Adrenal adenoma hormone tests. Common symptoms and methods of treatment of adrenal adenoma in women. Causes of adrenal adenoma

The adrenal glands are small paired endocrine glands that regulate metabolism, immunity, and blood pressure. Pathology of the adrenal glands occurs in childhood and adulthood. The peak incidence occurs in working age from 30 to 60 years. Of the diseases, benign tumors (adenomas) are in the first place in terms of prevalence.

Structure of diseases of the adrenal glands:

• benign tumor of the cortex (adenoma) - 30% of all cases;
• adenomatosis or cortical hyperplasia - 10%;
• pheochromocytoma - 10%;
• cyst or pseudocyst - 0.1%;
• lipoma - 0.2%;
• myelolipoma - 0.2%;
• adrenal cancer - 1.2%;
• other diseases - 52.3%.

Benign adrenal tumors are more common in women than in men. The clinical picture of the disease and the necessary treatment depend on the cellular composition and activity of the tumor.

Reasons for the appearance

The etiology of benign tumors of the adrenal glands is not well understood. Probably, one of the reasons for the appearance of a neoplasm is an increased need for hormones at some point in life. For example, injuries, surgeries, cardiovascular accidents (strokes, heart attacks) can provoke the appearance of an adenoma.

Risk factors for adrenal adenoma:

• hereditary burden;
• excess body weight;
• female;
• age over 30;
• arterial hypertension;
• elevated blood cholesterol;
• type 2 diabetes;
• polycystic ovaries in women.

Classification

Adrenal adenomas are benign neoplasms of glandular tissue cells. These tumors may have functional activity, that is, secrete hormones into the blood. In the cortex and medulla of the adrenal glands, several different biologically important substances are normally produced.

Depending on which hormones the adenoma produces, the following are distinguished:

• aldosteroma (produces mineralocorticoids);
• androsteroma (produces androgens);
• corticoestroma (produces estrogens);
• corticosteroma (produces glucocorticoids);
• combined tumor (mixed secretion);
• hormonally inactive tumors.

In addition, a tumor of chromaffin cells - pheochromocytoma (produces catecholamines) can be found in the adrenal glands.

Adrenal adenoma can be unilateral (96–97%) or bilateral (3–4%). In addition, several neoplasms can be found in one gland at once. The left adrenal gland is most commonly affected.

Structure

Adrenal adenomas can be small (up to 1 cm) or large (greater than 3–4 cm). The tumor is usually oval or round in shape. Like all benign tumors, adrenal adenoma has a pronounced capsule. The structure of the neoplasm is homogeneous. When examining a macropreparation on a section, the color of adenomas is yellow, beige, brown.

During the histological examination of the material (after a puncture or operation), the following are revealed:

• clear cell adenomas;
• dark cell adenomas;
• mixed adenomas.

Dark cell tumors are less common. There is little lipid in their cytoplasm, there are mitochondria, ribosomes in large quantities. Such neoplasms have a high functional activity.

Endocrine disorders in adrenal tumors

The most common is corticosteroma, which synthesizes cortisol and other steroid hormones. An excess of these substances leads to primary hypercortisolism (Itsenko-Cushing syndrome).

Aldosteroma is less common. It releases mineralocorticoids into the blood. Its manifestation is Conn's disease (primary hyperaldosteronism).

Androsteroma and corticoestroma are rare neoplasms. The first tumor produces testosterone and other androgens, the second estradiol and other estrogens. In women, testosterone-secreting tumors are most pronounced. Its functional activity provokes virilization (acquisition of male features).

Pheochromocytoma leads to the development of severe arterial hypertension and circulatory disorders. Its tissue releases adrenaline, norepinephrine, dopamine into the blood.

Hormonally inactive neoplasms of the adrenal glands do not have clinical manifestations. Usually they are discovered by chance (for example, during a medical examination).

Manifestations of adenoma in women

The clinical picture of adrenal adenoma in women and men is similar. Conn's disease, pheochromocytoma, Itsenko-Cushing's syndrome lead to the same changes in metabolism and the cardiovascular system.

Features of the clinical picture in women:

• hirsutism (hair growth on the face and body) with an excess of glucosteroids and androgens;
• violation of the menstrual cycle;
• infertility.

Androsteroma is the most specific tumor of the adrenal glands. Its manifestations in girls and women of all ages are extremely bright.

Complaints are associated with the virilizing and anabolic effects of testosterone and other androgens.

Girls have:

• premature sexual development;
• secondary sexual characteristics according to the male type;
• virilization (excessive hair growth, clitoral enlargement, rough voice, acne);
• short stature, relative shortening of the limbs;
• developed muscles;
• underdevelopment of the mammary glands;
• amenorrhea.

