Tumor of the adrenal glands: characteristics of the disease and methods of therapy. The difference between benign and malignant tumors of the adrenal glands Volumetric formation of the left adrenal gland that can reveal

The adrenal glands have a complex histological structure; they are formed from different germ layers during embryogenesis. The glands consist of a cortex and a medulla and produce several types of major hormones. The cortical substance synthesizes glucocorticoids, mineralocorticoids and androgens. The cells of the medulla secrete adrenaline, norepinephrine and dopamine. The adrenal glands, like other organs of the human body, are prone to the formation of benign and malignant tumors. Neoplasms can occur both from the cells of the cortex and from the medulla. A tumor of the adrenal glands can cause an excess of hormones in the body, a person develops an endocrine pathology. The causes of tumors are not fully understood.

Symptoms depend on the tissue from which the tumor originated. Adrenal crises are often observed, which are characterized by muscle trembling, increased heart rate, increased blood pressure, nervous excitement, pain in the chest and abdomen, a feeling of fear of death, and the release of large amounts of urine. After some time, the development of diabetes mellitus, kidney pathology and sexual dysfunction is possible. Treatment is shown surgical.

Classification of adrenal tumors

According to localization, tumors are divided into 2 large groups: originating from the cortical layer and originating from the medulla. They are fundamentally different from each other. Both of them can be benign or malignant. A benign volumetric formation in the adrenal gland is usually small in size and does not manifest itself in any way, it grows very slowly. Such tumors are an incidental finding during the examination of patients. Malignant formations - cancer of the adrenal glands, rapidly increase in size and have characteristic clinical signs. Cancers can be primary, that is, formed from the body's own tissues, and secondary - metastases in the adrenal glands from other organs.

Primary tumors are divided into hormonally active, which produce hormones, and hormonally inactive - do not synthesize biologically active substances. A benign neoplasm on the adrenal gland is usually hormonally inactive and occurs in people of various ages. The reason for this may be obesity, diabetes, high blood pressure.

Malignant hormonally inactive neoplasms are rare, they include: melanoma, pyrogenic cancer, teratoma. Hormonally active pheochromocytomas and inactive ganglioneuromas form in the inner medulla. Tumors of the adrenal cortex: corticosteroma, aldosteroma, androsteroma, corticoestroma are also hormonally active.

Volumetric formations are divided according to pathophysiological criteria:

Aldosteromas cause water and salt imbalances in the body.
Corticosteromas disrupt metabolism
Androsteromes provoke the formation of male secondary sexual characteristics in women
Corticoestroms provoke the formation of female secondary sexual characteristics in men
Corticoandrosteromas disrupt metabolism and contribute to the formation of male secondary sexual characteristics in women.

Special attention is paid to tumors that secrete hormones. Let's take a closer look at:

Aldosteroma is a tumor of the adrenal gland formed from cells of the glomerular zone of the cortical substance. It synthesizes the hormone aldosterone and causes a pathology such as aldosteronism - Conn's syndrome. Aldosterone regulates the metabolism of minerals in the human body. Its excess leads to an increase in blood pressure, muscle weakness, a decrease in the amount of potassium ions, alkalization of the blood. Usually there is a tumor of the right adrenal gland, multiple formations are diagnosed less often. Malignant aldosteroma occurs in 2-4% of patients.
Corticosteroma or glucosteroma is the most common tumor in the adrenal gland. It is formed by cells of the fascicular layer of the cortex and produces the hormones glucocorticoids. Patients have signs of Itsenko-Cushing's syndrome: obesity, increased blood pressure, in children - early puberty, in adults - premature extinction of sexual functions. A benign tumor of the adrenal glands is an adenoma, and a malignant tumor is adenocarcinoma or corticoblastoma.
Corticoesteroma develops from the reticular or fascicular layer of the cortex and is the cause of estrogen-genital syndrome in men. This condition is characterized by the appearance of female secondary sexual characteristics and sexual weakness. The disease is usually malignant.
Androsteroma - a volumetric formation on the adrenal gland, originating from the tissue of the reticular zone and synthesizing male sex hormones - androgens. Hyperactivity of the adrenal gland towards the formation of androgens leads to the formation of androgen-genital syndrome. In boys, this causes early puberty, in girls - pseudohermaphroditism, and in women, male secondary sexual characteristics appear. These tumors appear rarely in about 1-3% of cases and usually occur in women aged 20 to 40 years. The ratio of malignant androster to benign 1:1. Adrenal cancer metastasizes to the liver, lungs, retroperitoneal lymph nodes.
Pheochromocytoma in 90% of cases is formed from the cells of the medulla, less often from the sympathetic nerve plexuses and nerve nodes, it synthesizes catecholamines. People with this tumor experience autonomic crises. A malignant course is not common, in about 10 patients out of a hundred. Women between the ages of 30 and 50 are more susceptible to this disease.

For more information about adrenal diseases, see the video:

Clinical manifestations of tumors of the adrenal glands

The signs and symptoms of an adrenal tumor depend on the tissue from which it originated, so it is wise to consider each of them:

