Adrenal Adenoma In Men

Adrenal glands are paired glands located in the retroperitoneal space. These endocrine organs regulate metabolism, immune response, systemic blood pressure and other parameters.

The adrenal glands are affected in men 2-3 times less often than in the fairer sex. The peak incidence for all nosologies falls on the age from 35 to 60 years. The most common disease is adenoma (a benign tumor of glandular tissue). This pathology accounts for about a third of all problems with the adrenal glands in men and women. In 75% of cases, a neoplasm occurs in the adrenal cortex, and in 25% in the cerebral layer.

Adrenal Adenoma: Classification

Adenoma can affect only one adrenal gland. This happens in the vast majority of cases (96-97%). The left gland suffers somewhat more often than the right.

A bilateral tumor accounts for 3-4% of all cases. Sometimes in one adrenal gland, two or more foci of adenoma are immediately found. In this case, multiple tumor is diagnosed.

All adrenal adenomas are potentially capable of secreting biologically active substances (hormones) into the blood. Sometimes the functional activity of the tumor does not appear for a long time. But the growth of adenoma in diameter leads to an increase in hormonal secretion and the occurrence of an imbalance.

Benign tumors are divided into:

    • aldosteromas (produce aldosterone and other mineralocorticoids);
    • androsteromas (produce male sex steroids);
    • corticoestroms (produce female sex steroids);
    • corticosteroids (secrete glucocorticoids);
    • pheochromocytomas (catecholamines are released into the blood);
    • combined (have mixed secretion);
    • neoplasms without obvious hormonal activity.

The size of the adenoma can reach gigantic dimensions.

Allocate:

    • small tumors (up to 10 mm);
    • medium (10-30 mm);
    • large tumors (more than 30 mm);
    • giant (more than 100 mm).

Usually the tumor has a rounded shape. It is not fused to surrounding tissues. The tumor is benign, so its borders are clearly defined. Adenoma is surrounded by a dense capsule. The structure of the neoplasm itself is most often homogeneous. The color of the adenoma of the cortex is usually yellow, brown, beige. Pheochromocyte staining is dark brown, reddish.

The histological structure of adenoma:

    • clear cell;
    • dark cell;
    • chromaffin;
    • mixed.

Causes of Adrenal Adenoma

In most cases, it is impossible to establish the true cause of a benign tumor. It is believed that adenomas of the adrenal cortex can occur in response to an increased load on the glandular tissue at any period of life. Long-term stresses, injuries, heavy surgical interventions, strokes, heart attacks can theoretically provoke the disease.

It was found that heredity plays a role in the appearance of adenomas.

A tumor of the brain layer (pheochromocytoma) in 10% of cases is familial in nature. The patient has a burdened history (a similar tumor has already been identified in someone from close relatives).

Pheochromocytoma can also be one of the components of the genetic syndrome of multiple endocrine neoplasias (MEN). Such diseases are accompanied by damage to several glands.

Pheochromocytoma is fixed in:

    • MEN 2 A type (Sipple’s syndrome);
    • MEN 2 B (Gorlin’s syndrome).

The genetic cause of pheochromocytoma is also probable when combined with neuroectodermal diseases (neurofibromatosis, tuberous sclerosis, Sturge-Weber syndrome, etc.).

A hereditary predisposition is also detected in some patients with adrenal cortical adenomas.

Other factors provoking the development of benign adrenal tumors:

    • excess weight;
    • age over 30-35 years;
    • the presence of arterial hypertension;
    • dyslipidemia;
    • type 2 diabetes;
    • smoking.

Symptoms of adrenal adenoma

A benign tumor can occur without any manifestations. Such adenomas become accidental findings during ultrasound or tomography. In other cases, the disease has symptoms.

A neoplasm may have signs:

    • due to hormonal disorders;
    • due to compression of surrounding tissues.

The most common adrenal adenoma is corticosteroma. Produces an excess of cortisol and its analogues. Gives a clinical picture of primary hypercorticism. These disorders correspond to Itsenko-Cushing’s syndrome.

Aldosteroma is less common. It secretes aldosterone and other mineralocorticoids into the bloodstream. Such a tumor leads to the development of primary hyperaldosteronism (Conn’s disease).

Androsteroma releases androgens. The most active of these is testosterone. In men, such an adenoma causes increased sexual characteristics. In boys before puberty, the tumor provokes earlier sexual development of the isosexual type. All secondary male sexual characteristics appear.

Corticoestroma synthesizes estrogens. If such a tumor appears in a man, then his body acquires feminine features (feminizes).

Pheochromocytoma secretes dopamine, adrenaline and norepinephrine. This tumor provokes the development of one of the most severe secondary hypertension.

Adenomas without obvious hormonal activity are inactive, do not have significant clinical manifestations. But to reveal the functionality of such tumors is often possible during special tests.

