Diagnostic and Treatment of Adrenal Tumors ASK W2003

8/4/2019 Diagnostic and Treatment of Adrenal Tumors ASK W2003

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University of Lucian Blaga, Faculty of Medicine Victor Papilian Sibiu


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Adrenal tumors are rare, clinical syndromes with clinicalmanifestations causing excessive secretion of adrenal hormones.

These tumors are reported in 2% of autopsies most common lesionare benign adenoma.


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This paper aims to establish a clinical diagnosis and therapeuticprotocol of adrenal gland tumors.


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We studied a total of 21 cases with adrenal tumors, treated in theurology clinic between January 2001 and March 2011.

We used as documentary material of hospital records, patient casereport forms and registers transmission protocols. We divided patients by age and studied the relationship between

age and adrenal tumors.


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Distribution of patients by year:

Looking over the 10 years case law shows that the number ofhospitalizations for adrenal tumors is relatively low which indicates a lowincidence of this condition in the population.

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Number of patients


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Repartition by age and sex of patients:

Age ranged between 20 and 72 years, with an average of 45 years forwomen and 46 years for men. There is an increased incidence of thisdisease with advancing age with a maximum in the sixth decade of life.

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An U.S. study shows that indeed, these tumors are very rare andunusual is not very accurate statistics available. But its estimated that300 adults in the United States are diagnosed each year, with adrenalcancer. This type of cancer is less common than an adrenal adenoma,benign tumor are much more common in middle-aged people andelderly people. The average age of a person diagnosed with adrenaltumor is between 45 and 50 years, however, these tumors can occur atany age, really like us, often with increased incidence in femalescompared to male.

Pheochromocytoma is noticed as a rare disease by the Office of RareDiseases (ORD), National Institute of Health (NIH) meaning thatpheochromocytoma or pheochromocytoma subtypes affects more than200,000 people in the U.S. population.

Cushing's syndrome is also more common in women than in men. Themost common forms of endogenous Cushing's syndrome is 80% ofCushing's syndrome in adults and children older than 7 years.

A study made in Chisinau in 2009 reveals a predominance of pathologyin individuals aged between 25 and 40 years, mean age are 43.7 1.2

years.


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Distribution of the environment of origin

There was no essential difference in the distribution by place ofresidence (rural, urban) and type of patients occupation. The studyincluded 12 patients (57.14%) residents of cities and 9 patients

(42.85%) in rural areas.

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, %0000Urban

Rural


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Nosological distribution by type of adrenal tumors:

Patients were divided depending on nosologic form of adrenal tumors:16 patients with pheochromocytoma (77%) of which (11 patients (53%)benign pheochromocytoma and 5 patients (24%) malignantpheochromocytoma), Cushing's syndrome 5 (23%) which patients (3

patients (13.8%) with benign form and 2 patients (9.2%) as malignant.

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PheochromocytoCushing Sindro


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Distribution of patients by type nosologic group of adrenaltumors:

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Pheocromocitoma Cushing Sindrom

Benign

Malign


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Nature clinical onset of adrenal volume formations:

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Acute

Subacute

Slow


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Pheochromocytoma, clinical signs:

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Hipercatecolaminemie crisis ofparoxysmal hypertension

Hypertension permanent form

Hypertension, mixed form

Neuropsychiatric disordersand senso -motor

Visual disturbances

Intestinal transit disordersand abdominal pain

Hypertonic crisis


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Changes detected in the exam objective:

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Exam

Changes in bloodpressure, fever

Hyperhidrosis, arrhythmia

Anx iety, Raynaud's

phenomenon or livedoreticularis

Pupillary dilation, palenessof the face or upper body


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Paraclinical examination:

In all 16 patients the diagnosed was based on imaging (CT, MRI), highlevels of catecholamines in blood, was performed in 7 patients in thedetermination of 24-hour urine free catecholamines and

vanilmandelic acid (metanefrin).

