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Conn's Adenoma


Presentation

  • The most common presentation of adrenocortical carcinoma is that of an incidentaloma. At presentation, 19% have inferior vena cava (IVC) involvement and 32% have metastases.[emedicine.medscape.com]
  • The documents contained in this web site are presented for information purposes only. The material is in no way intended to replace professional medical care by a qualified specialist and should not be used as a basis for diagnosis or treatment.[orpha.net]
  • Removal of the affected adrenal gland usually resolves other medical conditions that may be present as a result of elevated adrenal hormones (i.e. primary aldosteronism, Cushing's syndrome ).[rarediseases.info.nih.gov]
  • Hypokalemia will be variably present. The easiest screening test for hospitalized patients is the dexamethasone suppression test.[cancertherapyadvisor.com]
  • Thyroid gland Adenomas of thyroids present as thyroid nodules. Surgery may be needed to remove them if they are secreting excess hormones. Breasts Breasts may be affected by fibroadenomas.[news-medical.net]
Fatigue
  • Common symptoms of Cushing's syndrome can include upper body obesity; severe fatigue and muscle weakness; high blood pressure ; backache; high blood sugar; easy bruising; and bluish-red stretch marks on the skin.[rarediseases.info.nih.gov]
  • The hypokalemia (low potassium level) can cause symptoms like fatigue, numbness, increased urination, increased thirst, muscle cramps, and muscle weakness.[columbiasurgery.org]
  • Non-specific, fatigue and generalized weakness are frequent complaints. Finally, neuropsychiatric symptoms have been reported, with depression and lethargy being the most common.[cancertherapyadvisor.com]
  • Cushing syndrome The clinical presentation of Cushing syndrome is hypertension, moon facies, abdominal striae, buffalo hump, muscle weakness, amenorrhea, decreased libido, osteoporosis, fatigue, hirsutism, and obesity.[emedicine.medscape.com]
Asymptomatic
  • The majority ( 95%) of adrenal adenomas are non-functioning, in which case they are asymptomatic. If found incidentally, please refer to the Management of incidental adrenal masses: American College of Radiology white paper.[radiopaedia.org]
  • These masses are typically asymptomatic, but some are associated with flank or abdominal pain. Adrenal myelolipomas can often be diagnosed with imaging studies.[emedicine.medscape.com]
Plethora
Constitutional Symptom
  • Adrenocortical carcinoma These patients present with constitutional symptoms such as weight loss, fever, and malaise. Up to 80% of adrenocortical carcinomas are functional, and patients with these present with clinical signs of Cushing syndrome.[emedicine.medscape.com]
Hypertension
  • Multi-drug resistant hypertension. Hypertension with spontaneous or diuretic-induced hypokalemia. Hypertension with an incidentally discovered adrenal mass.[cancertherapyadvisor.com]
  • In general, patients with a long-standing history of hypertension or difficult to control hypertension should be screened for hyperaldosteronism.[columbiasurgery.org]
  • […] following surgical excision: 2 hypertensive medications, duration of hypertension 6 years, serum aldosterone 350 pg/mL ( J Korean Med Sci 2010;25:1041 ) Treatment Surgical excision is most common treatment May initially attempt conservative medical management[pathologyoutlines.com]
  • The most common clinical sign of pheochromocytoma is hypertension. Persons with this condition may experience sustained hypertension, paroxysmal hypertension, or sustained hypertension with superimposed paroxysms.[emedicine.medscape.com]
  • […] body hair, and menstrual periods may become irregular or stop completely. [4] Mild hypercortisolism without any obvious symptoms, called subclinical Cushing's syndrome, is common in people with an adrenal incidentaloma, although glucose intolerance and hypertension[rarediseases.info.nih.gov]
Episodic Headache
  • The classic triad is episodic headache, tachycardia, and diaphoresis. The most common clinical sign of pheochromocytoma is hypertension.[emedicine.medscape.com]
Round Face
  • Too much cortisol can lead to Cushing’s syndrome, which can cause symptoms like weight gain around your belly, a very round face, and pink or purple stretch marks. It can also lead to mood swings and make you more likely to get diabetes.[webmd.com]
Headache
  • You may get too much epinephrine or norepinephrine in your blood, which can cause high blood pressure, headaches, and heart problems. Treatment If you have a nonfunctioning tumor, you probably won’t need any treatment.[webmd.com]
  • The hypertension may cause headaches, blurred vision, and dizziness. While patients with hyperaldosteronism may have normal potassium levels, many patients may have low potassium levels.[columbiasurgery.org]
  • Pathophysiology Neoplastic proliferation of adrenal cortical cells Aldosterone impacts distal tubules & collecting ducts of nephron sodium and water retention, potassium retention blood pressure Clinical features Hypertension, proximal muscle weakness, headache[pathologyoutlines.com]
  • Symptoms of this condition may include high blood pressure, fatigue, headache, muscle weakness, numbness and paralysis that comes and goes. [5] Benign cortisol-secreting adenomas can also produce small amounts of androgens (steroid hormones, such as testosterone[rarediseases.info.nih.gov]
Tremulousness
  • Other common signs are palpitations, anxiety, tremulousness, chest pain, and nausea and vomiting. A small group of these patients experience induced myocardiopathy due to sustained catecholamine release.[emedicine.medscape.com]