Itsenko-Cushing’s Syndrome

Pathology disrupts the metabolism, affects the systemic blood pressure and the work of all organs and systems.

Complaints of patients:

    • weight gain;
    • the appearance of striae (stretch marks) on the skin;
    • headache;
    • low mood background;
    • decreased muscle strength;
    • dry mouth
    • frequent urination;
    • multiple caries;
    • sweating
    • acne;
    • decreased sexual desire.

In men with primary hypercorticism, a redistribution of the fat layer is observed. The thickness of the subcutaneous tissue decreases on the arms and legs. Fat is mainly deposited in the abdomen and chest. The skin of such patients upon examination is dry, thinned. On the abdomen there are crimson wide striae. Patients find arterial hypertension, high blood sugar, and signs of immunodeficiency.

Conn’s disease

With primary hyperaldosteronism, most complaints are associated with arterial hypertension.

Patients concerned:

    • headache;
    • dizziness;
    • memory impairment;
    • the appearance of nervousness;
    • dyspnea;
    • pain in the heart;
    • visual impairment;
    • muscle weakness.

Conn’s disease leads to a persistent increase in systemic blood pressure. The usual treatment regimens for this disease are ineffective. Even in young patients, complications of hypertension develop rapidly. Target organs are affected: heart, blood vessels, kidneys, fundus.

On examination, patients with aldosteroma reveal a persistent increase in pressure, a decrease in muscle strength. In the analyzes, electrolyte disturbances are recorded.

Pheochromocytoma

A tumor from the adrenal medulla is manifested by a pronounced increase in pressure. Hypertension is usually a crisis. A sharp increase in systolic and diastolic pressure occurs against a background of provoking factors (stress, a change in body position, physical activity).

During the crisis, observe:

    • pallor of the skin;
    • dizziness;
    • visual impairment;
    • rapid pulse;
    • sweating.

Patients complain of severe anxiety, nervousness.

Pheochromocytoma without treatment often leads to severe complications. Patients develop strokes, heart attacks, retinal detachment, etc.

Androsteroma in men

Androgen secretion adenoma has few symptoms in adult men. Patients may notice a slight increase in hair growth on the face and body, an increase in strength and endurance.

In boys, such a tumor leads to early physical and sexual development. Children are ahead of their peers in growth and muscle strength. There is a high percentage of muscle tissue in the body. Bone age is also ahead of the norm. Because of this, early growth zones in the tubular bones are closed.

Puberty is expressed in:

    • growth of hair on the face and body;
    • Decrease in a voice timbre;
    • enlargement of the penis.

In some cases, spermatogenesis may begin in the testicles.

Corticoestroma in men

Corticoestroma produces female hormones, which are usually not detected in men. Such a tumor leads to feminization. The severity of the process depends on the activity of the adenoma.

Signs of feminization:

    • bilateral gynecomastia;
    • redistribution of the subcutaneous fat layer on the hips and buttocks;
    • reduced hair growth on the face and body;
    • testicle volume reduction;
    • penile malnutrition;
    • decreased sexual desire;
    • impotence.

If a corticoestroma appears in a boy before puberty, then the disorders are expressed in early sexual development of a heterosexual type. Boys are ahead of their peers in height and weight. They increase the percentage of adipose tissue in the body. Often there is bilateral gynecomastia.

Diagnosis of the adrenal gland

The disease can be detected by chance or with a special examination. If the patient suspects adrenal adenoma, then he is sent for diagnosis to the endocrinological hospital. Also, the examination can be carried out in a clinic.

For diagnosis, you need:

    • conversation with the patient (or his relatives);
    • analysis of complaints and medical history;
    • laboratory tests (hormones, glycemia, blood lipids, electrolytes);
    • visualization of the adrenal glands (ultrasound, tomography);
    • puncture of adenoma (according to indications).
In diagnostics, special attention is paid to hormonal tests.

For any adenoma, a study is indicated:

    • cortisol (morning, daily rhythm);
    • aldosterone;
    • potassium;
    • renin;
    • androgens;
    • estrogen;
    • methanephrine;
    • normetanephrine.

Evaluation of adrenocorticotropin (ACTH), large and small samples with dexamethasone, etc., are also often required.

Treatment of benign adrenal tumors

If a patient has a tumor of the adrenal gland with hormonal activity, then surgery is indicated. Adenoma removal is the main and most effective treatment.

If surgery is not possible, then symptomatic treatment is performed. Most often, correction of secondary diabetes, dyslipidemia, and a decrease in blood pressure are required.

If the tumor has a size of 3 cm in diameter and does not secrete hormones, then it is also desirable to remove it. It is known that such neoplasms can become malignant. In addition, large adenomas often have latent functional activity. Over time, this can lead to the manifestation of hypercorticism, hyperaldosteronism, etc.

Small adenomas without hormonal activity can be treated conservatively. The patient needs regular blood tests and undergoes an adrenal gland tomography (ultrasound) scan.