Tumors of the adrenal gland; carcinoma of the adrenal cortex

Tumors arising in the adrenal gland represent a very interesting group. Since the adrenal is divided into two anatomic portions, the cortex and the medulla, we can have tumors arising from either of these component parts. Those arising from the adrenal cortex which are benign rarely cause any symptoms and are found only at autopsy. The other great group of cortical tumors are malignant and give rise in children to a marked precocious development as characterized by marked growth of sexual organs, increased osseous growth and in the female in sexual development which often tends toward the masculine side. In the adult a chain of symptoms commonly called Cushing's syndrome may develop consisting of plethoric adiposity of the face, neck and trunk, purplish striae, acrocyanosis, polycythemia and vascular hypertension, frequently accompanied by hyperglycemia and osteoporosis, and in women by amenorrhea and hypertrichosis.     

Anatomy and pathology of the adrenal glands

The adrenals are paired glands that lie in the retroperitoneum and have a close anatomic relation to the kidneys. Each gland has a cortex and a medulla, which act as separate entities. The adrenals are affected by various pathologic conditions, including congenital abnormalities, hypofunction, nodular enlargement, hyperplasia, and malignant and benign tumors. Newer developments in pathologic evaluation are fine-needle aspiration biopsy, immunohistochemistry, and ploidy and oncogene analysis.     

Detectability and characteristics of the primary adrenal tumor by ultrasonography--comparison with CAT scan and adrenal scintigraphy

From March 1978 to May 1987, 22 cases of primary adrenal tumors were examined by ultrasonography. The patients ranged in age from 21 to 79 years with an average of 42.6 year, including 11 cases of pheochromocytoma, 6 cases of primary aldosteronism, 4 cases of Cushing's syndrome and 1 case of ganglioneuroma. Visualization of tumors was successful in 19 of the 22 patients (86.4%). The detecting rate of right adrenal tumors was 100% (12/12), while the rate of the left was 80% (8/10). The sizes of detected adrenal tumors were larger than 10 mm on the right and larger than 20 mm on the left. Obesity and bowel gas degraded the image of left adrenal tumors, resulting in a lower detective rate of the tumors. The suprarenal area and small lesions were best demonstrated by a lateral intercostal approach using longitudinal scanning plane and by a right subcostal approach using transverse scanning plane. In pheochromocytoma, cystic lesions (echo free space) existed, and the fact that no cystic lesion in other adrenal tumors was helpful for diagnosis of pheochromocytoma. It is concluded that ultrasonography is a very useful method for diagnosis of adrenal tumors as an initial imaging procedure, because it is totally non-invasive, rapid and less expensive than all of the other techniques.     

带蒂肾上腺背部皮下移位术治疗肾上腺髓质增生症

目的 进一步探讨肾上腺髓质增生症的手术方法。方法 肾上腺髓质增生患者8例,手术分离并结扎肾上腺下、内侧血管,使肾上腺上组血管形成5.0-6.0cm的蒂,自第11肋间拉至背部皮下,以带蒂肾上腺背部皮下移位术治疗,结果 术后8例均获得随访,随访时间6个月-4年,平均2年,除1例患者伴有神经官能症,症状未减,余7例血压及内分泌检查皆恢复正常。结论 带蒂肾上腺背部皮下移位术治疗髓质增生,操作简单,疗效满意。     

Imaging of the adrenal gland

Summary Clinically, the development of highly accurate imaging techniques that define adrenal anatomy and give information concerning adrenal physiology have revolutionized our approach to adrenal disorders [1, 2]. These techniques complement the highly accurate hormonal analyses that lead to the diagnosis of primary hyperaldosteronism, Cushing's syndrome, and pheochromocytoma. In addition, they help distinguish these entities from other adrenal disorders as well as other retroperitoneal processes. Thus, imaging techniques presently play a critical role in confirming the hormonal diagnosis and precisely localizing the specific adrenal lesion.This article reviews the imaging techniques available and attempts to direct the reader to the procedure of choice for each adrenal disorder.