HomeAdrenal gland diseases and tumors
The pair of adrenal glands are located on top of both kidneys. They are also called suprarenal glands. Adrenal glands produce and secrete multiple hormones that important in all human daily body functions
For more detailed description please see http://www.adrenaltumors.org or click on image below
What are adrenal tumors?
Tumors of the adrenal glands are rare. When present, they can cause a multitude of disorders by excessively secreting certain adrenal gland produced hormones. However most of them are not producing any hormones. Non hormone producing (non-functional) adrenal tumor called incidentaloma. Only small percent of adrenal tumors are cancerous. Growing of the adrenal tumor is always worrisome sign of adrenal cancer (adrenocortical carcinoma). Adrenal tumor that is growing has to be surgically removed. Tumor that is bigger then 4 cm also has to be removed for the same reason - to rule out or cure cancer.
There are several types of functional adrenal gland tumors. Most common are pheochromocytoma, Cushing's syndrome, and aldosteronoma. If adrenal tumor is functional the only treatment is surgical removal of the part or entire adrenal gland (glands)
What are overactive adrenal glands, or functional adrenal tumor?
When adrenal gland or both glans produce excessive amounts of certain hormones, they are called "functional." Symptoms and treatment depend on which hormones are being overproduced:
- corticosteroids - an overproduction of corticosteroids can lead to Cushing's syndrome or disease (see below). Syndrome is results of adrenal gland tumor or bilateral hyperfunction: Cushing's disease is result of pituitary (brain gland) tumor.
- Catecholamines and metanephrines - are hormones that into the blood during times of physical or emotional stress. Catecholamines include dopamine, norepinephrine, and epinephrine. They are released by adrenal medulla. Tumor that developed from this part of he adrenal gland called Pheochromocytoma. It results in overproduction of catecholamines and metanephrines, that cause significant elevation of blood pressure, heart rate and metabolism. Sudden stress or other activities result in acute elevation of these hormone levels in blood stream and may results in heart attack or stroke.
- aldosterone - an overproduction of the aldosterone hormone can lead to high blood pressure and to those symptoms associated with low levels of potassium (i.e., weakness, muscle aches, spasms, and sometimes paralysis).
- androgenic steroids (androgen hormones) - an overproduction of androgenic steroids (such as testosterone) can lead to exaggerated male characteristics in both men and women, such as hairiness of the face and body, baldness, acne, deeper voice, and more muscularity.
How are overactive adrenal glands diagnosed?
In addition to a complete medical history and medical examination, diagnostic procedures for overactive adrenal glands may include:
- specific blood tests to measure levels of hormones
- urine tests to measure levels of hormones
Treatment of overactive adrenal glands:
Treatment of overactive adrenal glands depends on the cause of the disease. Most of them are treated surgically, but it also depends on extend of the disease, your tolerance for specific medications, procedures, or therapies, expectations for the course of the disease.
Treatment usually include surgical removal of the entire adrenal gland(s) itself. Certain drugs that block the excessive production of certain hormones may also be administered.
What is Cushing's syndrome?
Cushing's syndrome is the result of the excessive production of corticosteroids by the adrenal glands. An overproduction of corticotropin -- the hormone that controls the adrenal gland -- by the pituitary gland, which stimulates the adrenal glands to produce corticosteroids, may be one cause. It is called Cushing's disease. In addition, certain lung cancers and other tumors outside the pituitary gland may produce corticotropins. Other causes include benign or cancerous tumors on the adrenal glands.
What are the symptoms of Cushing's syndrome?
The following are the most common symptoms. However, each individual may experience symptoms differently. Symptoms may include:
- upper body obesity
- round face
- increased fat around neck
- thinning arms and legs
- fragile and thin skin
- stretch marks on abdomen, thighs, buttocks, arms, and breasts
- bone and muscle weakness
- severe fatigue
- high blood pressure
- high blood sugar
- irritability and anxiety
- excess hair growth in women
- irregular or stopped menstrual cycles in women
- reduced sex drive and fertility in men
How is Cushing's syndrome diagnosed?