Aldosteroma is manifested by 3 groups of main symptoms: renal, cardiovascular and neuromuscular. A persistent increase in blood pressure is characteristic, which does not decrease with the use of antihypertensive drugs. There are also headaches, heart disorders, shortness of breath, degenerative changes in the myocardium, pathology of the fundus. If aldosterone is secreted abruptly, a crisis may develop. There is vomiting, a very severe headache, visual disturbances, myopathy, breathing becomes superficial. Sometimes the crisis is complicated by stroke and coronary insufficiency. Diagnosis reveals a pronounced deficiency of potassium ions in the body. Patients complain of thirst, frequent urination at night, copious urine output. There may also be muscle weakness, cramps.
Symptoms of hypercortisolism (Itsenko-Cushing's syndrome) are characteristic of corticosteroma. Obesity, high blood pressure, headaches, muscle weakness, severe fatigue, sexual dysfunction, steroid diabetes. Stretch marks appear on the chest, abdomen, skin of the inner thighs. Men may develop gynecomastia, reduced potency, testicular hypoplasia. In women - male-type hair, an increase in the size of the clitoris, a rough low voice. Sometimes osteoporosis develops, which causes fractures of the vertebral bodies. On the part of the kidneys, pathologies such as urolithiasis and pyelonephritis are observed. Many patients complain of depression or excessive nervous excitability.
Corticoestroms in girls lead to accelerated sexual development, and in boys, on the contrary, to its delay. In adult men, female secondary sexual characteristics, atrophy of the testicles and penis, a small number of spermatozoa, and impotence can be observed.
Androsteromes also cause accelerated puberty in children. In women, menstruation stops, the timbre of the voice decreases, the uterus and mammary glands become hypotrophic, the clitoris increases in size, sexual desire increases and the subcutaneous fat layer decreases. In men, the tumor may not manifest itself in any way.
Pheochromocytoma can be extremely life threatening. It is accompanied by hemodynamic disturbances and proceeds in 3 forms: constant, paroxysmal and mixed. The paroxysmal form is characterized by a sudden jump in blood pressure up to 300 mm Hg. Art. and more, dizziness, palpitations, pallor of the skin, headaches, vomiting and trembling, fear, anxiety, fever. Such symptoms may persist for several hours and stop as quickly and suddenly as they began. People with permanent pheochromocytoma always have high blood pressure. The mixed form is characterized by constantly high blood pressure and periodic crises.

Diagnostic and therapeutic measures for adrenal tumors

The functional activity of neoplasms is determined using urine tests for hormone levels. If pheochromocytoma is suspected, blood and urine tests are taken during or immediately after an attack. Diagnosis of a tumor of the adrenal glands is also possible thanks to special tests for hormones: a test with captopril, a clonidine test, with itropafen and tyramine. Blood is taken before and after taking special medicines. Blood pressure is measured before and after the use of clonidine. Adrenal phlebography allows you to evaluate the hormonal activity of tumor tissues. X-ray contrast catheterization of the veins of the gland is done and blood is taken for analysis. Such a study is contraindicated in pheochromocytoma, as it can provoke a crisis.

To determine the exact localization of the tumor and, if there are symptoms of cancer, the presence of distant metastases, CT, MRI and ultrasound are used. These modern methods can detect formations with a diameter of 0.5 to 6 cm.

This video shows the placement of an adrenal tumor:

If there are functionally inactive tumors, the size of which exceeds 3 cm, formations with signs of malignancy, as well as tumors that synthesize hormones, a surgical operation to remove the tumor is indicated. In other cases, it is recommended to control the neoplasm over time. Nowadays, surgical intervention is possible without the use of open access; laparoscopic operations have become very popular. The entire adrenal gland with a tumor is removed, if the formation is malignant, the lymph nodes located near the organ are also removed. If the function of the remaining adrenal gland is insufficient, hormone replacement therapy is prescribed. Previously, bark extract was used for these purposes, now it is almost never used.

Surgery for pheochromocytoma can be dangerous, as the risk of developing a crisis is too high. Before the operation, a serious preparation of the patient is carried out. Also, with this neoplasm, intravenous administration of radioisotopes is shown, which contribute to its reduction, the same thing happens with metastases. If the crisis nevertheless developed, the patient is given intravenous injections with nitroglycerin, phentolamine, regitin. When the crisis does not stop and catecholamine shock occurs, an emergency operation is performed for health reasons. Oncology in some cases is well treated with chemotherapy. Substances such as mitotane, chloditan, lysodren are used. The prognosis for timely treatment is favorable for life. Short stature often occurs after removal with an androster. People who have had surgery for pheochromocytoma may have hypertension that is easily managed with drugs and mild tachycardia. If corticosteroma is removed, all processes in the body will return to normal in 1-2 months.

An adrenal tumor is a neoplasm that forms within the boundaries of one or both endocrine glands located in the kidney area, this is a fairly rare disease. Most often in medical practice, benign tumors of the adrenal glands come across, but there are also cases of detection of malignant tumors. The main function of the adrenal glands is the production of hormones that are interconnected with many organic processes in our body: electrolyte metabolism, reproductive system, blood pressure regulation and other body functions necessary for normal functioning. The adrenal glands in their structure have an inner and outer layers. Each of them is responsible for the production and synthesis of their hormones. For example, the produced mineralocorticoid hormone helps a person to carry out water-salt metabolism, glucocorticoids - metabolism. The adrenal glands are surrounded by connective tissue in a small capsule, which is shrouded in fat.

Science does not know the exact causes of neoplasms in the adrenal region today. One can only assume that a person's genetic predisposition has a certain influence on the development of such a disease. These are the so-called associated and sporadic hereditary syndromes. Also, one of the main factors affecting the development of formations will be the environment in which the patient lives and his daily lifestyle.

The following circumstances can awaken a tumor of the adrenal glands:

excessive excitation of the nervous system, a state of depression or stress;
various kinds of injuries, which may be associated with surgery;
chronic diseases of the endocrine system;
anomalies and pathologies of the adrenal glands of a congenital nature;
arterial hypertension.

Adrenal Tumor Classification

In their structure, the adrenal glands are very complex organs; in the process of embryogenesis, they can be formed from several germ layers. This gland can produce from the medulla and cortical layer various, important for existence, hormones: androgens and glucocorticoids, mineralocorticoids, secretes the cortical substance. The secretion of dopamine, norepinephrine and adrenaline is produced by the cells of the medulla. As already mentioned, excessive secretion of adrenal hormones is fraught with endocrine pathologies.

Classification by localization

Tumors are divided into two groups according to localization: some arise from the medulla, others from the cortical layer. Both of these varieties can be malignant or benign. A benign tumor may not be detected for a long time, because it is small or grows slowly and does not make itself felt. Diagnose these neoplasms in patients of completely different ages. Doctors call high blood pressure, partial or complete obesity, and diabetes mellitus one of the initial causes of this type of tumor. Therefore, such cysts are found in most cases by chance during a medical examination.