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Paraclinic

Imaging, high levels of

catecholamines in blood

Determination of freecatecholamines in urine

and vanilmandelic acid

Imaging studies withiodine 000

(metaiodobenzilguanidina)


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Cushing's syndrome-clinical signs

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Clinical signs excessive production o f cortisol,neuropsychiatric disorders

Hypertension syndrome

Endocrine syndromehyperglycemia to normalinstallation type diabetes0

Kidney manifestations aspyelonephritis

Nephrolithiasis

Headache p ronounced

Reproductive dys function(menstrual disorder in femaleand male sexual potency

disturbance)


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Changes detected in the exam objective:

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Changes detected in the examobjective

Changes detected in theexamobjective


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Therapeutic protocol:

Emergency treatment of hypertensive crisis as if pheochromocytoma. Surgical: Removal of tumor Preoperative drug preparation. Conservation of adrenal function.

We investigated the treatment of patients under study. After preoperativeevaluation of all the 21 (100%) patients with adrenal tumors in the study

underwent surgical treatment.

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Curativ purposePalliative purpose

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Number of patients

Number of patients


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Treatment: Surgical

Of the 21 patients studied, 16 patients (76.19%) surgicalintervention was Toracofrenolaparothomy and to 5 patients(23.80%) was intervened by Lumbothomy.

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Surgical Procedures

Toracofrenolaparotomy

Lombotomy


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Surgical techniques used in interventions on the adrenal:

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Pheocromocitoma Cushing sindrom

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Adrenalectomy

Resection of adrenal

Tumor enucleation


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Intraoperative complications in surgery for adrenalectomy:

Complications described in literature as parenchymal infarction after ligationof the remaining adrenal vessels and development of acute adrenalinsufficiency. The Urology Clinic sibiu not had such complications.

Transabdominal0,00

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Transabdominal

Lumbar


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1.Adrenal tumor clinically manifested in 13 (61.90%) cases and

asymptomatic in 8 (38.09%) cases. 2.Diagnostic algorithm of adrenal tumors include the consecutive

binding and functional tests (hormonal and pharmacological),diagnostic imaging for viewing topic glands (CT or MRI) to determinefunctional status of all organs and organ systems.

3.All formations hormonal inactive adrenal volume larger than 2 cm,and the active hormone required to be ectomizate, while smallerthan 2 cm needs to be seen in dynamic imaging with screening andhormone obligatory.

4.Preoperative preparation of patients with hormonally active tumors

is mandatory and is to compensate hemodynamic disorders,endocrine and related pathologies and is strictly individual basis foreach nosologic form.


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5.Surgical approach in adrenal volume formations located on theright is preferred in urology clinic Sibiu its toracofrenolaparothomy,and for those located on the left is subcostal left lumbothomy.

6.Pathology analysis revealed only the type of cells that developedtumors (cortical or medullary) and their level of differentiation, but

does not allow us to appreciate their secretory function, which leadsus to establish a definitive diagnosis only after data duplicationClinical and biochemical investigations of hormone level in blood.

7.Quality of life in patients with adrenal tumor surgery returned tonormal in 95% cases patients reintegrate into social life and

professional. 8.After some authors, the evolution in the forms of malignant

pheochromocytoma, survival is about 2 years after the occurrenceof liver or lung metastases is only 20 years if bone metastases.


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SCHWARTZ: Principiile chirurgiei,Editura Teora Vol II,pag.1783-1784.

ANGELESCU NICOLAE: Tratat de patologie chirurgical,Editura Medical2003,Vol II pag.2919-2933.

SINESCU I., GLUCK G., HRZA M. : Urologie Oncologic, Editura UniversitarCarol Davila , Bucureti , 2006.

Prof. Dr. IOANEL SINESCU Dr. BOGDAN SERBNESCU Conf. Dr. MIHAI

HRZA, Dr. CRISTIAN SURCEL,Dr. MIHAELA MIHAI- AFECIUNILE GLANDELORSUPRARENALE.

SINESCU I-Urologie clinic, Editura Medical Amaltea, Bucureti, 1998.

BUJAC MARIANA -ATITUDINEA DIAGNOSTICO-CURATIV NFORMAIUNILE DE VOLUM ALE GLANDELOR SUPRARENALE CHIINU, 2009.

Oxford Handbook Of Urology (1st Edition).

Atlas of Clinical Oncology - Endocrine Tumors.

Advanced Urologic Surgery, 3rd ed.

Conf. Univ. Dr. Nicolae Grigore , Prof univ. dr. Ilie- Craciun Urologie Clinica.


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Diagnostic and Treatment of Adrenal Tumors ASK W2003

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