- Adrenal gland diseases:
Adrenal glands are triangular prism-shaped organs located above the kidneys. They are endocrine glands called retroperitoneum, located on the back wall of the abdomen very close to the main vessels (Aorta, Vena Cava Inferior and Renal Artery-Vein). Their normal dimensions are around 3x5x2 cm and their weight is around 3-6 g. These glands have an outer layer called cortex and an inner layer called medulla.
The most important hormones secreted in our body are secreted from these glands. Cortisol and aldosterone are secreted in the cortex layer, and epinephrine and norepinephrine hormones are secreted in the medulla layer. Apart from these, the adrenal glands also secrete sex hormones.
- Why and when is surgery required for the adrenal glands?
Surgical removal of the adrenal glands is required. The removal process is called Adrenalectomy. This procedure is performed when hormone production increases uncontrollably or in the presence of a mass in the glands that may be cancerous.
- 3 situations in which hormone production increases excessively require adrenalectomy:
Cushing Syndrome:There is increased steroid (cortisol)production in the adrenal cortex layer:
Conn. Syndrome:There is increased aldosterone production in the cortex layer. This condition is called Hyperaldosteronism. Clinically, it causes serious hypertension and a decrease in blood potassium level.
Pheochromocytoma:There is excessive secretion of adrenaline from the medulla layer. High blood pressure, excessive sweating, tremors and restlessness are observed in these patients.
Incidentaloma:For any reason (except for adrenal diseases, for example, in USG or abdominal tomography performed by the gynecology department) Masses originating from the adrenal gland, detected incidentally during examination, are called incidentaloma. Their sizes can range from 1 cm to 10 cm or more.
The incidence increases with age; It is 1-2% around the age of 30, 7% at the age of 50, and 12% at the age of 80. Today, with the more frequent use of techniques such as tomography and magnetic resonance imaging, Its frequency is accepted to be 7-10% on average.
These are tumors that generally do not cause hormone secretion (nonfunctional adenoma).
Perhaps the most important point in the evaluation of incidentalomas is to determine whether they are malignant or not. . The most used parameter for this purpose is the size of the mass (Only 2% of adrenal masses less than 4 cm in diameter and 25% of those larger than 6 cm in diameter are cancer).
Although incidencellomas do not cause excessive hormone production, their size or structural features require their surgical removal. Surgery is recommended, especially for kits exceeding 3-4 cm in size (due to the risk of cancer).
Although adrenal cancer is very rare, surgical treatment is the only chance for this disease. In some patients, this tumor may be a form of cancer that has spread to the adrenal gland from another part of the body.
- Adrenal surgery:
Removal of the adrenal glands There are various methods for surgical removal. Factors that decide the appropriate method for the patient; The size of the tumor, patient factors (weight, height, general condition, previous surgeries) and the experience of the surgeon. Open and laparoscopic methods can be used in adrenal surgery. While a larger incision is made in the open method, a few small holes are created in the laparoscopic method. The laparoscopic method is more suitable for small tumors (usually tumors smaller than 6 cm) and is a method that allows for less hospital stay, is less painful and leaves less scars on the patient. The open method is a larger-scale operation and is more appropriate to perform, especially in the presence of malignant cancer.
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