Adrenal adenoma removal
Adrenal adenoma is a common condition, most often seen between the ages of 40 and 60. According to statistics, women are more susceptible to this condition than men. This is due to hormonal changes in the body, chronic stress, and metabolic disorders that stimulate adrenal cell growth. Early diagnosis allows for optimal treatment and prevents complications.
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Classification of adrenal adenoma
Based on their functional activity, adenomas are divided into:
- Hormonally active - produce hormones
- Hormonally inactive - do not affect hormonal balance
Hormonally active adenomas often require surgical removal, as drug treatment cannot always completely normalize hormone levels in the body.
By size, a distinction is made between:
- Microadenomas – less than 1 cm in diameter, detected incidentally
- Standard adenomas – 1-3 cm in diameter, cause clinical symptoms with hormonal activity
- Large tumors – over 3 cm, put pressure on adjacent organs
Based on morphological features, adenomas are classified as classic, pigmented, and oncocytic. Classic adenomas have a uniform structure and a smooth surface. Pigmented adenomas contain melanin-containing cells, giving them their characteristic color. Oncocytic adenomas consist of large cells with a high mitochondria content and are extremely rare.
Types of adenomas (corticosteroma, aldosteroma, androsteroma)
Depending on the type of hormone secreted, a distinction is made between:
- Corticosteromas produce excess cortisol, causing Cushing's syndrome.
- Aldosteromas increase aldosterone levels, leading to hypertension and hypokalemia.
- Androsteromas produce androgens, causing virilization (secondary male sexual characteristics) in women, acne, and irritability in men.
Each type requires an individualized treatment approach and has its own clinical characteristics.
Causes of adenoma development
Tumor development is caused by:
- Hormonal imbalances
- Long-term psychoemotional stress
- Diabetes mellitus
- Overweight
- Metabolic syndrome
- Age-related changes
- Taking glucocorticoids or other hormonal medications
- Diseases of the thyroid gland, pituitary gland, and gonads
- Exposure to toxins and radiation
- Consuming poor-quality food or contaminated water
A family history of endocrine diseases or adrenal tumors increases the risk of developing adenoma. Genetic factors influence cell division and the adrenal gland's sensitivity to hormonal stimulation.
Symptoms of adrenal adenoma
With a hormonally active adenoma, the following symptoms occur:
- High blood pressure, which is difficult to control with medication
- General weakness
- Decreased endurance and muscle mass
- Increased sweating
- Cramps
- Mood swings
- Swelling of the extremities
- Decreased concentration and memory
The disease is also characterized by increased appetite, which leads to weight gain.
Symptoms in women
In women, the disease is accompanied by:
- Excessive hair growth on the face, chest, and abdomen
- Menstrual irregularities
- Darkening of the skin
- Deepening of the voice
- Sleep disturbances
With excess cortisol, central obesity develops—fat is deposited in the abdomen, neck, and face. The arms and legs remain relatively thin. The skin becomes thin and dry, and stretch marks appear on the abdomen and thighs. Blood vessels lose elasticity, increasing the risk of bruising and bleeding.
Symptoms in men
In men, this pathology causes:
- Erectile dysfunction
- Increased fatigue with normal physical activity
- Insomnia or interrupted sleep
- Anxiety, depression
- Increased sweating
- Decreased mental performance
Hormonal imbalances can lead to tachycardia or arrhythmia, which increases the load on the heart and leads to the development of cardiovascular complications.
Diagnosis of adrenal adenoma
The diagnostic process includes several stages. The main goal is to determine whether the tumor produces hormones.
History and examination
The endocrinologist will review the patient's complaints, lifestyle, chronic illnesses, and family history of tumors. During the examination, blood pressure, body weight, fat distribution, and skin symptoms are taken into account. If necessary, the specialist will palpate the lymph nodes and thyroid gland and evaluate the condition of the hair and nails.
Instrumental Diagnostics
The examination includes:
- Ultrasound — allows you to identify large tumors, assess their shape and location.
- CT — provides accurate information about the structure, density, and size of the adenoma.
- MRI — clarifies the contours and nature of the tumor, as well as its interaction with adjacent organs.
- PET-CT — used if malignancy is suspected.
Angiography is sometimes used to assess the tumor's blood supply. MRI with contrast can help determine the activity of the adenoma.
Laboratory diagnostics
The examination includes:
- Blood test for adrenal hormones - assesses the concentration of cortisol, aldosterone, and androgens in the blood.
- A dexamethasone test is performed to rule out Cushing's syndrome.
- Blood test for electrolytes and renin - identifies water-electrolyte imbalances characteristic of aldosterones.
