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What is the adrenal gland?
Adrenal gland is a
gland located above the kidneys, one on each side. It produces three kind of
hormones
Catecholamines- like
adrenaline and noradrenaline
Corticosteroids
Mineralocorticoids
When tumors arise
from this gland it may be benign or malignant, and can produce one or more of
these hormones
What are the common tumors of the adrenal gland?
The adrenal gland can
produce both benign and malignant tumors. When the tumor is smaller than 4 cm
these are generally bening like Pheochromocytoma or myelolipoma. But when the
tumor is larger than 4 cm then the chance of cancer is higher and also these
are more likely to produce one or more of these hormones.
How are they evaluated?
Generally these
tumors are detected by ultrasonography, But for finer evaluation a MRI study is
almost always needed.
Also to assess the
production of hormones generally a 24 hour urinary collection of catecholamines
and steroids is performed.
What is the best treatment for this tumor?
When these tumors are
detected and the surgeon decides that these can be either malignant or are
producing harmful excess hormones then surgery to remove these tumors is
performed.
Although the standard
treatment for these tumors was open surgery, but after the advent of
laparoscopic surgery , nowadays most of these surgeries are performed by
laparoscopy. Laparoscopy provides the advantage of minimal access and minimal
pain, since the muscles and skin are mostly spared, but also provides excellent
visualization of this deep seated gland. While open surgery needed a very large
incision and retraction of the ribs to gain access to this gland, which
resulted in severe post operative pain, laparoscopic surgery spares most of the
pain.
Also the adrenal vein
is much better seen by laparoscopic access as compared to open surgery
therefore laparoscopic surgery has become the current preferred modality of
surgery.
What follow up is needed
for this tumor after surgery?
The removed tumor is
always sent for post operative histopathology examination, If cancer is
detected then a onco-medicine consultation is needed for adjuvant treatment. if
the tumor was benign but produced vaso-active hormones then adequate endocrine
intervention is needed in the post operative period to prevent a crisis of
hormone deficiency in the post operative period.