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Adrenal cancer
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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