Description of adrenal tumors
The adrenal glands are two organs like kidneys or ovaries. It’s a combination of the endocrine glands, which includes two different bodies – the cortex and medulla. Endocrine glands, or endocrine, they are those that have no outlet, and their products can get into the body only through blood. They can therefore act both locally and globally. These include in addition adrenal more thyroid, ovary, parathyroid. In contrast, exocrine glands, exocrine, having an outlet which opens into a cavity. These include the need pancreas, whose secretions migrate to the abdominal cavity, liver, which produce the bile into the gall bladder and salivary glands that lubricate the oral cavity and help process bite.
All endocrine glands are controlled by signals from the brain, in part, called the hypophysis orpituitary gland. The regulation is performed on a chemical level, using the chemical compounds from the pituitary gland is given a signal, much of their adrenal hormones are produced and the amount of adrenal hormones in turn gives the brain signal that may no longer send information to be synthesized. This process is known as negative feedback.
The adrenal glands are annealed to the upper pole renal right is triangular, left semilunar shape, their weight is quite variable and depends on many factors. The age, gender (women have a slightly heavier adrenal) cortex also increases during pregnancy or after castration.
Bark předtavuje over 70% of the entire body and produces about 30 kinds of steroid hormones, chemical groups, which all have a common foundation from which are in the crust formed by enzymes further – cholesterol. The bark is further divided into three layers, wherein in each run specifiské conversion of cholesterol to hormones. Your body needs 1 gram of cholesterol per day, about 0.3 grams, it accepted food in animal fats. Cholesterol itself is not harmful, the much-discussed “good” and “harmful” cholesterol and its effect on atherosclerosis and myocardial infarction is a question to its binding with other substances and transport of blood to the tissues on itself is very poorly soluble in water . Cholesterol is found in the wall of the cells it is part of the bile acids and vitamin D. It is necessary to maintain reception at a reasonable level in order not to increase supply processing and thus to prevent its excessive treatment on the bad mold us detrimental. Its side effect, however, is potentiated by smoking, drinking and lack of exercise, again, you can not say that simply by eating animal fats would stem any cardiovascular problems and obesity. Under the influence of chemical signals coming from the brain produces cortex three basic groups of hormones – mineralocorticoids (regulating sodium, potassium and water in the body), glucocorticoids (patrol blood glucose during periods of stress, and have anti-inflammatory effects but also reduce the volume of bone material) and androgens (male sex hormones, but there is synthesized testosterone, only supplemental hormones, also there takes place also a synthesis of female sex hormones – estrogens). The main mineralocorticoid is aldosterone, glucocorticoid is cortisol.
Marrow contains cells producing catecholamines – adrenalin and noradrenalin, substances released during stress again. Increase blood pressure, blood flow to muscles and affect certain metabolic processes. From a development standpoint, it was the substance which our ancestors prepared for fight or flight.
The adrenal glands are very rich blood supply, leading them rich vascular network. It is necessary that the substance in which the synthesized received sufficiently circulated. The adrenal glands during its development may resort under construction or location. Rarely are found character adrenocortical tissue such as the ovaries or testes, around the kidneys or the liver. Nadleviny may be at birth reduced to normal, it happens when pooled do not develop a brain or is it hereditary defect enzymatic outfit adrenal cortex, to which it is made mandatory screening soon after birth (blood collection in the footer), adrenal glands may be affected by autoimmune inflammation, tuberculosis , myocardial (obliteration afferent vessels blood clot or fat), bleeding or meningococcal infection that leads to sepsis. All these conditions lead to a reduction in the adrenal glands and their subsequent impaired function.
The tumors in the adrenal glands, as everywhere else, may exist two kinds. Malignant and nonmalignant, or benign and malignant, and even on whether benign or malignant tumors of the cortex or marrow. Quite often, especially in the adrenal cortex, there are also secondary tumors, ormetastases, which have their original tumor elsewhere in the body and tumor cells release and secondarily foothold in the adrenal glands, usually clogged blood here.
Symptoms of adrenal tumors
Unfold according Lokalize tumor adrenals (cortex x marrow) and whether the tumor is hormonally active or silent that produces hormones or not. This determines and clinical symptoms.
Benign tumors of the adrenal cortex
adenoma
The most common tumor that is found in the adrenal glands. It can only be in one or both of the adrenal gland and is often associated with hormone production, which creates difficulties. Hormones are synthesized in excess, getting into the blood and by their nature cause corresponding syndromes from excess. If rampant producing cells mineralocorticoids, occurs hyperaldosteronism, or Conn’s Syndrome. Human kidney loses excessive amounts of potassium and retains much of sodium and water in the body. The volume increase in the blood vessels causes an increase in blood pressure. Patients complain of headache, fatigue, bleeding from the nose. Decreased levels of potassium, for example, leads to muscle weaknesses, constipation and may endanger the lives of cardiac rhythm disorders.
