Adrenal Tumors-Adrenal Gland Diseases: The adrenal glands, in other words, the adrenal glands, are located at the upper pole of both kidneys, yellow-green in color, each weighing 4-5 g, and measuring 5x3x1 cm, Apart from its anatomical neighborhood, it is a pair of endocrine organs that do not have a direct relationship with the kidneys and secrete some hormones that the body needs. The adrenal glands consist of two parts, the outer shell (cortex-80%) and the inner (medulla-20%) part. The outer shell consists of three layers, and different hormones are secreted from each layer. The adrenal gland has many tumors and diseases of its own.
Adrenal Hormones
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Aldosterone:
strong> It is secreted from the outermost layer (glomerulosa) of the shell (cortex) part of the adrenal gland and tries to maintain the water and salt balance of the body by affecting the kidneys. It helps to balance the blood pressure in the body by controlling the sodium and potassium levels. -
Cortisol: From the middle layer of the shell (cortex) part of the adrenal gland (Fasiculata) secreted and affects metabolism and contributes to the body's ability to cope with stress and infections.
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Dihydroxy Epiandrosterone (DHEA): It is secreted from the inner region and contributes to the sex characters (hair and hair distribution, shaping and maintaining the body in accordance with the gender) by acting as an androgen in men and like estrogen in women.
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Catecholamines: In the Inner-Medulla part of the adrenal gland, hormones called catecholamines (epinephrine-adrenaline, norepinephrine and dopamine) are secreted especially in situations of fear, stress and effort.They increase heart rate, increase blood pressure, increase respiratory rate, tension and stress. by raising awareness to a higher level, it allows the body to get rid of dangerous situations and to manage this situation.
Classification of Adrenal Tumors:
Adrenal gland tumors are divided into two parts as benign and malignant (cancer) and they are divided into two subgroups according to whether they produce excessive hormones (functional and non-functional). In other words, these tumors do not always mean cancer, they are mostly benign tumors.
1-Benign tumors: Benign adrenal tumors are not cancer, do not spread to other regions and organs (do not metastasize), relatively small tumors ( adenoma), and it is discovered incidentally in check-up or screening tests (Adrenal Incidentaloma)
2-Functional tumors (Excessive hormone-producing): The majority of these tumors are also benign A very few of them are malignant adrenal cancers. They produce hormones excessively and patients come with a clinical picture according to the type of hormone they produce excessively. Functional adrenal tumors usually overproduce a single hormone, but they can rarely overproduce more than one type of hormone.
3-Malignant adrenal cancers:Adrenal cancers are rare(4-12 / million people), and these are tumors that usually originate from the adrenocortical, that is, the shell part. It is more genetically at risk and appears to be associated with some syndromes.
Causes and risk factors of Adrenal Tumors: The causes of adrenal tumors are not fully understood, but some rare genetic conditions increase the risk, especially the risk of developing adrenal cancer. These include multiendocrine neoplasia type 2 (MEN-2), von Hippel-Lindau syndrome (VHL), familial paraganglioma syndrome, neurofibromatosis type 1, Carney complex and Li – Fraumeni syndrome.
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Symptoms of Adrenal Gland Diseases and Tumors (Adrenal Tumors):
Tumours that do not produce hormones and/or are small in diameter are usually may not cause any symptoms. Symptoms of adrenal tumors vary depending on the type of tumor and the hormones it secretes. Common symptoms include an increase in blood pressure, unexplained weight gain, feeling thirsty, and frequent urination; fall� High potassium levels, heart palpitations, extreme irritability, anxiety or panic attacks, headache, excessive sweating, diabetes, abdominal pain, weakness and weakness, cracks in the abdominal skin and excessive hair growth can be seen.
Types of Adrenal Tumors
1-Accidental Adrenal Tumors (Incidentalomas): These tumors refer to tumors that we encounter incidentally in routine health screenings and controls without any symptoms, which constitute the majority of adrenal tumors. . While most (90%) are benign, a small percentage are malignant (cancer) or functional (producing excess hormones) and may have tumors that need to be surgically removed. High blood pressure is the most common symptom of incidental tumors. Other symptoms include facial flushing, heart palpitations, muscle weakness and anxiety.
