Aldosteroma is a benign tumor of the adrenal medulla that produces the hormone aldosterone. Causes the development of a condition called Conn's syndrome.
Aldosterone is a hormone that helps the body retain fluid during dehydration. When its production is increased, patients usually complain of high blood pressure. This pathology is three times more common in women than in men aged 30-50 years. In rare cases, the tumor also affects children.
Symptoms
- Arterial pressure;
- Headache;
- Heart pain;
- Deterioration of vision.
Cramps, muscle pain, and sensory disturbances may also occur. In addition, there is an increase in the daily rate of urination, a decrease in urine density, and an increase in appetite due to the production of aldosterone.
As a rule, this disease is registered in people aged 30-50 years, but sometimes children can also be affected. It is important to know that the disease occurs three times more often in women than in men.
Diagnostics
When making a diagnosis, pay attention to the patient’s complaints: uncontrolled hypertension, interruptions in heart function, convulsions, weakness, etc. As with any disease, mandatory and additional research methods are necessary.
Mandatory examination methods:
- HOW (clinical blood test): in most cases within normal limits, but sometimes leukocytosis, accelerated ESR, can be observed, which indicates the disintegration of a malignant tumor.
- General urine analysis without pathology.
- 24-hour urinary test for aldosterone excretion (increased).
- Biochemical blood test for aldosterone (increased) and renin (decreased), potassium (
Causes
Unfortunately, doctors are not yet able to name reliable reasons for the appearance of a tumor in the adrenal glands. You can focus your attention on several factors that catalyze the formation of aldosterome:
- Injuries;
- Endocrine pathology;
- Genetic predisposition;
- Inflammation in the kidneys and adrenal glands;
- Endocrine pathology;
- Adrenal adenoma;
- Weak immune system;
- Adrenal dysfunction;
- Hormonal disorders
Prevention
To prevent tumor development, it is recommended:
- Avoid emotional stress, physical strain, and hypothermia.
- Limit table salt consumption to 3 g per day.
- Observe the work and rest schedule.
- Control body weight, do not overeat.
- Take daily walks in the fresh air.
- Do not take glucocorticoid medications without a doctor's prescription.
The exact factor that leads to the appearance of aldosteroma in the adrenal cortex is unknown. Presumably there is a genetic predisposition. In adult patients, neoplasms can occur due to gene mutations due to industrial pollution, viral infections, and decreased immunity.
Aldosterome can increase the release of aldosterone into the blood by 50-90 times . The main function of this hormone is to maintain an optimal balance between the intake and excretion of fluid and salts. With prolonged loss of potassium, the functioning of the myocardium and beta cells of the pancreas is disrupted, which can lead to increased blood sugar.
The tumor is small , rarely reaching 3 cm, and most often affects the left adrenal gland. In a benign process, it is surrounded by poorly functioning tissue or cells that intensely produce cortisol. Malignant tumors are prone to rapid growth and spread to surrounding tissues, metastasis. In addition to excess aldosterone, they are also accompanied by symptoms of cancer intoxication (nausea, vomiting, fever, emaciation). About 10% of neoplasms do not manifest clinically.
Signs of the disease
The whole complex of symptoms consists of three syndromes, resulting in dysfunction of the kidneys, neuromuscular and cardiovascular systems.
First, let's focus on the kidneys. The lesion syndrome is accompanied by nephropathy, as well as changes in the level of potassium in the circulatory system. The main manifestations are:
- Regular urination;
- Constant feeling of thirst;
- Increased urine output at night.
Dystrophy of nerve fibers and muscles determines the neuromuscular structure syndrome. Main manifestations:
- Fatigue;
- Muscle weakness;
- Sensory disorders;
- Paralysis;
- Pain in fingers and calf muscles;
- Frequent cases of constipation;
The last syndrome concerns the cardiovascular system. The reason lies in the lack of water and sodium. There is an increase in the amount of blood, a narrowing of blood vessels, which become much more susceptible to the effects of hormones. As a result, the following happens:
- Headache;
- High blood pressure;
- Heartache;
- Decreased vision as a result of damage to the vessels of the fundus.
An important point is that if the tumor in the area of the adrenal glands is malignant, then the sick person may experience the following clinical signs: pain in the abdominal area, increased sweating, fever and general weakness.
What is the danger to life?
If you do not treat the disease, complications may arise:
- Diabetes mellitus as a result of disturbances in the process of insulin synthesis and glucose susceptibility by cells.
- Significant disruption of blood circulation in the brain. The reason is high blood pressure.
- Kidney failure. Manifestations: edema, increased creatinine levels, increased intoxication, increased urea levels in the blood.
- Hypokalemic crises. Manifestations: nausea, vomiting, loss of vision, muscle weakness, headaches. In addition, paralysis and impaired motor activity of the limbs may occur.