Primary and secondary cancers

Cancer of the adrenal glands (malignant neoplasms of the adrenal glands), unlike benign neoplasms, has obvious manifestations and rapidly increases in size, and is also accompanied by specific signs. Such tumors include: teratoma, melanoma, pyrogenic cancer. Formed from the cells of its own tissue, cancerous cysts arise, which are called primary. And secondary are called cancerous neoplasms that arise from metastases of other organs in the patient's adrenal glands.

In turn, primary tumors are divided into hormonally active and hormonally inactive. The latter cannot synthesize biologically active substances.

The pathophysiological criteria for division have more extensive adenomas:

corticosteromas, which disrupt the normal metabolism of the body;
aldosteroma - causes a disorder in the balance of salt and water in the patient's body;
corticosteromas - develop a characteristic feature of female secondary sexual characteristics in the male;
androsteromas - form the development of secondary male sexual characteristics in the female;
corticoandrosteromas combine the characteristics of corticosteroma and androsteroma.

Stages of adrenal cancer

Criteria for the stages of cancer of the adrenal cortex:

T1 - cyst without invasion and less than 5 cm in size;
T2 - neoplasm without invasion, but more than 5 cm;
T3 - a cyst can be of different sizes, but with local invasion and without sprouting into the organs that are in the neighborhood;
T4 - the tumor can be of different sizes, but with local invasion into neighboring organs.

Hormonally active adrenal tumors

It is worth studying in more detail the varieties of tumors that produce hormones in excess.

Aldosteroma is a neoplasm of the adrenal tissue arising from the cortical substance and cells of the glomerular zone. The cyst produces the synthesis of the hormone aldosterone and causes such a pathological phenomenon as Conn's syndrome. More often there is a tumor of the right adrenal gland, less often doctors diagnose multiple formations;
Glucosteroma is a hormonally active cyst of the adrenal cortex, which mainly originates from its fascicular zone. It secretes corticosteroids and glucocorticoids in excess;
Corticosteroma is a neoplasm of the adrenal glands, which is formed from a bundle or mesh layer of the cortex and can cause estrogen-genital syndrome in men. Patients may exhibit female secondary sexual characteristics, as well as a weakening of sexual desire. Typically, tumors of this type are malignant in nature;
Androsteroma is a cyst that has three-dimensional forms on the adrenal gland, which originates from the tissues of the reticular zone. Such a cyst produces androgen hormones. The formation of androgen-genital syndrome occurs due to the extreme activity of the adrenal glands in the production of androgens. In male patients, such a manifestation can cause early puberty, in girls it can cause pseudohermaphroditism. Women with this diagnosis may have secondary sexual characteristics of a man. Metastases from adrenal cancer can give to the lungs, liver, and retroperitoneal lymph nodes;
Pheochromocytoma is a tumor that is formed from the medulla, but there are cases when it arose from the nerve plexuses, as well as nerve nodes. This type of neoplasm produces catecholamines. Most often it is a benign cyst, but there have been cases of malignant phenomena. Women between the ages of 35 and 55 are at risk for this disease.

Symptoms of adrenal tumors

The symptoms of adrenal tumors depend on the tissue from which they originated and on the hormones released. Therefore, each of them has its own manifestations and we will consider them separately.

Aldosteroma symptoms

Aldosteroma has three groups of symptoms: cardiovascular, neuromuscular and renal. Patients have high blood pressure, it does not decrease even with the use of antihypertensive drugs. The work of the heart is disturbed, headaches appear, pathologies of the fundus develop. It is possible to develop a crisis, but this is only if the aldosterone hormone is released suddenly and abruptly. The crisis can give complications such as coronary insufficiency or stroke. Diagnosis can reveal the acute need of the body for potassium ions. Often patients may become thirsty, complain of copious urine output, especially often this is observed at night. In some cases, there is a cramp, muscle weakness.

Symptoms of glucosteroma

Symptoms of glucosteroma disease are manifested extensively. All types of metabolism are disturbed, and an extremely high performance of cortisol is also observed. The severity of the disease can be different, so patients may experience differences in symptoms. The most characteristic phenomenon in this outcome will be a violation of fat metabolism, which will be an early sign of a glucosteroma tumor. But there are also cases when patients, having such a diagnosis, lost weight.

Doctors also refer to the early symptoms of menstrual irregularity, the complete absence of menstruation. The skin becomes thinner, becomes dry, stretch marks and hemorrhages may appear even with minor injuries. Stretch marks usually occur on the skin of the abdomen, but there are cases on the hips as well as on the shoulders. Almost all patients have an impaired carbohydrate metabolism, which in principle can be easily eliminated with treatment.

Symptoms of corticosteroma

Corticosteroma is characterized by the following clinical symptoms: headache, weight gain, impaired carbohydrate metabolism, cushingoid obesity, impaired sexual function of the patient. Frequent manifestations of corticosteroma in women can be baryphonia and clitoral hypertrophy. For men, too, everything is not so rosy, since this disease begins to worsen potency, gynecomastia is observed, as well as testicular hypoplasia. Kidney problems such as pyelonephritis and painful urination (urolithiasis) develop. Perhaps that is why nervous problems, depression and emotional breakdowns also join all these symptoms.

Androsteroma symptoms

The suspension or complete stop of menstruation for girls and women is one of the clinical manifestations of androsteroma. To this may be added a change in the timbre of the voice, an increase in the size of the clitoris, and sexual desire, on the contrary, increases. It is dangerous that in male patients this disease can be asymptomatic.

Pheochromocytoma Symptoms

The most dangerous type of adrenal tumor is pheochromocytoma. Many patients simply do not live up to a correct diagnosis. Death is due to stroke and cardiac arrhythmias. The forerunners of all this may be an increased heartbeat and headaches, a strong sweating. Symptoms that are inherent in this type of tumor can occur suddenly and disappear as well. The frequency and danger of attacks multiplies over time, and the clinical symptoms in different patients can be completely different and do not coincide.

It is worth noting that people who suffer from a malignant tumor of pheochromocytoma constantly have high blood pressure. In some cases, the course of the disease can pass with complications, and in some cases it is completely asymptomatic.