If the cancer to affect cells that produce cortisol leads to this condition Cushing’s syndrome.Overproduction of cortisol destroys the organism mainly fractured management with sugar, people have hyperglycemia and thus diabetes mellitus, or type 2 diabetes, obesity have a characteristic thin legs and thick hull and rounded (měsícovitým) face, the skin cracks appear reddish – striae, discovers high blood pressure, mood swings, bone loss can lead to osteoporosis, reduced is the immune function and examine the decrease sexual drive in both sexes, in females display a nepravidelnotem in the menstrual cycle.
If you start to grow tumor cells responsible for the production of androgens, occursadrenogenitálnímu syndrome. This can be a congenital defect of the enzymes involved in the formation of sex steroids from cholesterol. This syndrome arises from overproduction of estrogen, which is very rare, and often from androgens. Both sets of hormones are formed in both sexes, but each has different manifestations. In boys will develop premature (pseudo) puberty, they appear secondary sexual characteristics (penis enlarges, pubic hair grows), but currently there is no maturation of sperm in the testes. In adult males results in overproduction of androgens to sterility.In girls are serious consequences, the male hormones they cause so. Virilization, that is masculine appearance .. Girls zbytňuje clitoris, appears to them as body hair distribution in men (beards thicker pubic hair) girls have periods stopped and rougher voice they are prone to acne, grow rapidly, but also the early growth terminates, so that ultimately they are lower than their peers. For adult women are at the forefront of hirsutism, it is hair growth or hair on the body of a woman in a man’s intensity and localization of fertility disorders.
Malignant tumors of the adrenal cortex
Carcinoma
It is much rarer than adenoma, occurs more frequently in children and is associated with the occurrence of adrenogenital syndrome. In adulthood occurs between 4 to 5 decade. The first symptom is abdominal pain, sometimes can also palpable tumor mass, tumor weight is typically about 100 grams. Cancers frequently metastasize to the lung, liver, and bone, and large tumors typically grow into adjacent organs (kidney, liver).
Treatment of tumors of the adrenal cortex
It is primarily surgical. The diagnosis led doctors either clinical syndromes of overproduction of hormones, tangible or department, or an incidental finding on ultrasound, which was made for other reasons. Examine CT examination and surgical approach is usually on the side during the removal of the ribs. After surgery, hormones are administered until before the second adrenal gland begins to produce a sufficient quantity for both.
Complications of tumors of the adrenal cortex
Based on the syndromes overproduction, or in the case of cancer metastasis to other organs. Tumors that most commonly affects adrenal metastases, with half of the cases appear in both adrenal glands, and originate in the stomach, breast, colon, liver, melanoma, ovarian and thyroid.
Benign tumors of the adrenal medulla
pheochromocytoma
Malignant is only 10%. Occurrence at any age, most often again between 4 to 5 decade. Usually, it is found only in one of the adrenal glands, both are found again only 10%. It occurs within some genetic syndromes. Characterized by producing noradrenalinua adrenaline causing total ADRs.
The symptoms of benign tumors of the adrenal medulla
Catecholamines induce hypertension (high blood pressure), either permanent or seizure, if there is nárazovitému outpouring of adrenaline into the bloodstream. It can be life-threatening attack ended rupture the catheter in the brain and cerebral hemorrhage. Other symptoms include headache, sweating, palpitations and tingling in the extremities.
Complications of benign tumors of the adrenal medulla
High blood pressure damages the walls of blood vessels. This leads to serious consequences, especially in the heart and kidneys. In a patient with increased risk of heart attack and stroke.
Treatment of benign tumors of the adrenal medulla
Surgical, lies in the full withdrawal of the adrenal gland called. Adrenektomii. Suspicion usually confirms the biochemical analysis of urine, which is excreted metabolites of catecholamines. Selects a special view with labeled substances that picking up on the tumor cells and then followed by the operation.
Malignant tumors of the adrenal medulla
neuroblastoma
It is highly malignant tumor of childhood. It is usually diagnosed around the 4th year of life. It grows very fast, aggressive and metastasize to the liver via the blood and bones.
Symptoms of malignant tumors of the adrenal medulla
Neuroblastoma usually shows increasing belly. A tumor can grow along the spinal canal. Quite often, the first symptom to metastasis. Out of the symptoms the child has a fever, loss of appetite, lose weight, and at night a lot of sweat.
Complications of malignant tumors of the adrenal medulla
If the tumor grows along the spine, can oppress the nerves coming from the spinal cord or the spinal cord and to accommodate growth and show a variety of neurological symptoms by locating the place. Bone metastases affect swelling of the bone. Some neuroblastomas can produce catecholamines and then children with seizure hypertension and red skin.
Treatment of tumors of the adrenal medulla
To determine the extent of the disease it is necessary to do bone marrow biopsy, CT and MRI. Select the treatment is quite difficult, it is necessary to know precisely the extent of the tumor stage and even. Neonates with localized disease without catecholamine production can even be only monitored without treatment and tumor in most cases resolve spontaneously. On the other hand, patients above one year of age with metastatic disease deserve a very aggressive chemotherapy.
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