. Malignant aldosterome is observed rarely, its size is usually greater than 3-4 cm.
Pheochromocytoma is manifested by increased arterial pressure with severe crises and rapidly developing complications (retinopathy, cerebral hemorrhage, etc.). The level of adrenaline, norepinephrine in the blood and their metabolites in the urine is high. In 10-15% of cases, pheochromocytoma develops on both sides.
Treatment. The main method of treating patients with adrenal tumors is surgical. After removal of the secreting tumor, a dynamic laboratory control is necessary. The detection of a new increase in the level of hormones or other active substances helps early detection of tumor recurrence and timely re-operation. With malignant corticosterone, objective and symptomatic improvement is achieved by using o, n-DDD [1,1-dichloro-2 (chlorophenyl) -ethane] at 6-10 g / day, aminoglutetemide 500-1500 mg / day; Substitution therapy is performed with cortisone acetate.
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