Diagnosis of adrenal tumors

After detecting the first signs of adrenal tumors, you should immediately contact a specialist for advice and help. After that, the doctor will ask you to take standard blood and urine tests for hormone levels. If there is a suspicion of pheochromocytoma, then these same tests are taken directly during an attack or immediately after it.

Tests for hormonal levels

Special tests for hormonal levels will also help to recognize the disease: a clonidine test, a test with captopril, with itropafen and tyramine. In this case, blood is taken before and after taking special medications. Be sure to measure blood pressure, but this must be done before and after the clonidine test.

Phlebography

Phlebography of the adrenal glands will be able to determine the hormonal activity of neoplasms. To do this, do X-ray contrast catheterization of the veins of the gland, after which they take blood for analysis. With pheochromocytoma, this study is prohibited in order to avoid provoking a crisis.

MRI, ultrasound, CT

To detect the location of the neoplasm and its nature (benign or malignant), to find out if there are metastases, MRI, ultrasound and CT are used. These are state-of-the-art technologies that can identify tumors ranging in size from 0.5 to 6 cm in diameter.

Radioisotope bone scan

With symptoms of a malignant process, in order to exclude further metastasis, radioisotope bone scans are used.

Remember that early detection of the disease automatically improves the prognosis of further treatment.

Complications of adrenal tumors

Doctors consider the development of benign neoplasms into malignant ones, which can later metastasize to other organs (the skeletal system, lungs, brain, kidneys, liver, gastrointestinal tract, endocrine glands, uterus) as the most severe complications in adrenal tumors.

Lymphatic outflow of the adrenal glands takes place in different directions. The superior adrenal and inferior phrenic arteries are accompanied by lymphatic vessels from the superior poles of the adrenal glands. Thus, they penetrate into the posterior mediastinal lymph nodes, which are located at the level of Th9-10. For both adrenal glands, lymph nodes are regional, which are concentrated behind the aorta at the level of Th11-12.

Also, one of the main complications in such formations is considered to be an adrenal crisis, which does not allow the adrenal cortex to work normally and thereby ensure the necessary production of hormones in various diseases, stressful situations, and injuries.

Treatment of adrenal tumors

For a radical solution to such a problem as benign and malignant tumors of the adrenal glands, surgical intervention is necessary. It is the presence of a tumor that is already the first evidence of the need for surgical treatment. Even if doctors diagnosed a large tumor, this is not a verdict.

Patients are contraindicated for surgical intervention in such cases:

cysts that give a lot of metastases, they are also very distant;
any serious diseases that are fraught with serious clinical cases with any instrumental treatment.

Surgical removal of tumors of the adrenal glands belong to the category of severe interventions. This is predetermined by the complex anatomical location (you can accidentally damage the nearest organs or vessels), the depth of the cyst.

Preparation for surgery

It is necessary to properly prepare for the operation. Depending on the hormonal activity of the tumor, the presence of any pathologies and complications, preoperative preparation takes place. Sometimes this period can last for weeks, at this time you need to be under the supervision of a surgeon, an endocrinologist and a therapist, an intensive care specialist, and an anesthesiologist.

At this time, doctors must correct carbohydrate, protein and water-salt metabolism, cardiovascular disorders and the respiratory system. Before the operation, the patient is given endotracheal anesthesia. If the tumor is hormonally inactive, then anesthesia is carried out according to the standard method. But it is worth considering the anatomical features of each person, it is possible to provoke large hemodynamic disorders, which is dangerous at any stage of surgical intervention and in the early postoperative period.

Features of treatment

There are several groups that will allow the doctor to have access to the neoplasm: transthoracic, transperitoneal, combined, extraperitoneal. For each patient, treatment is individual.

The most important in the surgical intervention is the removal of the perirenal tissue that surrounds the tumor and the adrenal gland, as well as the tissue of the aorto-caval gap, where the regional lymph nodes for the adrenal glands are located.

One of the main requirements for the operation is the preservation of the integrity of the tumor capsule. This is necessary so that in case of any violation of the integrity of the capsule structure, the tumor masses do not get into the wound.

Medicine has not yet found the correct and most optimal solution that would allow such oncological surgical operations to be carried out without problems. Today, more and more often, when detecting tumors of large volumes, thoracophrenotomy in the tenth intercostal space is used. This is by far the best method, but it has some complications associated with pneumothorax and infection of the pleura.

It is worth admitting that the only effective and radical method for pathologies of this type is the surgical method. It is it that needs to be improved, and for more convenient operation it should be finalized.

Use of chemotherapy or a radioactive isotope

In many cases, adrenal tumors are treated with chemotherapy or radioactive isotope treatment given intravenously. Through this injection, a sufficient number of cystic cells can be destroyed, as well as the number of metastases can be reduced.

The use of this therapy is appropriate for primary advanced tumors or in the postoperative period, when metastases may reappear.

Such methods of treatment are not very useful, because when they are used, the human immune system suffers greatly, which means that the body will not be able to fully function. Failure of the immune system is a very important component of any disease, including adrenal tumors. Therefore, it is very important for any specialized doctor in this type of therapy, if not to maintain, then to maintain the patient's immune status at a high state. After all, the main component of the success of treatment is when the body itself, first of all, fights for its recovery.

Prognosis for adrenal tumors

Adrenal tumors that are benign may have a favorable prognosis. Patients with hormonally active tumors have a more favorable outcome than patients with endocrine inactive forms of the disease. This is directly related to the early diagnosis and timely treatment of tumors that produce hormones. Statistics show that the survival rate of operated patients is 32-47%, and inoperable patients with locally advanced cysts - 10-30%. Not so rosy statistics for patients who are sick with disseminated adrenal cancer, because they do not live with such a diagnosis for even one year.

Prevention in adrenal tumors

Prevention for adrenal tumors has not been fully identified, so it is worth preventing the recurrence of tumors that have already been removed. After removal of the adrenal tumor in the absence of metastases, the body recovers completely: fertility and the menstrual cycle are restored, the symptoms of virilization are removed. After the operation, it is worth being observed by specialists, systematically visiting a doctor. Patients after adrenalectomy of a tumor of the adrenal glands should stop using sleeping pills, drinking alcohol, they need to limit mental and physical activity.