In adult women with a virilizing tumor:

• the menstrual cycle is disturbed (oligomenorrhea, amenorrhea);
• infertility (anovulation) develops;
• the thickness of the subcutaneous fat layer decreases;
• the mass of muscle tissue increases;
• hair loss (baldness);
• excess hair growth on the face and body.

Diagnosis and treatment

For the diagnosis of all tumors of the adrenal gland is used:

• collection of anamnesis;
• analysis of complaints;
• blood test for hormones, blood sugar, cholesterol;
• Ultrasound, CT, MRI of the adrenal glands;
• puncture of the adrenal glands (rarely).

If a benign adrenal tumor is confirmed in a patient, surgery is the preferred treatment. If the neoplasm does not release hormones into the blood and is small in size, then observation tactics can be chosen (regular monitoring of blood tests and CT of the retroperitoneal space).

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Tumors of the adrenal gland is a disease that occurs in one patient out of 10 examined. Not so long ago, this pathology was considered the rarest and most difficult to diagnose. At the moment, modern diagnostic techniques make it possible to detect education at the earliest stages and conduct timely successful treatment.

Adenoma is a type of benign tumor that forms on the adrenal glands. Outwardly, the damaged area of ​​the glands looks like a small dense capsule, the contents of which have a uniform structure.

The disease is most often characterized disruption of hormone production which leads to dysfunction of many body systems.

Kinds

Depending on the clinical picture and the development of pathology, several types of adenoma are distinguished. The main criterion for classification in this case was the type of hormones that start in excess produce adrenal glands.

Aldosteroma

Characterized by overproduction aldosterone. It manifests itself in the form of a small benign formation, up to 3 cm in diameter. This type of pathology primarily leads to primary hyperaldosteronism.

Too much aldosterone provokes fluid and sodium retention in the body, as a result of which blood volume and pressure in the arteries begin to increase. High blood pressure is the main and first sign of aldosteroma.

Laboratory analysis reveals a lack of potassium, which is heavily excreted in the urine. Therefore, with the development of pathology, frequent convulsions and severe muscle weakness can be observed.

Aldosteroma

Androsteroma

With this type of adenoma, the male hormone begins to be intensively produced - androsterone. This education has an additional name - virilizing adenoma. It is characterized by the appearance in women male signs: underlined muscles, hair growth above the lip and in the chin area.

Most often, the first sign is a change in voice that becomes rougher. Additionally, there is a decrease in the size of the mammary glands and a violation of the cycle of menstruation. Due to pronounced signs, the tumor is mainly diagnosed at the initial stage of its development.

Corticoestroma

Unlike the previous species, with corticoestroma, they begin stand out actively female sex hormones. The tumor is localized in the adrenal cortex and originates from the fascicular and reticular zones.

Most often, corticoestroma is malignancy. The symptoms of the pathology are increased pigmentation of the areolas and emergence from the nipples, fluid. In addition to these symptoms, women may not have any additional manifestations of the disease.

Laboratory tests show only an increase in estrogen. If the tumor develops in girls, then there is too early puberty which is passing at a rapid pace.

Corticosteroma

Corticosteroma is manifested by increased production cortisol which causes excessive fat deposition in the abdomen, chest, face and neck. With this pathology in a patient, the person acquires round shape. Hands in the area of ​​​​the hands, on the contrary, become very thin. Their skin is very thin.

Over time, there is a weakening and amyotrophy shoulders, abdominal wall, legs and buttocks. Stretch marks and hemorrhages form on the skin. If left untreated, there is a loss of mineral salts, which leads to the development of osteoporosis.

Patients have a decrease in the height of the spinal column and frequent compression fractures.

This pathology is mainly found in women. from 20 to 40 years old.

Adenoma that does not secrete hormones

In addition to the types of pathology that lead to the uncontrolled release of various hormones, there is a type in which hormones are not released. An adenoma of this type passes almost asymptomatically.

In some cases, there may be general signs of pathology, characteristic of all species. The most common are obesity, diabetes mellitus and hypertension.

The inactive form of adenoma, in most cases, refers to benign tumors and includes: fibroma, myoma, lipoma.

Photo of a removed hormonally inactive tumor

By classification

According to the appearance of education, there are three main forms:

1. Adrenocortical- the most common form, characterized by the formation of a small nodule with a hard shell. Most often, it is formed as a benign tumor, but it can also develop into a malignant one.
2. Pigmentary- in most cases, it develops in patients with a diagnosis of Itsenko-Cushing's disease. Education has a pronounced maroon hue. The diameter of the tumor does not exceed 3 cm.
3. Oncocytic- the rarest type of disease, characterized by the formation of numerous mitochondria. Due to this, the capsule has a heterogeneous internal structure.