In ten cases out of a hundred, the disease passes without pronounced symptoms. For this reason, doctors strongly recommend that you undergo special preventive examinations as often as possible. With their help, they can promptly identify the disease if it is present.
A reason to visit a doctor may be an increase in blood pressure if it cannot be reduced by taking special medications. In addition, a sick person may have complaints due to blurred vision, headaches and heart pain, and high fatigue.
The complete list of diagnostic measures looks something like this:
- General urine test (excess potassium and reduced density of urine are detected);
- General and biochemical blood test (doctors detect an increase in the level of leukocytes and a decrease in hemoglobin levels, a decrease in potassium levels, and an increase in sodium levels);
- ECG (measurements characteristic of low potassium levels in the blood will be reflected);
- Radioisotope scanning;
- CT scan;
- Ultrasonography;
- Magnetic resonance imaging
The treatment of adrenal tumors is carried out by an endocrinologist and oncologist. You need to know that comprehensive diagnostics helps to effectively determine adequate treatment tactics by identifying the size and nature of the tumor located in the area of the adrenal glands.
Diagnostics
The disease is diagnosed based on a number of indicators. The doctor studies the characteristic clinical manifestations of the syndrome, prescribes laboratory tests, functional tests, and instrumental diagnostics.
It is necessary to pay attention to high blood pressure values against the background of hypokalemia and elevated sodium levels. Urine analysis for aldosterome shows low density and deviation towards alkalization. A decrease in renin activity and high aldosterone are detected in the blood serum. Additionally, tests with a load of hydrochlorocortisol and a test with suppression of aldosterone synthesis with cortinef may be prescribed if previous tests have not shown a clear picture of the disorders.
To clarify the nature of the formation (size, location, structure), instrumental studies are prescribed:
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Survey
When a patient complains, doctors diagnose the tumor. A thorough examination may be ordered. Laboratory tests determine the levels of sodium, chlorine, potassium and aldosterone.
A tumor can be detected using ultrasound or computed tomography, after which doctors assess its structure, size and integrity of nearby tissues. It may happen that aldosterone levels are measured in a vein passing through the adrenal glands.
Kinds
Aldosteroma can be single or multiple , and can be either unilateral or bilateral. As a rule, this is a small tumor (no more than 3 cm), yellow-brown in color and a capsule of connective tissue structures.
Malignant forms account for 5% of all cases and are formed from the adrenal cortex’s own tissues. These tumors grow rapidly and can metastasize to other organs and systems.
Treatment methods
Surgical intervention. The tumor is removed along with the adrenal gland. After the process is completed, hormonal therapy is prescribed. Surgery is performed through a lumbar approach if doctors know the exact location of the aldosteroma. In another situation, the operation is performed through the peritoneum.
The first option is to make several punctures from the back, approximately 3 centimeters in size. The second option is to dissect the muscles of the abdominal wall to form a large incision, about a centimeter long. Another option is laparoscopic surgery. This is a modern way to remove adrenal aldosteroma. What is it? Before starting the procedure, qualified doctors inject carbon dioxide into the abdominal cavity. The operation takes place through small punctures localized in the anterior wall of the peritoneum.
After surgery performed retroperitoneoscopically, patients are allowed to eat certain types of food in the evening. After a few days the person may be discharged. The success of surgery can be increased through a special preparatory process. Two weeks before surgery, the patient is prescribed a salt-free diet, focusing on potassium-containing foods. To reduce excess hormone levels, medications are prescribed to control potassium and sodium levels.
The most optimal method is determined by an experienced surgeon. Before doing this, the specialist must take into account many different factors, including the degree of pathology, the size of the tumor, the age of the patient and the general condition of the patient.
Recovery period
After a patient has their adrenal gland removed, they require special care. On average, rehabilitation takes 7-10 days, if there are no complications. At this time, the patient is in the clinic, under the supervision of medical workers.
The rehabilitation period is accompanied by a low-salt diet. In addition, patients should take medications containing potassium.
Doctors also prescribe medications after surgery. They are aimed at strengthening the immune system and suppressing aldosterone processes.
Is it possible to cure a tumor without surgery? No, It is Immpossible. With the help of special means you can only slightly reduce the pressure, but you will not be able to overcome the cause of its increase. Thus, hypertension will be provoked in the future.
Prognosis for patients with aldosteroma
After surgery, the prognosis is quite favorable. If high blood pressure remains after removal of the aldosteroma, the patient is prescribed antihypertensive drugs. The malignant nature of the neoplasm is characterized by rapid development, severe course and significantly worsens the prognosis.
Adrenal aldosteroma is a hormonally active tumor that requires mandatory treatment. Lack of therapy can lead to the development of dangerous diseases - diabetes, cerebrovascular accident and stroke, renal failure, hypokalemic crises. The only effective way to treat a tumor is to remove it surgically.
