Adrenal corticosteroma: symptoms and treatment
Corticosteroma is a benign or malignant neoplasm formed by the pathological proliferation of cells in the fascicle of the adrenal cortex.This tumor belongs to the number of hormones active.It carries an autonomous synthesis of cortisol.The overabundance of this biologically active compound causes the development of hypercorticism, known as the Itenko-Cushing syndrome.
According to medical statistics, corticosteroids are 5 times more likely to be diagnosed in women.Table of Contents: Characteristics of the tumor Reasons and pathogenesis Symptoms of adrenal corticosteroma Diagnosis Treatment of adrenal corticosteroid and prognosis
Characteristics of the tumor
Important: The older the patient, and the smaller the tumor volume, the higher the likelihood that the characterCorticosteroid benign, ie, it is an adenoma.On a share of such neoplasms it is necessary about 43%.Malignant corticosteroids include corticoblasts and adenocarcinomas of the adrenal glands.
Dimensions of adenomas vary from 1 to 15 cm, and weight - from 2 to 200 grams.A distinctive feature of benign tumors of the adrenal cortex is the presence of a tight connective tissue capsule, permeated with a variety of blood vessels.
Malignant corticosteroids often reach huge sizes, and their weight can be over 1 kg .Adenocarcinoma and corticoblast have a dense, bumpy surface.For such neoplasms characterized by infiltrative growth with the germination in the surrounding kidney tissue, adjacent organs and large blood vessels.Secondary tumor foci are formed during the migration of tumor cells by hematogenous and lymphogenous pathways. Metastases are mainly formed in paraaortic and retroperitoneal lymph nodes.
Note: for metastases is also characterized by hormonal activity;They are able to produce an excessive amount of cortisol even after a successful operation to resect the basic corticosteroma.
Causes and pathogenesis of
The true causes of corticostero development by now are unclear.
To predisposing factors, endocrinologists and oncologists refer to:
- Genetically predisposed;
- reception of some pharmacological preparations;
- aggressive environmental factors( contaminated atmosphere, ionizing radiation, etc.).
Corticosteroids primarily synthesize glucocorticoid hormones, but tumors can also produce androgens( male sex hormones) and mineralocorticoids .A high level of glucocorticoids in the patient's blood triggers a feedback mechanism, which leads to a decrease in pituitary adrenocorticotropic hormone production.The consequence of this pathological process are atrophic changes in undamaged adrenal structures.
Excess cortisol activates systemic catabolic processes, against which the muscular, bone and connective tissue undergo dystrophic changes.
In this pathology, water-salt( electrolyte) metabolism, as well as metabolism of lipids and carbohydrates, is seriously affected.In the blood drops the level of potassium and increases the sodium content.
Consequences of metabolic abnormalities:
- heart failure;
- high blood pressure;
Glucocorticoid hormones inhibit general immunity, resulting in patients with corticosteroids being more susceptible to diseases of infectious genesis.
Symptoms of adrenal corticosteroid
Clinical manifestations of hypercortisone:
- arterial hypertension( elevated blood pressure);
- musculoskeletal weakness;
- increased physical and mental fatigue;
- characteristic( centric) obesity;
- a violation of the metabolism of carbohydrates( steroid diabetes is not excluded);
- impaired sexual function;
- crimson striae( stretch marks) on the skin of the abdomen and thighs;
- point hemorrhages( petechiae);
- osteoporosis( its possible consequence is compression fractures of the vertebrae).
Water-electrolyte imbalance causes unquenchable thirst and an increase in diuresis( with a decrease in the specific density of urine).
Important: for male patients is characterized by demaskulination - development of gynecomastia, decreased libido and potency, hypoplastic testicles.In women, there are signs of virilism - hirsutism( atypical hair), coarsening of the voice and hypertrophy( increase) of the clitoris.
On the skin of patients often there are pustular eruptions - banal acne( acne) or folliculitis.On the legs can be formed trophic ulcers and hyperpigmentation zones.
Almost a third of patients with hypercortisy suffer from chronic pyelonephritis and urolithiasis.
Important: for adenocarcinoma and corticoblast are characterized by signs of general intoxication.
An important diagnostic criterion of corticosteroid is the combination of vivid manifestations of hypercorticism combined with an increase in the daily release of free cortisol( determined in urinalysis).The level of the hormone in the patient's blood is also assessed.
The most informative laboratory method is dexamethasone test with ACTH and cortisol levels.It allows to differentiate corticosteroma and Ithenko-Cushing's disease( neuroendocrine disease, not related to neoplasms).
To verify the diagnosis, hardware-based methods of investigation are used - scintigraphy( visualization with the preliminary introduction of a contrast - radioactive isotope), polypositional ultrasound scanning, magnetic resonance imaging and computed tomography.
Treatment of adrenal corticosteroid and prognosis
Detection of corticosteroma is an indication for surgical intervention - adrenalectomy( removal of a tumor-struck adrenal gland).
The operation is performed by open access or by endoscopic procedure.
To prevent the development of adrenal insufficiency, patients immediately after adrenalectomy are shown to have hormone replacement therapy.
In order to inhibit the production of hormones by metastases, after removal of the malignant neoplasm, Mitotan( an inhibitor of corticosteroids) is additionally treated. If x-ray confirmed the presence of secondary tumor lesions, the patient is prescribed a course of chemotherapy with cytostatics.
For diagnosed adenocarcinomas and corticoblasts, the prognosis is unfortunately unfavorable.Removal of neoplasms of a benign character leads to a gradual decrease in severity and even complete relief of symptoms.
All patients who underwent surgery for corticosteroids are shown a follow-up at the endocrinologist.
Plisov Vladimir, medical reviewer