adrenal tumor
Introduction
Introduction to adrenal tumors Classification of adrenal tumors can be divided into benign tumors and malignant tumors according to their nature; classified as non-functional tumors and functional tumors according to the presence or absence of endocrine function (such as secretion of certain hormones to cause hypertension); Medullary tumors, stromal tumors or metastases. Adrenal tumors that require surgical intervention in the clinic are usually functional tumors or tumors that are highly suspected of malignancy (or pre-operatively different from benign and malignant). The adrenal gland is an important endocrine organ in the body. Because of its close relationship with the kidney, it is traditionally a urological disease. The left and right sides of the human adrenal gland are located in the retroperitoneum, and the lower lateral side is closely adjacent to the upper and lower sides of the bilateral kidneys. The shape and size of the adrenal gland looks like the last finger of an adult. The head, body and tail are also like the end of the finger from the root to the fingertip, but if you carefully explain the part, the right adrenal gland is a triangle. The left adrenal gland is a semilunar shape. The former straddles the innermost pole of the right kidney, while the latter hangs over the innermost pole of the left kidney. The length, width and thickness are 4.0 cm to 6.0 cm, 2.0 cm to 3.0 cm and 0.3 cm, respectively. ~0.6 cm. The normal adrenal gland weighs about 4.0 to 5.0 grams. Although the volume of the adrenal gland itself is small, the volume of tumors it grows varies greatly. Usually, those with a diameter of 3 cm or less are called small tumors, and the smallest ones are less than 1 cm, and the larger ones can be more than ten to 30 cm. The shape of the tumor can be, for example, bean, peach, apple, cantaloupe, and pillow. basic knowledge The proportion of patients: 0.003%-0.004% (middle-aged people over 50 years old) Susceptible people: no special people Mode of infection: non-infectious Complications: high blood pressure
Cause
Adrenal tumor cause
Cortisol
A series of pathophysiological changes and clinical manifestations caused by increased cortisol in the human body are cortisol, or hypercortisolism, formerly known as Cushing's syndrome.
(1) Autonomous hypersecretion of cortisol due to the presence of adrenal tumors (adenomas or carcinoma); approximately 25% of cases.
(2) Due to the presence of pituitary adenoma or hypothalamic and even central nervous system neuroregulation, the pituitary gland secretes adrenocorticotropic hormone, which causes hyperplasia of the bilateral adrenal cortex and secretion of excessive corticosteroids.
(3) Organ tumors other than the endocrine system (such as small cell lung cancer), cancerous tumors (lung, gastrointestinal), thymoma, pancreatic tumor, medullary thyroid carcinoma, ganglion tumor, melanoma, prostate cancer, etc. The self-secreted ACTH (with ectopic ACTH syndrome) increased during the onset of the disease.
(4) Increased iatrogenic corticosteroids. Due to the long-term use of glucocorticoids in the treatment of similar symptoms, it gradually disappeared after stopping the drug.
Aldosterone
Aldosterone can be divided into primary and secondary. Primary aldosteronism is a rare disease caused by excessive secretion of aldosterone by adrenal adenomas and hyperplasia. Secondary aldosteronism is caused by excessive aldosterone secretion caused by various diseases of the adrenal gland, including nephrotic syndrome with varying degrees of edema, ascites in cirrhosis, heart failure, and rapid progression in hypertension. Described herein is primary aldosteronism.
Primary aldosteronism is a syndrome in which renin secretion is inhibited due to increased secretion of aldosterone in humans. It is clinically characterized by hypertension and hypokalemia. In 1954, Kong first reported a case of resection of an adrenal adenoma that secreted aldosterone, which was named Conn's syndrome. The vast majority of the adrenal glands causing this disease are small benign adenomas located in the outermost layer of the adrenal gland. Adrenal cancer is rare, accounting for about 1% of low renin aldosteronism. There are fewer than 50 cases reported internationally. Currently, internationally estimated aldosteronism accounts for 0.65% to 2% of hypertension.
Adrenal gland abnormality
An abnormality of the external genitalia and sexual characteristics caused by a certain congenital or acquired disease in the kidney, called adrenal gland abnormality or adrenal reproductive syndrome.
1. Classification This disease is also rare, with more than 100 domestic reports. This disease can be named according to the age of onset, gender, etiology, and abnormal sexual characteristics.
2. The cause of the disease is due to hyperplasia, mainly occurs in the relevant aspects of the cortex network. Sex hormones produced and secreted by the human adrenal gland are predominant, and there are few estrogens. In the normal development of the adrenal cortex, the normal role of the enzyme must be in order to complete successfully, the lack of enzyme supply or the occurrence of obstacles, that is, affect the synthesis of cortisol, promote adrenal hyperplasia, thereby increasing the role of androgen, which is equal to the fire A large number of male corticosteroids convert female patients into males. Because of the tumor, the disease is caused by the secretion of the tumor and the accumulation of sex hormones in the body.