This pathology is caused by uncontrolled proliferation of gland cells, as a result of which a tumor arises and grows. It can proceed in the form of benign or malignant, grow from the tissues of the brain or cortical area of the organ, have a different morphological affiliation and type of histology.

The disease shows itself with frequent paroxysmal crises in the form of:

Cardiac disorders - tachycardia, increased blood pressure;
Excitement and feelings of inexplicable danger;
Trembling in the muscles;
Pain in the chest;
Increased urination.

With the development of the disease, diabetes mellitus, sexual and renal dysfunction often occur.

Classification

Tumors of the adrenal gland, like others, are divided into benign and malignant, primary and secondary. In addition, there is a clear classification according to the histological structure of cancer cells.

Primary, called tumors, the source of formation of which is located in the organ itself - the adrenal gland. They can affect tissues, both brain and cortical structures, be hormonally passive or active. In the latter case, tumors produce steroid hormones.

Tumors of the adrenal glands, of a secondary nature of origin, arise as a result of damage to the organ by metastases produced by a cancerous tumor of another location.

Of paramount importance in predicting the development of the disease is whether the tumor belongs to benign or malignant formations. In the first case, its surgical removal, for the most part, leads to a complete recovery, in the second, the situation is more complicated. Its development is highly differentiated by the stage of development of the process and the histological type of cancer cells.

Classificationsaccording to the type of histology, tumors of the adrenal glands are subject to two main groups:

With localization in the tissues of the cortex of the organ. These include epithelial neoplasms - carcinoma, adenoma of cortical tissue cells and mesenchymal - angioma, lipoma, myelolipoma and fibroma;
With the localization of the focus in the tissues of the medulla. These are neuroblastoma, ganglioma, pheochromocytoma and sympathogonioma.

According to another classification - according to the Nikolaev method, tumors are distinguished, which can equally have signs of benign neoplasms or malignant:

Androsteroma;
Corticosteroma;
Aldosteroma;
Corticoestroma;
Corticoandrosteroma.

Separately, it is worth dwelling on the properties of some neoplasms - independently and in large quantities, produce hormones. Neoplasms that are inactive in this regard, for the most part, have a benign cellular structure and are often accompanied by overweight, diabetes mellitus and a strong increase in blood pressure. They are detected in both men and women in all age categories. Much less often, hormonally passive tumors are observed. These include melanomas, teratomas and pyrogenic tumors.

Hormonally active tumors include aldosteroma, androsteroma, corticoestroma, pheochromocytoma. They are the most significant from the point of view of the clinic, so we will describe them in more detail.

Tumors that produce hormones

The tumor is an aldosteroma, leads to a violation of the mineral-salt balance of the body, since it produces a hormone in large quantities - aldosterone. Its excess leads to muscle atrophy, hypertension, hypoglycemia and alkalosis. The vast majority of cases of detection of such neoplasms are single tumors, and about a tenth of them, with multiple foci on one or both adrenal glands. No more than 4% of all cases have a malignant nature.

Glucosteroma- a tumor producing a secret - a glucocorticoid. Its focus grows in the fascicular area of the adrenal cortex and leads to premature maturation of the genital organs in children, a decrease in libido and sexual function in mature patients. In addition, glucosteroma manifests itself as arterial hypertension and obesity. This type of tumor can also have a dual nature - benign and malignant, and is considered the most common oncopathology of the adrenal cortical tissues.

Corticoesteroma grows from the cortical tissues of the reticular and fascicular areas and secretes, in the form of its metabolic products, secrets - estrogens, and this leads to the development of sexual dysfunction in men and the restructuring of the female hormonal background according to the male principle. Most often, such a tumor of the adrenal glands is of a malignant nature, develops rapidly and aggressively, and is detected mainly in men at a young age.

Androsteroma localized, as a rule, in the ectopic area of the adrenal gland, somewhat less often in the reticular area of the cortical substance. It produces a hormone - androgen in large quantities. For women, this translates into symptoms of virilization, for girls into pseudohermaphroditism, and the consequences of the development of this tumor for the male are accelerated puberty. Androsteromas are twice as likely to affect the weaker sex, mainly under the age of 40 years, with more than half of those diagnosed with androsteromas being malignant. In the latter case, tumor development is extremely aggressive, with early production of metastases to the liver, lungs, and regional lymph nodes.

Pheochromocytoma- a neoplasm, in most cases affecting the cells of the brain tissue, less often the tissues of the neuroendocrine system, accompanied by autonomic disorders. In nine out of ten patients, the identified phoechromocytoma is benign in nature, however, some of these tumors are prone to degeneration into malignant - about 10 per hundred cases. This type of tumor has a pronounced, hereditary predisposition and is predominantly inherent in the female sex in the period of 30-50 years.

Symptoms of adrenal cancer

Each of the described types of tumors has its own characteristics and symptomatic manifestations inherent only to it.

Albdosteroma

The growth of this tumor produces stable arterial hypertension, pain in the brain, shortness of breath, cardiac arrhythmias, changes in the structure of the myocardium - first hypertrophy, and with the development of the process, its degeneration. At the same time, such hypertension does not respond to conventional therapy.

The influence of these processes leads to disruption of the visual apparatus - at first, angiospasms appear, then there are more frequent ocular hemorrhages, which ultimately leads to irreparable degradation and inflammation of the optic nerve.

With the activation of the production of aldosterone by the tumor, there are:

Intense headaches;
Nausea and vomiting;
myopathy;
Dysfunction of the visual apparatus;
respiratory dysfunction;
Moderate paralysis and paroxysmal tetany.

In addition, hypokalemia develops, with markedly pronounced irrepressible thirst, necturia and polyuria. Urine at the same time acquires a pronounced alkaline reaction. Muscle weakness increases, convulsions occur, and over time, cell acidosis and atrophy of muscle tissue and nerve endings develop. The development of this condition can lead to coronary pathology and stroke.

According to the majority of interviewed patients, their aldosteroma proceeded with mild symptoms or was completely asymptomatic, however, this is true only for the initial stages of the development of the oncological process and, when a certain line is passed, the symptoms appear and grow like an avalanche.

