Adrenal Diseases And Their Symptoms

The adrenal glands are small paired glands located above the upper poles of the kidneys. These endocrine organs have a complex structure and perform some functions in the body. In the anatomical structure of the adrenal glands, two parts are distinguished: cerebral and cortical. The inner (cerebral) part produces stress hormones (catecholamines). The cortical part distinguishes several groups of steroids: genital, mineralocorticoids, glucocorticoids.

Adrenal function in men:

    • support systemic blood pressure;
    • maintain water-electrolyte balance;
    • participate in the formation of genital organs (before puberty);
    • help in adapting the body to various stresses;
    • activate the central nervous system;
    • increase working capacity and muscle strength;
    • increase blood sugar, etc.

Adrenal disease

Diseases of the adrenal glands can be manifested by an increase or decrease in their hormonal activity. But part of the diseases of this zone for a long time does not violate the function of endocrine cells.

There are several pathologies:

    • benign neoplasms without hormonal activity;
    • malignant neoplasms without hormonal activity;
    • neoplasms with hormonal activity;
    • hypertrophy of the adrenal cortex with hormonal activity;
    • congenital dysfunction of the adrenal cortex;
    • decreased adrenal function.

Tumors without hormonal activity

In the cex and medulla of the adrenal gland tumors can be detected that do not synthesize biologically active substances. Such neoplasms are called incidentalomas. They can be either benign or malignant in nature.

Typically, these neoplasms are an accidental finding during an examination for other diseases.

The most informative method for visualizing adrenal tumors is computed tomography (with contrast). During this study, focal lesions can be detected, as well as information on the structure of the tumor and its blood supply.

An adrenal gland tumor can also be visualized using ultrasound. But this type of diagnosis is considered less accurate.

Benign incidentalomas have practically no clinical manifestations. If the tumor is cancer, then there may be symptoms of cancer (intoxication, weight loss, compression of surrounding tissues, impaired functioning of organs and systems).

Tumors with hormonal activity

According to the results of hormonal tests, the functional activity of the tumor can be detected.

Meet:

    • pheochromocytomas;
    • aldosteromas;
    • corticosteroids;
    • androsteromas;
    • corticoestroms;
    • tumors with mixed hormonal secretion.

Pheochromocytomas are neoplasms from cells of the brain of the adrenal gland. They are often bilateral (10-15%). Pheochromocytomas in many cases (up to 10%) are detected outside the adrenal gland (in the abdominal and chest cavity, etc.). Every tenth patient has a malignant tumor. Pheochromocytoma synthesizes and releases catecholamines into the blood.

Aldosteroma is a tumor of the most superficially located cells of the adrenal cortex (glomerular layer). Such a neoplasm releases mineralocorticoids (primarily aldosterone). An excess of these biologically active compounds leads to the development of Conn’s syndrome (primary hyperaldosteronism).

Corticosteroma is a tumor from the bundle layer of the adrenal cortex. A neoplasm from cells in this region can synthesize an excess of glucocorticoids. As a result, a patient with corticosteroma manifests Itsenko-Cushing’s syndrome (primary hypercorticism).

Androsteromas and corticoestroms are neoplasms of the lower layer of the adrenal cortex. The cells of this mesh zone have a morphological affinity for the gonads. Normally, weak androgens are synthesized in this part of the cortex. Tumors of the reticular layer can secrete female and male sex steroids into the bloodstream. In women, such neoplasms often lead to virilization. In men, corticoestroms provoke the appearance of female traits in appearance.

Pheochromocytoma: symptoms, diagnosis

The main symptom of a tumor of the adrenal medulla is arterial hypertension. In most cases, patients experience a critical rise in blood pressure. Attacks can be triggered by physical exertion, a change in body position, food intake or emotional experience.

A typical crisis with pheochromocytoma is accompanied by a feeling of fear, trembling, rapid pulse, pallor of the skin. After the pressure returns to normal, the patient fixed abundant urination.

Pheochromocytoma should be examined in all patients with hypertension, which is difficult to respond to standard treatment.

First of all, in the diagnosis of pheochromocytoma, the adrenal glands are imaged (ultrasound, tomography). Then prescribed blood and urine samples. The most informative is the diagnosis of decay products of catecholamines. Adrenaline and norepinephrine themselves are very unstable compounds. They quickly collapse after getting into the blood. But their metabolites (methanephrine and normetanephrine) have a much longer period of existence. It is the tests for these substances that are prescribed to patients with suspected pheochromocytoma.