Pheochromocytoma
The adrenal medulla is located in the middle part of the adrenal gland, accounting for only about 10% of the adrenal gland. The morphology of medulla cells is different. Since granulocytes in these cells are stained when they are treated with a chromium-containing liquid, they are called chromaffin cells.
Pheochromocytoma is mostly benign, accounting for about 90%. Therefore, its shape is less than , or as large as cantaloupe. Generally, it is citrus-sized, has a flattened fan shape, and has a deep yellow or brown cut surface. There is a lobulated structure, the tumor cells are irregular polygons, or small or large, the bones are multinucleated and contain most of the chromate-stained particles, especially suspected to be malignant dark and dark, for reference.
Adrenal medulla. Both the sympathetic nerve endings and the central nervous system can synthesize dopamine, norepinephrine and epinephrine from chrome from blood. These three are collectively referred to as catecholamines. In the sympathetic nervous system and the central nervous system, catechol is synthesized by nerve cells and then delivered to the nerve endings for release. Dopamine in the adrenal medulla is an intermediate product that must be converted to norepinephrine by dopamine beta-enhanced enzyme and further converted to adrenaline, which can be directly released into the blood circulation. When a tumor occurs in a chromaffin cell, a large amount of adrenaline and norepinephrine are stored in the tumor. In normal times, it is not easy to be perceived by the patient himself or others. However, once a certain stimulus is encountered, the tumor releases a considerable amount of catecholamine, and the patient will suddenly have elevated blood pressure, heart rhythm disorder, explode, or even fatal. Strike.
Adrenal malignancy
Adrenocortical carcinoma is rare, generally functional, usually larger than adenoma, often weighing more than 100g, invasive growth, normal adrenal tissue destruction or submersion, outward invasion of surrounding adipose tissue or even Lateral kidney. Small adenocarcinomas can have an envelope. Cut face brownish yellow, common bleeding, necrosis and cystic changes. Microscopically differentiated patients with high heterotypicity, tumor cells vary in size, and can be seen with strange nucleus and multinuclei, mitotic figures are more common. Often transferred to the abdominal aortic lymph nodes or blood to the lungs, liver and other places. Patients with high differentiation are like adenomas under the microscope. If the cancer is small and has a capsule, it is difficult to distinguish it from adenoma. Some people think that those with a diameter of more than 3 cm should be considered as highly differentiated adenocarcinoma.
Prevention
Adrenal tumor prevention
Women pay attention to the physiological and mental health care during pregnancy and childbirth, and ensure the smooth and healthy development of the fetus, or may prevent the occurrence of such lesions.
In Western countries, families with close relatives, pheochromocytoma patients have family members who also have pheochromocytoma and multiple secretory tumors, which can secrete a variety of endocrine gland hormones. This number of cases has gradually increased, and there are also a few reports in the country. In 1993, the Cancer Hospital of the Chinese Academy of Medical Sciences admitted a 15-year-old male black, right adrenal pheochromocytoma with thyroid tumor, rescued, surgically cured and discharged.
Complication
Adrenal tumor complications Complications
Different types of tumor complications are also different. More with high blood pressure.
Symptom
Adrenal tumor symptoms Common symptoms Menstrual cycle changes numbness of the distal extremities, ... limb weakness, fatigue, high blood pressure, amenorrhea, skin, purple, full moon, face vision, often foggy, fuzzy, dizziness
Cortisol
The disease is mostly female. From the end of 1980 to the end of 1998, the Cancer Hospital of Chinese Academy of Medical Sciences received 48 cases, 30 females and 18 males, aged 12-74 years. Most of the patients were obese and the limbs were not fat. The so-called "central obesity". Head bald, face round, the so-called "full moon face" color dark red dark sore, back and neck and more fat, such as "buffalo back", thin skin, hairy, armpit, lower abdomen, purple part of the thigh The patient has high blood pressure, complaining of general weakness, low back pain. Female patients appear to be dumb, amenorrhea or menstrual disorders, osteoporosis and other typical symptoms.
Aldosterone
(1) Hypertension is mainly due to increased plasma volume and increased vascular resistance caused by increased sodium ion, which is the most important or earliest symptom of this disease. Increased blood pressure is moderate or slightly elevated. Malignant hypertension can occur in children with a maximum pressure of 34.5/20.5 kPa. General antihypertensive drugs are difficult to work. There is also a normal blood pressure type of primary aldosteronism, the mechanism is unknown. Because of high blood pressure, high blood sodium often causes dizziness, headache, fatigue, blurred vision, upset, thirst and other symptoms.
(2) Myasthenia and muscle paralysis caused by hypokalemia and hypokalemia make the patient feel top-heavy, limb weakness, lower limbs, and severe paralysis. Hypokalemia leads to arrhythmia, cerebral hypoxia, and polyuria and nocturia caused by renal dysfunction. When the pancreas is affected, fasting blood sugar is increased.
(3) Alkaline poisoning caused by imbalance of water and electrolyte balance, eventually causing loss of calcium and magnesium ions, right numbness of the extremities, pain in the limbs, etc.