Corticosteroma

The clinical course of the disease leads to obesity, fatigue, steroid-type diabetes develops and sexual dysfunction increases. At the same time, microhematomas and striae appear in the region of the mammary glands, abdomen and thighs, in their inner area. For men, the development of testicular hypoplasia, gynecomastia, impaired potency is characteristic, and the weaker sex develops masculine signs - a decrease in voice timbre, male-type hair growth and an increase in the external dimensions of the clitoris.

As side effects it is worth noting:

Osteoporosis leading to increased susceptibility to vertebral compression injury;
Pyelonephritis;
Urolithic pathology.

In difficult situations, there is a modification of the mental state - a strong unreasonable excitement or, on the contrary, depression.

Corticoesteroma

Symptoms of this type of tumor in children appear depending on their gender. For example, in boys, the process of puberty is inhibited, while in girls, on the contrary, it occurs faster than in children of the same age. The girl's body responds to the development of corticosteroma, premature development of the mammary glands and genital organs, hair growth, early menstruation and accelerated growth of the bone tissue of the skeleton.

Signs of corticoesteroma in men are expressed by symptoms of feminization:

Degeneration and atrophy of the genital organs;
Hair loss on the face, chest and pubis;
Increase in voice timbre;
Formation of a figure according to the female type;
Developing infertility due to oligospermia and suppression of potency.

In mature women, the symptoms of this tumor are often very blurred or not noticeable at all. The disease can only be determined by an increase in the content of estrogen in the blood test above the norm.

Androsteroma

This tumor produces a large amount of active androgens - testosterone, dehydropiandrosterone, androstenedione and the like, while having a pronounced anabolic and viril effect.

Symptoms for children:

Precocious puberty;
Accelerated growth of muscle and skeletal mass;
The formation of a profuse rash on the face and body;
Not childishly low timbre of voice.

For mature women, the following signs are characteristic:

Violation of cyclicity and termination of monthly cycles;
Hypotrophy of the mammary glands and uterus with a simultaneous increase in the size of the clitoris;
Reducing the mass of subcutaneous fat;
Decrease in the timbre of the voice and increase in sexual desire.

In men, this type of adrenal tumor is mostly diagnosed incidentally, due to the extremely mild and subtle manifestations of the disease.

Pheochromocytoma

This tumor is characterized by severe hemodynamic pathologies. With a paroxysmal course of the disease, observe:

Paroxysmal bursts of arterial hypertension, accompanied by severe headaches, dizziness, heart rhythm disturbances;
Bloodlessness of the skin - pallor;
increased sweating;
Nausea and vomiting;
polyuria;
Pain in the chest area;
High body temperature;
Unreasonable panic attacks.

High physical activity, overeating, alcohol and any severe stress can lead to the occurrence of a paroxysmal attack. The duration of such a crisis is several hours and can be systematically repeated with varying regularity - from several times a day, to one for a month or even several.

Such a crisis arises and ends almost instantly - a rapid increase in its signs is replaced by an equally rapid normalization of processes. At this time, there is a strong secretion of saliva and sweat.

Unclassified tumors of the adrenal gland

Such neoplasms include tumors that do not give symptoms of femenization, virilization, the course of which is asymptomatic or does not have a clear histological classification. These neoplasms are detected for the most part by chance, during a hardware examination of the peritoneum regarding the diagnosis of diseases of a different nature.

Treatment

According to the reviews of patients who have been treated, its most effective method, especially for hormonally active types of tumors, is the surgical removal of its focus and part of the tissues adjacent to it, however, provided that the tumor is small. The remaining cases are treated with therapeutic methods aimed at inhibiting cancer cells and slowing down or stopping the development of the process.

When choosing surgical treatment, it is carried out laparoscopically, while the tumor is removed along with the gland - adrenalectomy. With a benign course of the disease, this is considered sufficient, but if the process has malignant signs, locally located lymph nodes are also subject to resection along with the adrenal gland. Reviews about this treatment are the most positive.

In the treatment of pheochromocytoma, surgical intervention is undesirable, since there is a high risk of severe hemodynamic pathologies, therefore, more and more often, such a tumor is treated radiologically, by introducing radioactive particles into the blood that inhibit not only the tumor focus, but also metastases, in their presence.

Recently, the treatment has been successfully carried out with chemical preparations - lysodren, mitotane and the like.

The success of treatment depends not only on the stage of development of the oncological process, but also on competent rehabilitation therapy. For example, to reduce the risk of developing a pheochromocytoma crisis, the patient is given a course of drug therapy, drugs based on nitroglycerin, regitin or phentolamine, and after a radical removal of the adrenal gland, hormone replacement therapy is indicated on an ongoing basis.

Treatment Predictions

The most favorable forecasts for benign neoplasms. Their timely removal is almost guaranteed to lead to healing, but not without complications. For example, when removing androsteroma in children, they usually remain significantly lower than healthy peers, and the removal of pheochromocytoma, in about half of the patients, including children, brings chronic heart disorders that require constant medical correction.

The best prognosis is in patients with benign corticosteroma. Within 1-2 months after its removal, stable processes of restoring natural processes are observed - appearance, weight, metabolic processes are normalized, the symptoms of steroid diabetes and hirsutism disappear.

As for tumors of a malignant nature, the prognosis of their treatment is unfavorable, especially if there is branched metastasis on the face. The survival of these patients is questionable.

Of great importance in the prognosis of survival is the quality of therapeutic therapy, which directly depends on the level of the clinic. According to numerous patient reviews, clinics in Israel, Germany and the USA are considered the best oncology clinics, however, recently, the number of the same positive reviews about the Moscow Cancer Centers in the capital has increased significantly.

Description

The adrenal glands are paired glands responsible for the production of certain hormones (mineralocorticoids, glucocorticoids, androsteroids) and participating in a number of metabolic processes:

protein;
water-salt;
carbohydrate.

All of the above steroid hormones are synthesized by the adrenal cortex. The medulla produces the neurotransmitters catecholamines, which are responsible for the transmission of impulses and metabolism.