Symptoms

A hardware examination reveals a capsule with dense walls, localized in the upper region of the adrenal glands.

Externally, the pathology is manifested by the following signs:

• rapid weight gain, due to the deposition of fat;
• violation of the menstrual cycle;
• change in voice timbre;
• excessive hairiness;
• the appearance of shortness of breath during physical exertion;
• fast fatiguability;
• weakness of the muscular apparatus;
• increased sweating;
• violation of the rhythm of the heart;
• pain in the abdomen, radiating to the chest.

These symptoms may indicate both an adrenal adenoma and other pathologies. Therefore, for an accurate diagnosis, it is necessary to undergo detailed research.

Development mechanism

The main soil for the development of adenoma is the cortical layer of the adrenal gland. The tumor begins to form in the depths of one cell, gradually covering more of them.

Affected cells replaced by fibrous tissue, which has a dense homogeneous structure. Inflamed cells are characterized by a common localization, as a result of which they form a homogeneous capsule, covered with a dense layer of replacement tissue.

As it develops, the tumor grows and causes serious disturbances in the process of hormone production. If untreated, a benign formation can degenerate into a malignant tumor.

Diagnostics

For diagnosis, in addition to the instrumental method and external examination, additional examination methods are used:

• ultrasound. Allows you to detect a tumor in the early stages of its development. The only disadvantage of this method is that the organ has an inconvenient location and is not always well visible. Therefore, to make a diagnosis, ultrasound should be performed only by a highly qualified specialist;
• MRI and CT. They are used to accurately study the tumor: the size, structure of the tissues of the adrenal glands and adjacent tissues, as well as organs;
• radiography. It is used in the case of diagnosing the development of a malignant process, to detect metastases;
• laboratory tests. Allow to identify the presence and type of hormones in the urine and blood.

Right adrenal adenoma on ultrasound

Treatment

For the treatment of adenoma, several effective methods are used. With minor changes, hormonal therapy is prescribed, aimed at restoring the balance of hormones.

With a benign formation, the size less than 3 cm the most efficient method is laparoscopy. It is a point impact on the tumor with a special scalpel and camera, through miniature incisions.

If the tumor has a diameter more than 4 cm, then it is shown abdominal operation, implying a dissection of a part of the abdominal wall in order to expose the adrenal gland. In case of development malignant education shows abdominal operation in combination with chemotherapy.

Removed tumor

Laparoscopy

Laparoscopy refers to the endoscopic method of adenoma removal. For the operation, a special apparatus with three micro blades on manipulators. Through small incisions in the abdominal wall, each blade summed up to the problematic part of the adrenal gland.

In order to create free space in the abdominal cavity for work, it must first introducing carbon dioxide. After excision of the affected tissue, it, together with the manipulators removed, and the incisions are sutured.

This procedure is one of the least traumatic surgical interventions, but has limitations. It cannot be performed after operations previously performed in the abdomen.

Abdominal operation

The most used method for the treatment of adenoma. To remove it, section of the abdominal cavity closer to the side surface. The tissue incision is at least 20 cm in length. During the operation, produce detachment surrounding tissues, to expose the adrenal glands and the area adjacent to it, to identify tissues involved in the pathological process.

Wound after abdominal surgery to remove the right adrenal gland and kidney

Chemotherapy

If the tumor is malignant, in addition to removing the adenoma, chemotherapy is added. To stop the disease in inoperable cases, apply adrenotoxic mitotane, ketoconazole, metyrapone. If possible, appoint doxorubicin, etoposide, cisplatin and methotrexate.

Rehabilitation

After surgery, a rehabilitation period follows, which lasts from 7 days to 2.5 weeks. After laparoscopy, the recovery period does not exceed 10 days. For speedy rehabilitation, the patient is prescribed hormone replacement therapy.

In addition, fully restored proper nutritional balance, with the exception of strong tea, coffee, legumes and nuts. The menu includes baked fruits and vegetables, as well as a large variety of greens.

Suture after surgery to remove the right adrenal gland

Forecast

With timely treatment of a benign adenoma, the prognosis is favorable in 100% of cases. But, as a rule, after treatment, 30% of patients have a partial hormonal imbalance with concomitant symptoms: high blood pressure, weight gain, etc.

In the case of late detection of malignant tumors, the prognosis, unfortunately, is not comforting. More than half of the patients does not live for 5 years.