Workup

  • The workup of adrenal disorders requiring surgical intervention has undergone a revolution with the tremendous advances in hormonal research, as well as in radiographic techniques and localization.[emedicine.medscape.com]
Ventricular Hypertrophy
  • Left ventricular hypertrophy may be seen and typically is out of proportion to the degree of hypertension.[cancertherapyadvisor.com]

Treatment

  • The treatment for hyperaldosteronism depends on the underlying cause. In patients with a single benign tumor ( adenoma ), surgical removal ( adrenalectomy ) is curative.[columbiasurgery.org]
  • Nonfunctional adrenal adenomas typically do not cause any problems and rarely require treatment. [7] Last updated: 11/26/2014 Research helps us better understand diseases and can lead to advances in diagnosis and treatment.[rarediseases.info.nih.gov]
  • The material is in no way intended to replace professional medical care by a qualified specialist and should not be used as a basis for diagnosis or treatment.[orpha.net]
  • The preferred surgical treatment for PH due to an adenoma is laparoscopic total adrenalectomy.[cancertherapyadvisor.com]
  • Treatment If you have a nonfunctioning tumor, you probably won’t need any treatment. Your doctor will just want to keep an eye on it to make sure it doesn’t become functional. For functional tumors, you typically get surgery.[webmd.com]

Prognosis

  • Treatment and prognosis Small adrenal masses with manifestations of hormonal excess require resection, as do large ( 3-5 cm) non-functioning adrenal mass lesions, as they are considered potentially malignant (see adrenal carcinoma ).[radiopaedia.org]
  • However, with appropriate treatment, this disease is treatable and has an excellent prognosis. Patients with difficult to control or long-standing hypertension should be screened for primary hyperaldosteronism.[columbiasurgery.org]
  • Prognosis and Patient Counseling Cushing's syndrome Patients with Cushing’s syndrome from a benign adrenal adenoma experience a 5-year survival rate of 95% and a 10-year survival rate of 90% after definitive adrenalectomy. Recurrence is rare.[cancertherapyadvisor.com]
  • Adrenocortical carcinoma Adrenocortical carcinoma is a rare disease with a poor prognosis. Up to 80% of adrenal carcinomas are functional and secrete multiple hormones.[emedicine.medscape.com]

Etiology

  • Etiology Primary hyperaldosteronism The most common causes of aldosterone overproduction are idiopathic adrenal hyperplasia, followed by adenomas, and then (rarely) adrenal carcinoma.[emedicine.medscape.com]

Epidemiology

  • […] cortex, usually without discrete nodules Nodular adrenal hyperplasia (NAH): adrenal cortex contains multiple nodules with / without generalized thickening Various cutoffs exist for macro versus micronodular hyperplasia (range 0.5 - 3.0 cm in diameter) Epidemiology[pathologyoutlines.com]
  • Epidemiology Frequency In the United States, tumors of the adrenal cortex are reported in 2% of all autopsies, with the most common lesion being a benign adenoma.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • Adrenocortical carcinoma See Adrenocortical carcinoma in Pathophysiology.[emedicine.medscape.com]
  • […] micronodular hyperplasia (range 0.5 - 3.0 cm in diameter) Epidemiology F M, ages third to fifth decade Sites Unknown, theoretically zona glomerulosa, however cells may resemble any of the 3 layers of the adrenal cortex or a mixture of these cell types Pathophysiology[pathologyoutlines.com]

Prevention

  • Sometimes, instead of surgery, you may be able to get medicine that prevents hormones from working or lowers their levels so you won’t have any symptoms.[webmd.com]
  • Appropriate Prophylaxis and Other Measures to Prevent Readmission NA VII. What's the evidence? Arnaldi, G, Angeli, A, Atkinson, AB. “Diagnosis and complications of Cushing's syndrome: A consensus statement”.[cancertherapyadvisor.com]

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