Incidentaloma of the adrenal gland classification, symptoms and treatment

The term incidentaloma comes from the English word incidental, which translates as “accidental”. This is the name of any tumor that does not manifest itself in anything and is discovered quite by accident.

In 98% of cases, these are benign hormonally inactive tumors. About 90% of people live and do not even know about the presence of such neoplasms in their bodies.

  • clinical picture
  • Diagnostic methods
  • Therapies

What is an adrenal incidentaloma?

Incidentaloma of the adrenal gland is a general diagnosis that includes all sorts of adrenal gland masses that are discovered quite by accident. If detected, an examination is required to determine the type of tumor and the dynamics of its growth.

Most often they have no specific symptoms. In some species, changes may appear that a person does not associate with the presence of a neoplasm in the body.

When a tumor is found on the adrenal gland, first of all, its type is determined, depending on hormonal activity.

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Hormonally active

They are characterized by increased production of certain hormones.

These include:

  • Corticosteroma. Large amounts of cortisol are produced.
  • Pheochromocytoma. The production of a large number of stress hormones is provoked.
  • Aldosteroma. The amount of aldosterone increases.
  • Androsteroma and corticoestroma. The production of sex hormones increases.

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The appearance of these neoplasms does not proceed without symptoms. However, a person often does not associate them with such serious diseases. It is because of this that their diagnosis is difficult. In some situations, hormone levels remain normal.

Hormonally inactive

They appear much more often and most of them do not pose a danger to human life. However, in this group there are malignant tumors that can be life threatening in the future.

This group includes:

  • Adenoma. Neoplasm in the form of a capsule with a homogeneous content.
  • Fibroma. A neoplasm consisting of fibrous tissue.
  • Lipoma. A neoplasm consisting of adipose tissue.
  • Adreno is a cortical cancer. Reaches 5 cm or more, with uneven edges. It grows rapidly and grows deep into tissues. It is more often diagnosed on the left side.
  • Sarcoma. Malignant tumor with rapid growth dynamics. It is prone to metastasis, relapse and invasion into adjacent organs and tissues.

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Malignant tumors are rarely diagnosed by chance. They are characterized by severe symptoms that force a person to see a doctor.

Other entities

There is one more group of neoplasms that cannot be classified as tumors in origin and structure.

This group includes:

  • Cysts.
  • Nodular hyperplasia of the adrenal cortex.
  • Hematomas.

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Such formations can affect both one and two adrenal glands at the same time.

clinical picture

The absence of clinical manifestations is characteristic of incidentaloma. However, some species have characteristic symptoms.

With pheochromocytoma, frequent attacks of increased pressure appear, up to a hypertensive crisis. There is a feeling of fear, panic, convulsions appear. The skin turns pale. These symptoms appear abruptly and also abruptly disappear.

Corticosteroma is rarely randomly diagnosed because its symptoms are hard to miss.

It has the following manifestations:

  • Burgundy stripes appear on the abdomen and armpits.
  • Persistent increase in blood pressure.
  • The appearance of fatty deposits in the lower part of the face.
  • Increased blood sugar.

Androsteroma and corticoestroma alter the level of sex hormones. In women, an estrogen-producing tumor may not manifest itself.

The only manifestation is an increase in the level of the hormone during testing. In men, an increase in this hormone can cause sexual dysfunction, a change in the female body, obesity, and voice changes.

An increase in testosterone for women is fraught with a change in the timbre of the voice, an increase in sex drive and a set of muscle mass.

Aldosteroma is characterized by clinical manifestations of hypertension. Blood pressure, dizziness, weakness, flashing of flies before the eyes and other symptoms increase. Muscle function is impaired, weakness and convulsions appear. Kidney failure often occurs.

With an impressive size of the neoplasm, the following symptoms appear:

  • A sharp decrease in body weight.
  • Myalgia
  • Arthralgia.

The presence of hormonally inactive tumors is often asymptomatic, especially if they are benign.

Diagnostic methods

Basically, incidentalomas are diagnosed using CT and ultrasound. If an ultrasound scan is performed with a targeted method, then the tumor can be examined in more detail. Basically, CT of the adrenal glands is performed to clarify the diagnosis.

CT of the adrenal glands allows you to determine the type of:

  • Most of benign tumors are rounded neoplasms with smooth, clear edges, no more than 3 cm in diameter.
  • The hematoma has uneven edges and a heterogeneous mass, as it consists of blood clots,
  • Malignant tumors are large formations, with indistinct boundaries, with an increase in lymph nodes.

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To clarify the diagnosis, angiography and scintigraphy are used with the introduction of a contrast agent.

To determine hormonal activity and other criteria, it is necessary to conduct a general and biochemical blood test, as well as a urinalysis.

In some cases, a biopsy is done. With it, you can determine the nature of the tumor.

Therapies

Treatment for incidentaloma can be conservative or surgical. The method of treatment depends on its nature.

However, there are several medical rules:

  • If the tumor is more than 6 cm, regardless of whether it is malignant or not, it is removed. This is done by any means, but most often through an open incision.
  • Tumors less than 3 cm of a benign nature, without manifestations and growth, are not removed. Observation is required every six months for its dynamics.
  • If the tumor is hormonally active, but small in size, doctors prefer to perform a surgical operation to remove it.

If the malignancy of the tumor is confirmed, then in most cases it is removed along with the adrenal gland. This avoids the occurrence of relapses. However, after such an operation, hormones are required.

If the tumor is inoperable, then radiation and chemotherapy are used.

After surgery, the patient must be monitored. Disorders in the work of the cardiovascular system may appear.

Despite the fact that more often such formations are found in old age, it can still appear in young people. It is important to identify the disease before it manifests itself. In this case, it will be possible to carry out prevention and monitor the dynamics of the tumor.

Minor changes in the body (obesity, hair growth, and others) are a reason to consult a doctor, as they may be the first signs of a tumor.

Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.

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