The progress of the pathology can be seen by the following symptoms:

• appearance changes: puffiness of the face and discoloration of the skin appear;
• blood pressure can reach the highest and lowest boundary marks. The change in pressure can occur several times in 2-3 hours;
• appear signs of diabetes;
• starts hirsutism;
• excessive increase or decrease body mass.

Until recently, tumors of the adrenal glands were considered quite rare, and they accounted for no more than 1% of all neoplasms. The situation has changed with the introduction into general clinical practice of such research methods as ultrasound, computed and magnetic resonance imaging, which allow visualizing the pathology of this organ. It turned out that tumors, in particular, adrenal adenoma, are common, and according to some reports, they can be found in every tenth inhabitant of our planet.

Adrenal cancer is rarely diagnosed, and benign tumors originate in the cortex or medulla. Inactive adenomas of the adrenal cortex account for more than 95% of all detected tumors of this localization.

Adenoma- a benign glandular tumor that can secrete hormones, causing various and sometimes severe disorders in the body. Some adenomas do not have this ability, and therefore are asymptomatic and can be detected by chance. Among patients with this pathology, there are more women, whose age ranges between 30 and 60 years.

benign tumors, that are diagnosed in the adrenal gland should not be called adenomas until a thorough examination of the patient. In case of accidental detection of asymptomatic neoplasms, it is recommended to call them incidentals, indicating the unexpectedness of such a finding. After the patient is examined, and the malignant nature of the neoplasm is excluded, it will be possible to judge with a high degree of probability the presence of an adenoma.

The adrenal glands are small paired endocrine glands located at the upper poles of the kidneys and produce hormones that regulate mineral and electrolyte metabolism, blood pressure, the formation of secondary sexual characteristics and the fertility function of men and women. The spectrum of action of adrenal hormones is so wide that these small organs are rightfully considered vital.

The cortical layer of the adrenal gland is represented by three zones that produce different types of hormones. Mineralocorticoids of the glomerular zone are responsible for normal water-salt metabolism, maintaining the level of sodium and potassium in the blood; glucocorticoids (cortisol) of the fascicular zone ensure proper carbohydrate and fat metabolism, are released into the blood during stressful conditions, helping the body cope with sudden problems in time, and also participate in immune and allergic reactions. The reticular zone, which synthesizes sex steroids, ensures the formation of secondary sexual characteristics in adolescents and the maintenance of a normal level of sex hormones throughout life.

The hormones of the adrenal medulla - adrenaline, noradrenaline - take part in all kinds of metabolic processes, regulate vascular tone, blood sugar levels, and in a stressful situation, a large amount of them enters the bloodstream, which makes it possible to compensate for dangerous conditions in a short time. Tumors of the adrenal medulla are recorded very rarely, and adenomas are completely formed only in the cortical substance.

Among hormonally active adenomas allocate aldosteroma, corticosteroma, glucosteroma, androsteroma. Inactive asymptomatic tumors often appear as a secondary phenomenon in diseases of other organs, in particular, the cardiovascular system (arterial hypertension).

To determine the malignant potential of the identified neoplasm, it is important for the doctor to establish the rate of its growth. Thus, the adenoma increases by several millimeters during the year, while the cancer is rapidly gaining mass, sometimes reaching 10-12 cm in a relatively short period of time. It is believed that every fourth tumor with a diameter greater than 4 cm will be malignant in morphological diagnosis.

Causes and types of adrenal adenoma

The exact causes of benign glandular tumors of the adrenal glands are unknown. The stimulating role of the pituitary gland, which synthesizes adrenocorticotropic hormone, which enhances the release of hormones of the cortical layer under certain circumstances that require their increased amount is assumed: trauma, surgery, stress.

• hereditary predisposition;
• Female;
• Obesity;
• Age over 30 years;
• The presence of pathology of other organs - diabetes mellitus, hypertension, changes in lipid metabolism, polycystic ovaries.

As a rule, the adenoma is unilateral, although in some cases it can be detected in both the left and right adrenal glands at the same time. Outwardly, the tumor looks like a rounded formation in a dense, well-defined capsule, the color of the adenoma tissue is yellow or brown, and its structure is homogeneous, which indicates a benign process. Adenoma of the left adrenal gland is somewhat more common than the right.

Type of adenoma is determined by its hormonal activity and the hormone produced at the same time:

The histological type is determined by the type of cells - clear cell, dark cell varieties and a mixed variant.

The most commonly diagnosed corticosteroma, releasing glucocorticoids and manifesting Itsenko-Cushing's syndrome. Aldosteroma is considered more rare and very rare - adenomas that produce sex hormones.

Manifestations of adenoma

The vast majority of adenomas do not produce any hormones, and in view of the fact that their sizes rarely exceed 3-4 cm, then there are no local signs in the form of compression of large vessels or nerves. Such formations are detected by chance during CT or MRI for the pathology of the abdominal organs.

