Malignant Adrenal tumors
Adrenocortical Carcinoma is less common and difficult to diagnose because it is more likely to spread to other organs. The incidence rate is 2 per 1,000,000. It is more common in children and adults aged 40-50 years.
1. Adrenocortical Carcinoma is both hormone-producing (50%) and non-hormonal producing (50%). In non-functioning tumors, the symptoms are usually caused by pressure effects such as abdominal pain or back pain. Other symptoms that may be associated, such as weight loss, anorexia. In children, 90% will be virilization. The boy has a precocious puberty. There is gynecomastia, gonadal atrophy, loss of libido. The girls are virilization with hairy, but hair loss, abnormal menstruation.
2. Adrenal Metastases is 26-50%. The most common found is lung cancer and breast cancer, followed by stomach cancer , colon cancer, Thyroid cancer, kidney cancer, ovarian cancer, mole cancer, etc., but usually without symptom. CT will show that one or both adrenal glands are unequal in size, shadows, shape of the jumpy mass, unequal density. It can be easily developed to cyst with bleeding. This disease is usually coincidently found in CT for other causes. If the location of cancer is found, it is clearly diagnosed.
Diagnosis of Adrenal tumor
1. Special X-ray method to see the appearance of adenoma, distribution of lymph nodes, and pressing other organ which is near by such as scan , MRI , or PET. MIBG Scan may be applied to children with high blood pressure who are suspected to have neuroblatoma that produces the hormone so that the medulla can be seen.
2. diagnostic hormonal test by collecting the blood or urine throughout 24 hours. If abnormal hormone level is detected and even the x-ray result shows that it is normal adenoma, the surgery is needed anyway.
Treatment
Currently, adrenal adenomas have been reported that it is coincidently found in annual health checkup more. It is important for the physician to distinguish whether it is benign or malignant tumor and it is a functional tumor or not. Surgery is recommended for Adrenal incidentaloma that is larger than 4 centimeters because there is a chance of cancer around 10%
Commonly found functional tumor are primary hyperaldosteronism( Conn’s syndrome) , Cushing’s syndrome and Pheochromocytoma. In this case the surgery is needed regardless of the size.
1. perioperative medical management
2. Laparoscopic Adrenalectomy has been recognized as a gold standard, with the potential for open surgery to be less than 5% and a better outcome than open adrenalectomy, in terms of small incision, reduce death rate, and shorten the hospitalization.
3. Radiation therapy is often used to treat patients who have spread to the bone.
พญ. กมเลส ประสิทธิ์วรากุล
Surgeon of Laparoscopic Surgery Center,
Bangkok Hatyai Hospital
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