2-Aldosteronomas (Conn Syndrome): It is a disease of the outermost layer (glomerulosa) of the shell (cortex) of the adrenal gland, and excessive secretion of Aldosterone It is a benign tumor characterized by Conn's syndrome or hyperaldosteronism. Aldosterone is a hormone that raises blood pressure due to water-salt retention in the kidneys and lowers potassium levels. In their tumors, aldosterone is secreted excessively and causes fatigue, bloating, intense thirst and frequent urination, and low potassium and high salt (sodium) levels in the blood, in addition to uncontrolled high blood pressure. Sometimes, the same picture, namely hyperaldosteronism-Conn's disease, can be seen due to the excessive work of this bilateral layer (Bilateral adrenal hyperplasia-BAH) even without a tumor. If the necessary treatments are not provided, high blood pressure can cause stroke, heart attack and kidney failure.
3--Adrenal Cushing's Syndrome: Cushing's syndrome is a tumor or graft of the middle layer (Fasiculata) of the adrenal gland, also in the shell part It is the clinical picture caused by the high cortisol produced due to the study. Cortisol is a hormone that affects metabolism and under normal conditions, it supports metabolic events that will enable the body to protect the body and resist these stresses in cases of stress such as surgery, injury or infection. Hypersecretory cortisol in tumor or bilateral adrenal hyperplasia with overproduction; While it causes fat accumulation-central lubrication especially on the body and face, it does not cause any change in the arms and legs. This phenotypic changes are typical for Cushing's syndrome, resulting in asymmetrical fat deposition and rapid weight gain on the face and a buffalo hump-buffalo hump on the shoulders and back. Apart from these findings, again due to excessive secretion of cortisol; thinning of the skin, typical purple stretch marks (Stretch) in the abdomen and thighs, increased facial hair and excessive hair growth, restlessness, extreme nervousness and depression, weakness and fatigue, thinning and weakness in the muscles, sexual dysfunction, osteoporosis can be seen. It also causes type2-diabetes, low potassium levels and hypertension. Menstrual disorders can be seen in women.
Tumors Producing 4-Sex Hormone: It is a clinical picture caused by high sex hormone-androsterone (DHEA) produced due to tumor or overwork of the inner layer (Reticularis) in the shell (cortex) part of the adrenal gland, it is a very rare disease. Excessive production of sex hormones-androgens; It causes early puberty in young men, deepening of the voice in women, increased hair growth and facial acne and menstrual disorders. These tumors were found to be more likely to be malignant-cancer than other adrenal tumors. Again, tumors that secrete both sex hormone-androgen and other adrenal hormones are more likely to be malignant-cancer.
5-Peochromocytoma and Paragangliomas: Peochromocytoma is a tumor of the inner (Medulla) part of the adrenal gland or due to its overworking, high catecholamines (epinephrine-adrenaline, norepinephrine and do pamine) refers to the clinical picture it causes. Normally, these hormones help the body cope with stress again and keep the body protected and alert to any danger. However, in tumors or hyperplasia (overproduction state) where these hormones are over-secreted, it causes high blood pressure that cannot be controlled by drugs and can lead to serious conditions such as stroke-stroke. There is even a risk of sudden death. 90% of pheocrocytomas are benign tumors and only 10% are malignant-cancers. Paragangliomas are a type of neuroendocrine (hormone-producing) tumors found in the abdomen, pelvis, chest, and neck. Diseases such as genetic multiple endocrine neoplasia and von Hippel-Lindau disease increase the risk of developing pheochromocytoma and other adrenal tumors. Clinically, sweating, headache, high blood pressure, increased heart rate and palpitations, excessive anxiety and fear, and increased blood sugar can be seen in pheochromocytoma and paragangliomas.
6-Adrenal Cancers: Only 5-10% of tumors of the adrenal gland are malignant-cancers. Adrenal cancers make up only 00.5%-02% of all cancers, they are very rare cancers. It most commonly occurs under the age of 5 and in the age group of 40-50. These cancers have a very severe and aggressive course, spread rapidly, metastasize to other regions and organs, and cause many complaints and findings in the patient. Depending on the hormone secreted by cancer, its spread and direct effect, patients may experience weight gain, hypertension due to fluid retention, swelling and edema, diabetes, abnormal growth of hair, hair growth, and abnormal skin changes. Abdominal pain, a feeling of fullness, and weight loss may occur depending on the area where the cancer has isolated and metastasized.
Diagnosis of adrenal tumors:
In order to diagnose adrenal gland tumors, advanced technology opportunities are generally used. With anamnesis, systematic physical examination and blood pressure and body measurements (weight, height, etc.), routine laboratory tests, hormone levels and some complex hormone level measurements, it is determined whether there is a hormone above normal and it can be visualized by CT, MRI and whole body PET scans.
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