The number of cases of diagnosing these neoplasms has increased significantly, but the idea of ​​removing them for each patient is more than unreasonable and irrational. In addition, the benefits of removing an asymptomatic and very slowly growing tumor are doubtful, since the surgery itself is quite traumatic and can cause more problems than the carriage of an adenoma.

Functionally inactive tumors can occur as a result of the pathology of other organs - diabetes mellitus, arterial hypertension, obesity, requiring enhanced adrenal gland function.

Unlike inactive adenomas, hormone-producing tumors of the adrenal glands always have a vivid and rather characteristic clinical picture, so patients need appropriate treatment from endocrinologists and even surgeons.

Corticosteroma

Corticosteroma- the most common type of adenoma of the adrenal cortex, which releases an excess amount of cortisol into the blood. The tumor often affects young women. Its symptoms are reduced to the so-called Cushingoid syndrome:

In addition to the described signs, patients may notice a decrease in mood and apathy up to severe depression, lethargy, lethargy. Diabetes mellitus accompanies this pathology in 10-20% of cases, and jumps in blood pressure disturb almost all patients. Arterial hypertension can be malignant in nature, the pressure figures at the time of the crisis are quite high, so the risk of stroke at this moment is especially high. Over time, the kidneys are also involved in the pathological process.

In women, unpleasant external manifestations in the form of obesity and stretch marks are often complemented by hirsutism - the appearance of hair where they usually grow in males (ears, nose, upper lip, chest). Menstrual irregularities and infertility are common, reflecting severe hormonal imbalances.

Aldosteroma

Aldosteroma It is considered a rarer type of adenoma of the adrenal cortex. It secretes aldosterone, which promotes the retention of sodium and water in the body. This condition leads to an increase in circulating blood volume, increased cardiac output and arterial hypertension, which can rightly be considered the main symptom of the tumor. A decrease in the concentration of potassium in aldosteroma causes convulsions, muscle weakness, and arrhythmias.

Video: aldosteroma in the program “Live healthy”

Androsteroma

Adenomas capable of synthesizing sex hormones, are rare, but their symptoms are quite characteristic and noticeable if the tumor secretes hormones of the opposite sex than its owner. So, androsteroma, which secretes male sex hormones, is diagnosed in men quite late due to the absence of symptoms, while in women, the appearance of an excess of male hormones leads to a coarsening of the voice, the growth of a beard and mustache and hair loss on the head, restructuring of the muscles according to the male type, lack of menstruation, decrease mammary glands. Such symptoms almost immediately attract attention and suggest the pathology of the adrenal gland.

Diagnosis of benign tumors of the adrenal glands

Hormone-producing adrenal adenomas have such characteristic symptoms that often a diagnosis can be made after examination and conversation with the patient.

Probing a large tumor through the abdominal wall does not speak in favor of its benign nature. The formation of large sizes in the retroperitoneal region may be a sign of kidney adenoma, but the latter has slightly different symptoms and is easily determined using ultrasound or CT.

To confirm guesses, doctors use:

• Biochemical analysis to determine the level of hormones, blood sugar, and it is also advisable to determine the lipid spectrum;
• CT, MRI, ultrasound diagnostics;
• Puncture of a neoplasm, which is very rare.

Due to the deep location of the adrenal gland in the retroperitoneal space, ultrasound does not always provide the necessary amount of information, so computed and magnetic resonance imaging are considered the main diagnostic procedures for small adenomas. CT is often supplemented with contrast enhancement, and the best results can be obtained with a multispiral tomography (MSCT) examination, which allows obtaining a large number of sections of the tumor.

Biopsy of an adrenal adenoma is very difficult due to its localization, the trauma of this procedure is not justified, and the diagnostic value is low if a benign neoplasm is suspected. Basically, this method is used for the alleged damage to an organ of a different localization.

Treatment approaches

The choice of tactics for the treatment of adrenal adenoma is determined by its type. So, functionally inactive tumors diagnosed by chance require observation, periodic (once a year) CT and a blood test for hormones. If the condition is stable, no treatment is required.

If the tumor secretes hormones or its diameter exceeds 4 cm, then there are direct indications for surgical removal of the adenoma. The operation should be performed only in specialized centers with the necessary equipment.

laparoscopic adrenalectomy - surgical removal of the adrenal glands

The most traumatic operation is open access through a large incision up to 30 cm long. A more modern method is laparoscopic removal through abdominal wall punctures, but damage to the peritoneum and penetration into the abdominal cavity make this operation traumatic as well. The most rational and most modern way to remove the tumor is through the lumbar approach, without affecting the peritoneum. In this case, the patient can be discharged home after a couple of days, and the cosmetic effect is so good that the traces of the operation are not noticeable to others at all.