- 24-hour urine analysis for hormone metabolites - assesses the levels of cortisone, metanephrine, and normetanephrine, intermediate products of cortisol and aldosterone biosynthesis.
Since hormonally active adenomas are often accompanied by metabolic disorders, a lipid profile is prescribed to confirm these. Excessive cortisol production increases fat synthesis and disrupts fat metabolism, leading to elevated high-density lipoproteins and triglycerides.
Adenoma Biopsy
This procedure is prescribed when imaging results are inconclusive, malignancy is suspected, or a lesion larger than 3 cm with an irregular structure is detected. The procedure is performed under ultrasound or CT guidance, using local anesthesia. Using a fine needle, the doctor takes a tissue sample from the adrenal gland and sends it to the laboratory for histological examination.
Treatment of adrenal adenoma
The treatment regimen is selected based on the type, size, and hormonal activity of the tumor. The doctor also assesses the tumor's growth dynamics and its impact on other organs.
Drug therapy
The goal of drug treatment is to stabilize hormonal levels, reduce symptoms, and prevent complications associated with excess hormone secretion. For corticosteroma, drugs that suppress cortisol synthesis are used, such as ketoconazole, metyrapone, and aminoglutethimide. If an aldosterone tumor is diagnosed, aldosterone antagonists, such as spironolactone or eplerenone, are included in the treatment course. They promote the excretion of sodium and water, normalizing blood pressure and potassium levels. Antihypertensive agents and potassium supplements are also prescribed to correct electrolyte imbalances.
For androsteroma, antiandrogen agents are used, such as cyproterone acetate and flutamide, to reduce the severity of virilization.
For hormonally inactive adenomas, drug treatment is not required. Monitoring with periodic CT or MRI scans and hormonal testing is sufficient.
Surgical intervention
If the tumor size exceeds 4 cm or malignancy is suspected, surgery is performed. During surgery, the doctor completely removes the affected adrenal gland or just the adenoma, preserving healthy tissue.
There are several types of interventions:
- Laparoscopic adrenalectomy - performed through small incisions in the abdominal wall using endoscopic equipment.
- Retroperitoneoscopic adrenalectomy - performed through a lumbar approach.
- Open adrenalectomy - performed through a classic incision and requires a longer recovery period.
To restore hormonal balance, the patient is prescribed hormone replacement therapy in the postoperative period. This helps compensate for the temporary hormone deficiency that occurs after removal of the adrenal adenoma or decreased adrenal function. Subsequently, the remaining adrenal gland takes over the functions of the removed one, and the need for constant hormone intake disappears.
General information
Preparing for surgery
For a successful surgery, it is important to follow these recommendations:
- 7-10 days before surgery, reduce salt intake and avoid fatty, fried, and spicy foods.
- 2 weeks before surgery, stop drinking alcohol and smoking.
- Undergo medication-based hormone therapy for hormonally active tumors.
- Avoid stress and overwork, and improve sleep.
- Drink at least 1.5 liters of water per day.
The surgery is performed strictly on an empty stomach in the morning. Any medications may only be taken with the doctor's permission.
FAQ
Why does adrenal adenoma occur?
Hormonal imbalances, diabetes, obesity, hypertension, and a genetic predisposition contribute to the development of tumors. The risk of developing adenomas increases with age.
What are the different types of adrenal adenomas?
There are two types of adenomas: hormonally active and hormonally inactive. The former produce cortisol, aldosterone, or androgens. The latter do not secrete hormones and do not require immediate surgical intervention.
What symptoms does an adrenal adenoma cause?
If the adenoma is inactive, there are no symptoms. If the tumor is hormonally active, seizures, high blood pressure, headaches, general weakness, acne, and weight gain are possible. Clinical manifestations depend on the type of hormone secreted.
How is adrenal adenoma diagnosed?
The tumor is detected by ultrasound, CT scan, or MRI. Hormonal blood and urine tests are performed to confirm the diagnosis. If a malignancy is suspected, a biopsy is required.
How is adrenal adenoma surgery performed?
Laparoscopic adrenalectomy is often performed. This surgery allows for tumor removal with minimal tissue trauma, reduces recovery time, and has a lower risk of complications. After discharge, it is important to follow your endocrinologist's recommendations and regularly monitor your hormone levels.
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General definition and information about the disease
An adenoma is a benign tumor that develops from the cells of the adrenal cortex. It appears as a round or oval tumor with clear borders, a dense structure, and a smooth surface. Occasionally, cystic or fatty inclusions are present, which alters the tumor's density on CT and MRI.
Please note! The tumor can develop on one or both adrenal glands. Unilateral localization is usually detected. Adenomas rarely become malignant and are generally asymptomatic.