Adrenal gland abnormality
Abnormal adrenal symptoms are mainly manifested in the conversion of female patients to males. The so-called gender transformation is only a change in the shape of the genitals. Its true gender has not changed, because the gonads and sex chromosomes that determine its gender have not changed. Therefore, the so-called "female pseudo-hermaphroditism" occurred in the fetal period, indicating that she is different from the true hermaphroditism. The latter have both ovarian and testicular gonads, and such cases are rare. Female pseudohermaphroditism can be seen at birth when the clitoris, labia majora with the male genitalia with congenital hypospadias, the author has seen an untreated girl, the voice of the smile and the boy, and the skin Dark, hairy, taciturn, clitoris such as the penis, can erect, labia majora such as the scrotum. The urethra is the opening of the urogenital sinus. The abnormality of the male genital dysfunction in the fetal period is mainly due to the large external genitalia, and the growth is rapid in the future. The physique of the children of 4 to 5 years old and the right genitalia are as large as the size. The premature puberty at birth is mostly caused by adrenal tumors. The main symptoms are: subcutaneous fat disappearance, masculine masculinity, clitoris hypertrophy, low voice, breast and uterus shrinkage, menstrual cessation, loss of libido, etc.
Pheochromocytoma
The disease is mostly young and middle-aged patients aged 20 to 40, and the ratio of male to female is almost equal. The main symptom is the change in basal metabolism of high blood pressure: high blood pressure can be paroxysmal, persistent, or persistent hypertension. Sustained people often have dizziness, headache, chest tightness, chest pain, heartbeat and palpitation, blurred vision, nervousness, anxiety, and fear of heat. The paroxysmal sudden sudden headache, palpitations, chest tightness, pale, sweating, shortness of breath, the patient has the feeling of sudden death. At this time, if the blood pressure can reach 40.OkPa (200 ~ 300mmHg), it may relieve itself after about half an hour. After recovery, it is as ordinary. In the future, I will encounter some kind of stimulation and attack again. The number of gradual attacks is more frequent, the interval is shortened, and the situation is getting heavier. The seizure stimulation may not be very strong. There are those who wake up when they brush their teeth or dream in their dreams, sweating, and feeling awkward. There are also tumors with large tumors, high blood pressure and no symptoms of seizures, or no masses, no seizures, and deaths due to other diseases. Therefore, patients with such symptoms should be examined and treated as soon as possible.
Examine
Examination of adrenal tumors
Cortisol
B-ultrasound, CT or MRI should be used to examine the size and nature of the adrenal tumor and its relationship with the surrounding structure, as well as the X-ray positive lateral radiograph of the skull saddle, the X-ray positive lateral position of the fault and the three-dimensional saddle Slices, tomosynthesis and three-dimensional saddle images, as well as CT scans, magnetic resonance imaging to diagnose the presence or absence of pituitary adenomas or microadenomas.
Aldosterone
Laboratory inspection
1 Measure plasma potassium and sodium concentrations and 24-hour urinary potassium excretion. Hypokalemia is a spontaneous or prone to occur, or hypokalemia, should be highly suspected of this disease.
2 Plasma or 24-hour urine aldosterone concentration and plasma renin activity were measured. Standing at a plasma renin activity of less than 2.46 mol L / h, standing plasma aldosterone concentration and plasma renin activity ratio > 20.
3 aldosterone inhibition test was negative. The aldosterone secretion of primary aldosteronism is autonomous. This can rule out essential hypertension and secondary aldosteronism.
4 Glucocorticoid secretion and discharge are most normal.
5 Oral sodium chloride inhibition test: plasma aldosterone level above 554 pmll / L, urine aldosterone value of 38.8nmol / 24h or more, urinary sodium excretion more than 200mol / 24, can be diagnosed as primary aldosteronism.
Laboratory test results, such as hypergloss patients with normal glucocorticoid secretion, increased aldosterone secretion can not be inhibited by high sodium diet, accompanied by spontaneous hypokalemia and increased urinary potassium excretion, can be diagnosed as primary aldosteronism.
Imaging diagnosis
In addition to adrenal adenomas and adenocarcinomas, the introduction of adrenal cortical hyperplasia also accounts for a large proportion. The former is mainly for surgical treatment, and the latter is treated with drugs. The two methods are different, and the three must be differentially diagnosed by B-ultrasound, CT and MRI. Because adenomas that cause primary aldosteronia may be small, CT scans can be used to avoid missing tumors by using a dense layer of 0.5 cm. In the case of difficulty in identification, the adrenal isotope iodine cholesterol scintigraphy scan plus dexamethasone suppression test can be applied, that is, the patient is injected with 131I-6-iodomethyl-19-demethylol cholesterol, and the cortical adenoma absorbs more radiation than normal. Markers, cortical hyperplasia intake is normal, cortical cancer is not shown. Its accuracy rate can reach 70%~90%.
Diagnosis
Diagnosis and diagnosis of adrenal tumors
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
Adrenal gland abnormalities, pheochromocytoma were identified.