It is important to note that with any suspicion of an adrenal tumor, the patient should be referred to a specialized medical center, where endocrinologists and surgeons will choose the best treatment for a particular patient.

Video: adrenal tumors - treatment and differential diagnosis

Video: about the causes, prevention and treatment of diseases of the adrenal glands and pituitary gland

The author selectively answers adequate questions from readers within his competence and only within the limits of the OncoLib.ru resource. Face-to-face consultations and assistance in organizing treatment are not currently provided.

20.10.2018

One of the mechanisms that regulate human life is the endocrine system.

It is responsible for the production and release of hormones. Includes: thyroid and pancreas, adrenal glands, germ cells responsible for the secretion (excretion) of a certain type of hormones.

The adrenal glands are endocrine glands involved in the regulation of certain processes that occur in the body.

These glands secrete several types of hormones necessary for the normal functioning of the body. The adrenal glands are small, paired, encapsulated organs located on top of the kidneys.

The structure of the adrenal glands

These glands are similar in weight and size, but they have different shapes: the right one is pyramidal, the left one is crescent. They are small in size, with a total weight of 12 g. They begin to appear in the embryo at the 3rd week of pregnancy, and at the beginning of the 3rd month they already produce some hormones. They are finally formed in a child at the age of 3.

Each of the adrenal glands consists of a cortex and a medulla, each part is responsible for the synthesis of certain hormones.

medulla:

• adrenalin,
• norepinephrine,
• group of peptides.

Adrenaline (epinephrine) is released into the human blood during stress, in a calm state it is released in small quantities. It affects the transmission of nerve impulses, the pulse and blood pressure.

Adrenal cortex:

• mineralcorticoids,
• glucocorticoids,
• sex hormones.

The cortical substance is located under the capsule and occupies 90% of the mass of the gland. It is divided into 3 zones: glomerular, fascicular, reticular.

The glomerulus secretes hormones (aldosterone and corticosterone), which are responsible for mineral metabolism, the removal of excess fluid from the body, and help maintain normal pressure.

The beam part - hormones (glucocorticosteroids) - regulators of protein, fat and carbohydrate metabolism, are involved in the suppression of inflammatory reactions, and affect other processes in the body.

The reticular part of the cortical substance is responsible for the synthesis of sexual ghormones and the formation of secondary sexual characteristics.

The medulla and adrenal cortex are responsible for the most important processes in the body. The adrenal glands are interconnected with other components of the endocrine system, the disruption of which affects the entire human body.

Types of diseases:

1. Congenital.
2. Pathogenic.
3. Hyperfunction of the adrenal glands.
4. Pheochromocytoma.

Functions

• participate in metabolic processes (chemical reactions of converting food into vital energy) Metabolism - the process of metabolism and energy for the construction of tissues and cells;
• provide stress resistance;
• recovery of the body after stress;
• stimulates responses to stimuli;
• produce the necessary hormones;
• produce biologically active substances involved in the transmission of nerve impulses (substances-mediators). Mediators (from lat. mediator - intermediary).

main function- protection from stress. In the fight against stressful situations, the body is exhausted, which manifests itself in a feeling of fatigue, anxiety, fear.

Substances secreted by the adrenal glands help a person cope with these symptoms, increase resistance to stress. If necessary, they increase in size and begin to produce more hormones to protect the body.

Adrenal adenoma

This is a neoplasm of the adrenal glands that can lead to disruption of the entire hormonal system. A benign tumor affects one of the adrenal glands and is prone to malignant degeneration. It happens: hormonally active and inactive. Sometimes, when examining organs, an inactive adenoma is discovered by chance and is called an "incidentaloma."

If the tumor is inactive and small in size (up to 5 cm), then it does not show any symptoms.

If its size is more than 10 cm, then it begins to manifest itself, squeezing the vena cava, causing pain in the lower back. Hormonally activeadrenal adenoma has symptoms depending onon the type of hormones it produces.

signs

• weight gain, especially in the abdomen, chest, neck;
• the face is rounded, becomes "moon-shaped";
• the skin becomes thinner, stretch marks, red stripes appear on it;
• muscles of the legs and shoulders atrophy;
• the abdominal muscles weaken, the stomach sags, hernias appear;
• osteoporosis of bones leading to sudden fractures;
• there is lethargy, drowsiness;
• the menstrual cycle in women is disturbed;
• reduced potency in men;
• hair grows intensively all over the body;
• drops in blood pressure;
• signs of secondary diabetes.

