ADRENAL TUMORS

adrenal home page/ pheochromocytoma/ conn's syndrome/
cushing's syndrome/ unsuspected adrenal mass on CT scan/
adrenal cancer/ laparoscopic adrenalectomy

What is the adrenal gland?

The adrenal glands are approximately two and half by one inch long yellowish-orange colored glands that are found just above the kidneys. Adrenal glands provide a very important function in protecting the body against stress. This function is carried out by secretion of a number of different types of hormones by the adrenal glands.

Adrenal cortex

The adrenal gland is actually two glands that are fused together into one gland. The outer part of the adrenal gland also called the adrenal cortex produces steroid hormones that are involved in regulating a number of different body functions.

The adrenal cortex also produces a hormone called aldosterone that is involved in regulating the amount of salt and water in your body.

Adrenal medulla

The inner part of the adrenal gland is called the adrenal medulla. The adrenal medulla produces hormones called catecholamines such as adrenaline and noradrenaline. Catecholamines play a role in the response to acute or sudden severe stress, for example during life threatening event.

Catecholamines are responsible for the palpitations (racing heart), sweatiness, widening of eyes and shakiness of the hand when faced with sudden fear or other stressful situation.

What are adrenal tumors

Tumors of the adrenal glands arise from the cortex or the medulla part of the adrenal gland. Adrenal tumors commonly present because symptoms from excess secretion of hormones by the tumor.

The tumors from the adrenal cortex produce excess secretion of steroid hormones and aldosterone and tumors from the adrenal medulla produce excessive amounts of catecholamines.

Adrenal tumors can be benign (non-cancerous) or malignant (cancer). Often this separation is difficult to make and long term close follow up is necessary after removal to detect recurrences early in patients who have adrenal cancer.

How do adrenal tumors present?

Adrenal tumors may present in the following ways:

An unsuspected tumor that is found on a CT scan performed for another reason: As CT scan evaluation of the abdomen has become widespread, an unsuspected swelling of the adrenal gland is frequently detected in many patients. These tumors should be carefully evaluated.

Production of symptoms due to oversecretion of hormones from the tumor: The adrenal gland may produce distinct syndromes based on the profile of the hormones that are secreted by the tumor.

Some of hormones that the tumor produces are:

What is the treatment for adrenal tumors?

  • Observe with no surgery: Very small tumors tumors not producing any symptoms and found by chance on CT scan can be followed with a repeat CT scan in six months, larger tumors should be removed due to the risk of an underlying cancer. It is recommended that tumors greater than four centimeters should be removed.
  • Laparoscopic adrenalectomy:This is the treatment of choice for tumors less than 10cm.
  • Open adrenalectomy: This is recommended only in patients where there is suspicion of cancer
  • Laparoscopic removal of both adrenal glands: Recommended for patients with disease in both adrenal glands causing Cushing's disease or pheochromocytoma.



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