Tumors, which are growths in one or both organs, interfere with the normal functioning of the adrenal glands. Growths can originate from the cortex or medulla and differ in their morphological and histological structure.

The disease is very dangerous due to the inaccessible localization and the small size of the neoplasm. Pathology is poorly amenable to drug treatment, in most cases the tumor is removed promptly.

Classification

Depending on the etiology of the disease, benign and malignant tumors are distinguished.

benign(lipoma, myoma, fibroma) are characterized by the absence of clinical manifestations, are small in size. They are usually discovered by chance.

Malignant(melanoma) are characterized by rapid growth, the presence of intoxication manifestations. Subdivided into primary(arising directly in the adrenal glands) and secondary(metastasized from other organs).

According to their localization, neoplasms are divided into:

tumors of the adrenal cortex;
brain tumors.

The first, in turn, are classified into:

aldosteroma- neoplasm from the epithelial layer of the adrenal cortex, synthesizing mineralocorticoids;
androsteroma- a tumor characterized by increased production of androgens;
corticosteroma- a neoplasm of the cortical substance that produces cortisol in excess;
corticoestroma- hormonally active formation of the adrenal cortex, characterized by an increased synthesis of female sex hormones;
mixed forms(glucoandrosteroma).

Depending on their activity, tumors are divided into:

hormonally inactive(fibroma, lipoma, myoma). These neoplasms do not have severe symptoms and are most often benign. They occur with equal frequency in both sexes and are often accompanied by obesity and diabetes mellitus. Malignant tumors of a hormonally inactive type (eg, teratoma, melanoma) are not common pathologies.
hormonally active characterized by excessive production of a certain hormone.
These include:

aldosteromas- their occurrence leads to violations of water-salt metabolic processes. Aldosterone produced by this tumor causes an increase in pressure, removes potassium from the body and leads to muscle weakness and alkalosis. This formation can be single or multiple. Poor-quality aldosteroma is detected in 2-4% of cases;
corticosteromas provoke the production of glucocorticoids and are the cause of metabolic disorders. Patients develop symptoms of Itsenko-Cushing's disease - obesity, hypertension, dysfunction of the reproductive system. It is considered the most common type of tumors of the adrenal glands;
androsteromes- neoplasms that synthesize male hormones. The development of pathology in boys leads to early puberty, in girls - to the appearance of male secondary sexual characteristics. Approximately half of androsteres are malignant neoplasms and occur in young men;
corticoestroms produce female hormones and lead to the appearance of female secondary sexual characteristics in men, the development of impotence. Pathology is malignant in the vast majority of cases;
pheochromocytoma produces catecholamines, provokes the occurrence of vegetative crises. In 90% of cases, the formation is benign. It occurs predominantly in women under the age of 50.

Symptoms

Signs of the development of pathology are caused by those hormones, the synthesis of which occurs in excess.

On the increased synthesis of aldosterone indicate:

persistent hypertension, not amenable to medical adjustment;
systematic headaches;
violations of cardiac activity;
thirst;
profuse and frequent urination;
ophthalmic disorders (problems with blood supply to the retina, hemorrhages, edema of the optic nerve);
convulsions due to hypokalemia;
tissue degeneration.

Asymptomatic aldosteroma occurs in 6-10% of patients.

On occurrence corticosteromas indicate the following factors:

the presence of obesity;
headaches;
increased blood pressure;
muscle weakness;
diabetes;
the occurrence of kidney diseases: pyelonephritis and urolithiasis;
depression or, conversely, increased excitability.

Men complain of impotence, gynecomastia, testicular hypoplasia. In women, the type of hair growth changes, the voice becomes coarser.

Androsteromes in women, they manifest themselves as a combination of the following symptoms :

low timbre of voice;
underdevelopment of the uterus and mammary glands;
increased libido;
reduction of the fat layer.

In men, it may not appear at all or be detected by chance.

For possible development corticoesteromas indicate:

breast and vulvar enlargement;
gynecomastia;
high timbre of voice;
distribution of body fat by female type;
impotence.

In women, corticoesteroma is asymptomatic.

emergence pheochromocytomas accompanied by a number of dangerous conditions, including:

hypertension;
dizziness;
increase in temperature;

The development of the condition is provoked by physical stress and prolonged exposure to stress.

Diagnostics

Modern methods of research allow not only to diagnose a tumor of the adrenal glands, but also to thoroughly determine its type, size, location.

Based urinalysis the functional activity of neoplasms is revealed. To do this, the level of content in the liquid is calculated:

aldosterone;
cortisol;
catecholamines;
vinylmandelic acid.

Blood for research take before taking medications, as well as immediately after their consumption. It is also necessary to check blood pressure before and after taking medication.

Phlebography of the adrenal glands serves to assess the hormonal activity of the neoplasm. Radiography of the adrenal glands is contraindicated in pheochromocytoma, which can provoke a crisis.

Ultrasound, MRI and CT used to determine the localization of the tumor, as well as suspected of its malignant etiology.

Treatment

To date, there is no effective medical treatment for adrenal tumors. All hormonally active neoplasms, as well as all others with a diameter of more than 3 mm, are removed surgically.

Medical manipulations are carried out in an open or laparoscopic way. With a benign nature of the tumor, the affected adrenal gland is removed completely. Glands with malignant neoplasms are excised along with nearby lymph nodes.

In the event that the remaining adrenal gland is not able to fully perform its natural function, the patient is prescribed hormone replacement therapy throughout life.

Operations to remove pheochromocytoma are considered the most difficult due to possible complications of a hemodynamic nature and the development of a crisis. In the event of complications, the patient is shown injections with nitroglycerin and phentolamine.

Some types of tumors can be treated with chemotherapy drugs (chloditan, mitotane, lysodrenome). After the end of the course of chemotherapy, the patient is prescribed hormonal drugs.

Removal of the adrenal glands along with the tumor is fraught with the development of complications. When the androster is removed, the patient may develop short stature. After removal of pheochromocytoma, tachycardia and hypertension are recorded.

With timely treatment of benign formations, doctors give a favorable prognosis and guarantee an active life until old age.

You will learn more about adrenal tumors from the video.