Often manifested by a violation of the menstrual cycle, up to a complete cessation. There are signs of masculinization: hair on the face and chin, increased hair growth throughout the body, the voice becomes low (male). In children, this disease can cause early puberty.

Against, adrenal adenoma in men is manifested by the development of female characteristics. There is an abnormal increase in the mammary glands, their soreness, a decrease in sexual desire (libido) and potency.

The appearance of adrenal adenoma leads to a malfunction of their work, a violation of the hormonal background, which worsens the general well-being. The causes and factors of this pathology have not been precisely established. The following risk factors are noted:

• an increase in the tissues of the adrenal cortex (hyperplasia) with obesity, alcoholism, stress;
• age (more often after 50 years);
• hereditary predisposition;
• endocrine tumors of the pituitary, thyroid, pancreas;
• environment and lifestyle.

The appearance of a tumor can provoke several factors at the same time.

When examining the abdominal cavity using ultrasound, CT or MRI, adenoma is sometimes detected by chance. This pathology of the adrenal glands in women (30-60 years old) is more common than adrenal adenoma in men.

A randomly found adenoma is called an incidentaloma before the examination. If the benign formation is confirmed, then most likely it is an adenoma.

Inactive adenomas do not show unpleasant symptoms and their treatment is not necessary in the absence of increased growth. The benefit of removing a slowly growing tumor is questionable; the surgery itself may do more harm.

The process is usually unilateral, adenoma of the right and left adrenal glands are rare. The most common adenoma of the left adrenal gland. A benign adenoma looks like a yellow-brown rounded tumor of a homogeneous structure, enclosed in a dense capsule.

Often adrenal adenoma manifested in women, its symptoms, and treatment depends on its size and activity. The growth rate of the neoplasm indicates its predisposition to degeneration into a malignant one. Cancer is gaining mass rapidly, sometimes reaching 10-12 cm.

Adenoma can increase by several millimeters per year. Exceeding the size of 4 cm indicates that the tumor can take on a malignant character and morphological diagnosis is required.

Hormone-producing tumors behave aggressively and are accompanied by pronounced symptoms. In such cases, patients need the treatment of endocrinologists, and sometimes surgeons.

Corticosteroma - a common type of adenoma of the adrenal cortex, thisa type of tumor that affects young women, it releases excess cortisol into the blood, which gives the symptoms of cushingoid syndrome:

• visible deposits of fat on the abdomen, neck, face, which rounds and enlarges these parts of the body;
• there is a process of atrophy of the muscles of the abdomen and legs (sagging of the abdomen, hernia, difficulty walking);
• skin changes, thinning, stretch marks, purple stripes on the hips, abdomen, shoulders (Itsenko-Cushing's syndrome);
• violation of mineral metabolism, as a result - osteoporosis.

It can cause lethargy, depression, accompanied by pressure surges, diabetes mellitus. Hormonal imbalance leads to hirsutism (hair growth characteristic of men), menstrual disorders, and infertility.

Aldosteroma - less common, the tumor secretes aldosterone, leading to water and sodium retention in the body. Blood volume increases, blood pressure rises, arrhythmia occurs. The content of potassium in the body drops - hence muscle weakness, convulsions.

Androsteroma - is rare. The tumor synthesizes sex hormones. If these are hormones of the opposite sex, then the manifestations are very noticeable. In women, an excess of male sex hormones leads to the appearance of secondary sexual characteristics of men (coarsening of the voice, beard growth, reduction of the mammary glands, lack of menstruation). For men, the opposite is true.

For diagnosis, carry out:

• biochemical analysis of blood (level of hormones, blood sugar, etc.);

• MRI, CT, ultrasound examination;

• Puncture for biopsy is very rare due to the deep retroperitoneal location of the adrenal glands.

If an adenoma is detected, then the observation of an endocrinologist should be regular. Hormone therapy can be used to normalize hormonal levels.

Treatment of adenoma

The choice of treatment depends on the type of adenoma. Those who are inactive should be observed, once a year a CT scan and a blood test should be done. If the tumor is more than 4 cm in diameter and actively secretes hormones, an operation is necessary to remove it:

• Band surgery with open access through the incision is traumatic. But the only possible one, if an adenoma of the left andright adrenal.

• Laparoscopic tumor removal is a modern way. Access is through the abdominal wall through three small incisions using a miniature camera. But it is also associated with the risk of traumatic damage to the peritoneum.

• The most rational and modern is access from the lumbar side. The patient quickly recovers and the trace of the operation is invisible.

If the tumor is malignant, it is possible to use chemotherapy, with an advanced stage - radiotherapy.

