Inactive Adrenal Tumors

Inactive adrenal tumors are expansile tumors that have no hormonal activity. Symptoms, clinical signs and treatment depend on the type and size of the tumor.

Inactive adrenal tumors are expansile tumors that have no hormonal activity. Symptoms, clinical signs and treatment depend on the type and size of the tumor.

(See illustration of the adrenal function.) Inactive adrenal tumors are expansile tumors that have no hormonal activity. Symptoms, clinical signs and treatment depend on the type and size of the tumor. The most common inactive adrenal tumor in adults is an adenoma (50%), followed by carcinomas and metastases (10%). Most remaining tumors are cysts and lipomas. However, the exact proportions will depend on the clinical manifestation. Masses, the accidental discovery in the screening, are usually adenomas. In newborns spontaneously occurring hemorrhages can cause large adrenal masses in the adrenal glands and be mistaken for a neuroblastoma or Wilms tumor. In adults, bilateral massive hemorrhage in the adrenal glands may be due to thromboembolic events or coagulopathy. Benign cysts are observed especially in older patients and can occur on the floor of cystic degeneration of traumatic vascular lesions, lymphomas, bacterial infections, fungal infections (eg. As histoplasmosis), or parasitic infestations (Echinococcus). The hematogenous spread in tuberculosis can also cause adrenal masses. Hormonally inactive adrenal carcinomas cause diffuse infiltrative and retroperitoneal processes. Here, too, bleeding can cause adrenal hematoma. Symptoms and signs Most patients are asymptomatic. Adrenergic insufficiency in adrenal tumor rarely occurs unless both sides are affected. The main symptoms of bilateral, severe adrenal hemorrhage are abdominal pain, falling hematocrit, signs of acute adrenal insufficiency, and proof of a suprarenal tumor in ultrasound, CT or MRI. Tuberculosis of the adrenal glands causes calcification and Addison’s disease. Inactive adrenal tumors manifest themselves usually as an invasive disease or metastases. Messsung diagnosis of adrenal hormones fine needle biopsy Inactive adrenal tumors are most often discovered during an ultrasound examination, a CT or MRI, which has been performed due to a completely different indication. The inactivity is first clinically suspected and then confirmed by the measurement of adrenal hormones. If metastasis is possible (See also ACR Appropriateness Criteria for incidentally Discovered Adrenal Mass.), A fine-needle biopsy can be diagnostic, but is contraindicated if a strong suspicion of adrenal carcinoma or pheochromocytoma is. Therapy Sometimes excision, depending on size and / or results of the imaging Regular inspection Although new imaging techniques may be diagnostic (eg. As in-phase and out-of-phase MRI), the tumor should when solid, adrenal origin and> 4 cm, are usually removed, unless the characteristics of the imaging techniques are very early benign. Tumors with a diameter of between 2 and 4 cm represent a particularly difficult problem. If the imaging method is not show evidence of a cancer, and no hormonal activity is present (in particular normal values ??for electrolytes and Metanephrines, no evidence of Cushing’s syndrome) reasonable to evaluate the tumor it from time to time with imaging techniques again, usually for 1 to 2 years. If by then no progression is seen, no further follow-up is necessary. However, many of these tumors secrete cortisol in doses that are too small to produce symptoms, and whether these tumors ever be clinically apparent or cause morbidity is unclear. Most doctors see patients with these tumors only, but they should also consider the removal of these tumors into consideration if a significant cortisol secretion present. Adrenal adenomas (<2 cm) do not require special treatment. but they should be observed for an increase in size or the inclusion of a secretory activity (eg. B. clinical signs and by the regular measurement of electrolytes). An inactive adrenal carcinoma that has metastasized is an operation not accessible, but can mitotane plus. Corticosteroids help to control the disease. For more information ACR Appropriateness Criteria for incidentally Discovered Adrenal Mass

Health Life Media Team

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