Hyperaldosteronism

Primary hyperaldosteronism (Conn’s disease – read morehere) is manifested by persistent arterial hypertension and neuromuscular disorders. The pressure with aldosteroma is consistently high. Hypertension cannot be removed using standard therapy regimens. Patients develop early lesions of target organs (heart, fundus). A common consequence of the disease is a brain stroke or myocardial infarction.

Conn’s disease is also manifested by muscle weakness, fatigue, cramps, pain in the limbs. Digestive disorders are also observed: appetite worsens, constipation occurs.

Over time, aldosteroma leads to severe damage to the kidneys, as a result of which renal failure develops.

Primary hyperaldosteronism is detected using laboratory diagnostics: a patient is taken blood for aldosterone, renin, potassium. Special tests are also carried out (with sodium, hypothiazide, spironolactone).

Hypercorticism

Itsenko-Cushing’s syndrome is manifested:

    • Obesity
    • redistribution of adipose tissue;
    • the appearance of striae;
    • hypertension
    • increased blood sugar;
    • decreased libido;
    • psychological changes (depression).

In men with Itsenko-Cushing’s syndrome, appearance changes. The legs and arms lose weight significantly (both the fat layer and muscle volume decrease). Excess subcutaneous tissue is deposited in the abdomen, on the upper half of the body, on the face. The skin undergoes dystrophic changes. Wide burgundy stretch marks (striae) appear on the anterior abdominal wall.

Patients are often disturbed by headache, dizziness, tinnitus. When measuring pressure, hypertension is recorded. Patients have complaints of dry mouth, thirst, and frequent urination. Typically, these symptoms are associated with secondary steroid diabetes. Another characteristic complaint with hypercorticism is a decrease in libido. Men note a deterioration in potency and the disappearance of sexual desire.

To diagnose Itsenko-Cushing’s syndrome:

    • blood test for cortisol;
    • daily rhythm of cortisol (analysis in the morning and evening);
    • blood test for adrenocorticotropin;
    • a small sample with dexamethasone;
    • large sample with dexamethasone.

It is also necessary to study the level of blood electrolytes, glycated hemoglobin and other indicators.

Hypercorticism is often secondary, that is, associated with a brain tumor. To rule out this cause of increased cortisol, pituitary tomography is performed.

Sex Steroid Tumors

Corticoestroms and androsteromas are relatively rare. If such a tumor is detected, then the risk of oncology is high.

In boys before puberty, such neoplasms cause early puberty. If the tumor secretes estrogens, then the child has female sexual characteristics. If the tumor synthesizes androgens, then puberty corresponds to male.

In adult men, corticoestroma causes:

    • gynecomastia;
    • redistribution of adipose tissue on the hips and buttocks;
    • cessation of growth of beard and mustache;
    • increasing the tone of voice;
    • loss of potency.

Androsteroma in adult men is manifested by an increase in hair growth on the face and body, an increase in muscle strength and endurance, and a decrease in the percentage of adipose tissue. Such a tumor may remain undiagnosed for a long time.

To identify corticoestroms and androsteromas use:

    • blood tests for androgens and estrogens;
    • tests for gonadotropins (luteinizing, follicle-stimulating);
    • tests with dexamethasone and adrenocorticotropin.

Primary adrenal insufficiency

If both adrenal glands collapse, then primary adrenal insufficiency develops. This condition threatens the life of the patient.

Symptoms of the disease:

    • fatigue;
    • low blood pressure;
    • weight loss;
    • darkening of the skin;
    • various digestive disorders.

Primary adrenal insufficiency develops as a result of autoimmune or infectious (tuberculosis) inflammation in the glands. The disease can be hidden for a long time. But a variety of stresses enhance the symptoms of this pathology. For example, adrenal insufficiency may occur due to emotional distress, acute respiratory infections, or minor surgical intervention.

Diagnose the disease using blood tests for:

    • cortisol;
    • aldosterone;
    • potassium;
    • sodium;
    • pH

Endocrinologists conduct special tests (with adrenocorticotropin, metirapone).