In the initial stages of the disease, folk remedies can also be used to influence the dynamics of adenoma development. However, these funds will not be able to stop its growth. Simple recommendations: Be attentive to your health, notice and do not ignore any unusual manifestations and symptoms. Get regular check-ups with your doctor.

The adrenal glands, which are paired organs, play an important role in maintaining human health. Their function is the formation of hormones responsible for the proper functioning of many systems and organs of our body, as well as maintaining the necessary immunity and pressure.

Consider what is adrenal adenoma in women, its symptoms and treatment.

Among all types of lesions of the adrenal glands, one of the first places is occupied by adenoma, which is a benign tumor. Adenoma can occur at any age - both in childhood and in the more elderly. Moreover, adrenal adenoma affects mostly women, the age category of which is in the range from 30 to 55 years.

The reasons for the formation of adenomas have not been precisely established, but there are a number of factors that can provoke this formation. These should include:

• hereditary predisposition;
• the presence of significant excess body weight;
• elevated blood cholesterol levels;
• belonging to the female sex;
• excessive adherence to smoking;
• age over 30 years;
• the presence of diabetes mellitus - to a greater extent, the appearance of adrenal adenoma is likely in the presence of diabetes mellitus of the second degree;
• polycystic ovaries in women.

Also, risk factors can be injuries of a different nature, a high need for certain hormones in the body, a period of rehabilitation after surgery, as well as serious disorders in the cardiovascular system: heart attacks and strokes.

An additional cause of adrenal adenoma may be the use of hormonal contraceptives - this is due to a change in the hormonal background of a woman.

Therefore, before deciding to use this particular method of contraception, you should consult with a gynecologist.

Disease classification

The structure of the adrenal glands determines the production of certain hormones - their cortex and medulla produce various types of them.

Adenoma, being a benign neoplasm, may also have the ability to produce hormones in the blood.

And depending on the type of hormones produced by the adenoma, there is a special classification of this disease:

1. Aldosteroma - its function is the secretion of mineralocorticoids.
2. Androsteroma - produces androgens.
3. Corticoestroma is the production of estrogen.
4. Corticosteroma - this type of adenoma performs the function of producing glucocorticoids.
5. Also, an adenoma can release several types of hormones into the blood. Then it is called a combined tumor.
6. An adenoma that does not secrete hormones is a hormonally inactive tumor.

Both adrenal glands can be affected unevenly - benign neoplasms are most often formed in the left adrenal gland, and there are also variants of several tumors in one adrenal gland.

Additional classification

The classification may be different.

1. Adrenocortical adenoma, for example, is the most common adenoma, it is considered that outwardly it resembles a nodule that has a hard shell. It can be either benign or have malignant manifestations.
2. Pigmentary adenoma is more rare, it is mainly observed in people with Itsenko-Cushing's disease. It has a pronounced maroon color, the size can be about 2-3 cm in diameter.
3. Oncocytic adenoma is another rare species. Its structure differs from other types of this type of benign neoplasms - it is granular, due to the large number of mitochondria in it.

Adrenal adenoma is a dangerous disease that is fraught with a sufficient number of complications.

Development of adrenal adenoma

Externally, the adenoma is a hard capsule with homogeneous contents.

It is located on the upper part of the adrenal gland and its development occurs in steps.

The greatest danger in diagnosing adrenal adenoma is the possibility of degeneration of a benign tumor into a malignant one.

This is what should be emphasized when diagnosing the disease.

For this reason, it is the timeliness of diagnosis that makes it possible to determine the nature of the tumor that has arisen and the list of further actions. The adenoma is most often observed for a certain time, and then it is removed by surgery.

Features of manifestation and clinical picture

Since the adrenal glands are responsible for the process of producing hormones in the body, and an adenoma on them can also have the ability to form a certain group of hormones, their excessive intake into the blood can become a manifestation.

An excess of hormones primarily affects the manifestation of many male qualities, which is unpleasant for any woman:

• voice becomes rougher;
• excessive hair growth both on the body and on the face;
• the appearance of excess body weight;
• violation of the menstrual cycle.

The listed violations can remain even after the operation to remove the adenoma, therefore their appearance should be considered a reason for an early examination by an endocrinologist.

In addition, more general manifestations of hormonal imbalance can be observed, which include the following manifestations:

• the appearance of shortness of breath during physical exertion;
• increased fatigue;
• muscle weakness;
• prone to injury;
• increased sweating;
• pain in the chest and abdomen.

The deterioration of the condition occurs due to the constant imbalance of the hormonal background, therefore, a mandatory action for the expressed manifestations listed above should be a diagnosis in order to clarify the final diagnosis.

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