Adrenal cancer
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The term adrenal tumor can refer to one of several benign and malignant neoplasms of the adrenal gland, several of which are notable for their tendency to overproduce endocrine hormones. |
Adrenal cancer specifically refers to malignant
adrenal tumors, which include neuroblastoma,
adrenocortical carcinoma, and a minority of
adrenal pheochromocytomas. Most adrenal
pheochromocytomas and all adrenocortical
adenomas are benign tumors, which do not
metastasize or invade nearby tissues, but which
may still cause significant health problems by
giving rise to hormonal imbalances.
Tumors of the Adrenal Cortex
The adrenal cortex is composed of three distinct
layers of endocrine cells which produce critical
steroid hormones. These include the
glucocorticoids which are critical for
regulation of blood sugar and the immune system,
as well as response to physiological stress, the
mineralcorticoid aldosterone, which regulates
blood pressure and kidney function, and certain
sex hormones. Both benign and malignant tumors
of the adrenal cortex may produce steroid
hormones, with important clinical consequences.
Adrenocortical
adenoma
Adrenocortical adenomas are benign tumors of the
adrenal cortex which are extremely common
(present in 1-10% of persons at autopsy). They
should not be confused with adrenocortical
"nodules", which are not true neoplasms.
Adrenocortical adenomas are uncommon in patients
younger than 30 years old, and have equal
incidence in both sexes. The clinical
significance of these neoplasms is twofold.
First, they have been detected as incidental
findings with increasing frequency in recent
years, due to the increasing use of CT scans and
magnetic resonance imaging in a variety of
medical settings. This can result in expensive
additional testing and invasive procedures to
rule out the slight possibility of an early
adrenocortical carcinoma. Second, a minority
(about 15%) of adrenocortical adenomas are
"functional", meaning that they produce
glucocorticoids, mineralcorticoids, and/or sex
steroids, resulting in endocrine disorders such
as Cushing's syndrome, Conn's syndrome (hyperaldosteronism),
virilization of females, or feminization of
males. Functional adrenocortical adenomas are
surgically curable.
Most of the adrenocortical adenomas are less
than 2 cm in greatest dimension and less than 50
gram in weight. However, size and weight of the
adrenal cortical tumors are no longer considered
to be a reliable sign of benignity or
malignancy. Grossly, adrenocortical adenomas are
encapsulated, well-circumscribed, solitary
tumors with solid, homogeneous yellow-cut
surface. Necrosis and hemorrhage are rare
findings.
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