In addition to a complete medical history and medical examination, diagnostic procedures for Cushing's syndrome may include:
- 24-hour urinary test to measure for corticosteroid hormones
- blood test for ACTH level
- dexamethasone suppression test - to differentiate whether the excess production of corticotropins are from the pituitary gland, brain (pituitary) tumor, or tumors elsewhere
- corticotropin-releasing hormone (CRH) stimulation test - to differentiate whether the cause is a pituitary tumor or an adrenal tumor
- computed tomography (CT scan) - a non-invasive procedure that takes cross-sectional images of the abdomen and brain or other internal organs;
- magnetic resonance imaging (MRI) - a non-invasive procedure that produces two-dimensional views of an internal organ or structure, especially the adrenal gland and brain
Treatment for Cushing's syndrome:
Treatment for Cushing's syndrome depends on its cause. Surgery may be needed to remove tumors or the adrenal glands. Other treatment may include radiation, chemotherapy, and use of certain hormone-inhibiting drugs
What is a pheochromocytoma?
A pheochromocytoma is a benign adrenal gland tumor that secretes epinephrine and norepinephrine hormones. These hormones are responsible for regulating heart rate and blood pressure, among other functions. Pheochromocytomas occur most frequently in young to middle-aged adults between the ages of 30 and 60.
What are the symptoms of pheochromocytoma?
The most common symptom of pheochromocytoma is high blood pressure, which is sometimes extreme. Other symptoms are usually nonexistent, unless the person experiences pressure from the tumor, emotional stress, changes in posture, or is taking beta-blocker drugs for a heart disorder. Each individual may experience symptoms differently. Other symptoms may include:
- rapid pulse
- palpitations
- headache
- nausea
- vomiting
- clammy skin
How is pheochromocytoma diagnosed?
In addition to a complete medical history and medical examination, diagnostic procedures for pheochromocytoma may include:
- blood and urine tests to measure hormone levels
- MRI
- radioisotope scan - MIBG - uses radioactive substances introduced into the body to create an image of the functioning adrenal gland
Treatment for pheochromocytoma
Treatment for pheochromocytoma is surgical - removing the adrenal gland(s) with tumor. Before removing the tumor, however, your physician have to prescribe drugs to control high blood pressure for several weeks prior to surgery. Previously laparoscopic approach through the abdomen had been widely used, but currently the best approach for the patient is posterior retroperitoneoscopic adrenalectomy.
Rarely pheochromocytomas can be malignant and may metastasize to other organs. This may happens in about 10% of the patients. Chemotherapy following resection of the primary tumor is the treatment of choice for malignant pheochromocytomas.
What is aldosteronoma?
The adrenal gland normally secretes a hormone called aldosterone. Aldosterone helps the body conserve fluids in times of dehydration. When an aldosterone producing tumor occurs (aldosteronoma), this adrenal tumor over produces this substance and results in high blood pressure. This disease called primary aldosteronism (or primary hyperaldosteronism). Blood and urine tests confirm the chemical diagnosis of primary hyperaldosteronism. These small adrenal tumors are usually localized with a CT scan or MRI of the abdomen prior to planning surgery. The best and surgical treatment is laparoscopic removal of adrenal tumor. It is minimally invasive and allows quickest recovery. The best for the patient and more advanced approach is from the back - posterior retroperitoneoscopic adrenalectomy. Posterior retroperitoneoscopic adrenalectomy (PRA) is truly minimally invasive adrenal surgery, patients have minimal pain and able to go back to normal activities the day of the surgery (see it on YouTube http://youtu.be/g1z3hjlUosw). Posterior retroperitoneoscopic adrenalectomy has the best cosmetic result, but it is only performed by limited number of endocrine surgeons in the country, such as it requires high level of expertise and advanced training.
For more details and pictures see http://www.adrenaltumors.org