The adrenal glands are an endocrine gland that has a paired structure. Pairs or lobes of the adrenal glands are fixed in the upper part of the right and left kidneys.

The structure of the adrenal glands has a complex structure, therefore, two layers are distinguished in them: the outer one is the cortical one, and the inner one is the brain one.

Regardless of what provokes tumors of the adrenal glands, they can be located in any of the layers, but the external manifestations of tumors located in the cortical layer and tumors located in the medulla differ significantly from each other. So why do adrenal tumors occur? Symptoms, diagnosis, treatment of adrenal cancer - read on.

Scientists have not yet been able to single out a certain pattern of the occurrence of pathology with a clearly traceable causality. However, it is known that the risk group for this disease includes patients:

With congenital pathologies of the thyroid and pancreas, pituitary gland, endocrine neoplasia of all types.
People whose next of kin have been diagnosed with lung or breast cancer.
Patients with hereditary hypertension, diseases and pathologies of the structure of the kidneys and / or liver.
The maximum risk of rapid development of a tumor of the adrenal glands in persons who have independently undergone oncological diseases of any organs. This is due to the spread of cancer cells from the affected tissues through the blood and lymph of the body.

Classification of tumors

In the focus of pathological growth of new tissues, both malignant (10%) and benign (90%) cells can be found.

In the vast majority of cases, growths of a benign nature are diagnosed. The frequency of detection of malignant structures does not exceed 2% of cases in adults, and 1.5% of cases in children.

Tumors of the adrenal glands are classified according to the tissues within which they originated:

in the epithelial tissue of the adrenal cortex - aldosteroma, androsteroma, adenoma, corticoestroma and carcinoma;
in the connective tissue between the cortical and cerebellar layers - fibroma, lipoma, myeloma, angioma;
in the tissue of the medulla - ganglionoma, ganglionevroma, pheochromocytoma (the most common type of tumor), sympathogonioma, neuroblastoma;
combined, that is, located in the tissues of the cortical and medulla layers - incidentalomas.

In any of these tumors, a benign or malignant structure can be found.

Signs of a benign tumor:

small size - diameter up to 5 cm;
absence of external manifestations (symptoms);
discovered incidentally during ultrasound examination of the gastrointestinal tract.

Signs of a malignant tumor (cancer of the adrenal glands):

large size - 5–15 cm in diameter;
rapid growth and rapid growth;
pronounced symptomatic manifestations, provoked by an excess of the hormone produced by the affected tissues.

Additionally, malignant tumors can be classified as primary, that is, consisting of the organ's own tissue, and secondary, that is, resulting from the penetration of metastases from other organs.

There is a more detailed classification of primary tumors - they can be hormonally inactive and hormonally active.

Hormonally inactive or clinically “silent” (not manifesting external symptoms) are mostly benign, the most common are fibroids and fibromas in women, and lipomas in men.

They can occur at any age, as an element that accompanies chronic obesity, hypertension, type II diabetes mellitus.

Among malignant hormonally inactive tumors, the most common are: pyrogenic cancer, teranoma, melanoma.

Hormonally active, that is, producing increased daily doses of hormones and having vivid clinical symptoms:

arising in the cortical layer - corticosteroma, aldosteroma, corticoestroma, androsteroma;
arising in the medulla - pheochromocytoma.

The adrenal glands control the body's fat reserves, help to adapt to stressful situations, that is, it is a very important organ in the human body. Here you can learn how to check the work of the adrenal glands and diagnose possible pathologies in time.

Classification according to the physiological pathologies they cause

Imbalance of water-salt and sodium metabolism - aldosteroma.
Acceleration or slowdown of metabolic processes - corticosteromas.
The manifestation of secondary male sexual characteristics in women (pathological growth of body hair, male-type hair growth, change in gait, coarsening of the voice) - androsteromas.
The manifestation of secondary female sexual characteristics in men (breast growth, hair loss, increased voice timbre - corticoestroms.
The manifestation of male sexual characteristics in combination with metabolic disorders in women - corticoandrosteroma.

Hormonally inactive benign tumors often do not require surgical removal or corrective hormone therapy. People in whom they were found can continue their usual lifestyle, but they need to be examined by an endocrinologist every 6 months and turn to him with a sharp change in well-being.

Hormonally active tumors, regardless of nature, require surgical removal and subsequent hormone therapy, which must be constantly adjusted under medical supervision.

The only right decision in each case can only be made by a specialized medical specialist.

Pathogenesis and symptoms of the most common hormonally active types of tumors

Aldosteroma

Aldosteroma is a tumor that grows in the tissues of the adrenal cortex and causes a pathological excess of the hormone aldosterone. Its development is manifested by Conn's syndrome, which includes such disorders of mineral-sodium metabolism:

development of hypertension;
weakening of muscle tissue, periodic spasms and convulsions;
alkalosis - an increase in the level of blood ph above normal (7.45 units per milliliter of blood);
hypokalemia - a decrease in the calcium content below the minimum normal limit (3.5 units per milliliter of blood fluid).

Aldosteromas are found in such varieties: single, multiple, bilateral or unilateral.

Malignant variants among them found no more than 4%.

Androsteroma

Androsteroma - can be located in the zone of the adrenal cortex and in their ectopic tissue. Outwardly, it reveals itself as an androgenital syndrome, which has the following symptoms:

In girls who have not reached puberty - pseudohermaphroditism.
In mature women - hirsutism, delayed menstruation, sometimes their complete cessation. Rapid loss of total body weight, dystrophy of mammary gland tissues, a decrease in the volume of the uterus, resulting in infertility.
In boys who have not reached the age of puberty - untimely early sexual development, purulent acne on the skin of the whole body.
In men, the symptomatic picture is erased, the diagnosis of this tumor in them is usually accidental.

Most often, androsteroma occurs in children under adolescence and women 20-40 years old. In more than 50% of cases, this tumor is malignant in nature and can quickly metastasize to life-supporting organs: lungs, liver, lymphatic system and blood cells.

However, androsteroma is a rare tumor, its share of the total percentage of tumors that occur in the adrenal glands is no more than 3%.