What does the adrenal cortex do?
The adrenal cortex consists of several layers, each of which is responsible for its own group of hormones. The external one produces aldosterone, which retains sodium and removes potassium, the middle one produces cortisol, which regulates metabolism and the response to stress, and the internal one produces precursors of sex hormones. The tumor can come from any layer, and the picture of the disease depends on this. Excess cortisol gives Cushing's syndrome, excess aldosterone - persistent hypertension with low potassium, excess androgens - virilization. Hormonally inactive tumors appear only as they grow.
- Aldosterone regulates sodium and potassium
- Cortisol controls metabolism and stress
- The inner layer provides precursors to sex hormones
- The type of tumor determines the clinical picture
- Inactive tumors are detected by chance
Symptoms
With an excess of cortisol, the face becomes rounded, fat is redistributed on the torso, wide purple stretch marks appear on the stomach and thighs, the skin becomes thinner and easily injured, bruises occur, blood pressure and sugar increase, osteoporosis and muscle weakness develop, and mood changes. With an excess of androgens in women, hair growth on the face and body increases, the voice becomes rougher, and menstruation stops; Children experience premature sexual development. Large tumors cause dull pain in the lower back and a feeling of heaviness. Often the manifestations are combined.
- Rounding of the face and weight gain on the torso
- Purple stretch marks and easy bruising
- Persistent hypertension
- Increased blood sugar and muscle weakness
- Male pattern hair growth in women
- Premature sexual development in children
- Pain and heaviness in the side with a large tumor
Diagnostics
The examination is carried out in two directions. Hormonal includes assessment of excess cortisol using a suppressive test and daily indicators, determination of aldosterone and renin, mandatory exclusion of pheochromocytoma by metanephrines, as well as measurement of androgens. Imaging is a contrast-enhanced CT scan of the adrenal glands, which evaluates the size, density, and pattern of contrast uptake; large size, heterogeneity, uneven contours and high native density are alarming. MRI is used as an adjunct. A biopsy of the adrenal gland is not performed without exception for pheochromocytomas, and if primary cancer is suspected, they try not to do it at all.
- Cortisol and suppressive test
- Aldosterone and renin, potassium levels
- Metanephrines to exclude pheochromocytoma
- Androgens and their precursors
- CT scan of the adrenal glands with contrast
- MRI as an additional method
- Examination to exclude distant lesions
Accidentally discovered adrenal mass
With the spread of computed tomography, adrenal masses are often found, and most of them turn out to be harmless benign adenomas. You shouldn’t be afraid of such a find, but you shouldn’t ignore it either. The algorithm is simple: check hormonal activity and evaluate signs of malignancy on CT. Small homogeneous formations with low density and without hormonal activity are usually observed. Large, heterogeneous, with unclear contours and rapid growth require referral to an endocrinologist surgeon and a decision on surgery.
- Most findings are benign adenomas
- Assessment of hormonal activity is mandatory
- Size and density on CT are key criteria
- Rapid growth upon repeated examination is alarming
- Small inactive formations are observed
- Suspicious formations are removed
Treatment and observation
The only method that offers a chance of cure is complete surgical removal of the tumor along with the adrenal gland, performed by an experienced surgical team; if malignancy is suspected, open access is preferred so as not to disrupt the integrity of the tumor. Before surgery, if there is hormonal activity, preparation is necessary, and after removal of the cortisol-producing tumor, replacement therapy is prescribed, since the second adrenal gland is temporarily not working. For common forms, specific drug therapy and chemotherapy are used under the supervision of an oncologist. Post-treatment follow-up is long-term, with regular imaging and hormonal monitoring.
- Complete removal of the tumor and adrenal gland
- Preoperative preparation for hormonal activity
- Replacement therapy after removal
- Drug therapy for common forms
- Regular monitoring of CT and hormones
- Observation by an endocrinologist and oncologist
- Discussion of genetic testing in familial cases
