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Non-functional adrenal formations
Last reviewed: 23.04.2024
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[Causes of the nonfunctioning adrenal structures
In adults, adenoma (50%), carcinoma (30%) and metastatic tumors (10%) are the most common non-functioning adrenal gland formation. The rest is made up of cysts and lipomas. However, the proportions depend on the clinical manifestations; with an occasional finding, adenomas are often found. More rarely in newborns, spontaneous hemorrhage to the adrenal gland can cause the appearance of large formations in the adrenal region simulating neuroblastoma or Wilms tumor. In adults, a bilateral massive hemorrhage to the adrenal gland can be caused by thromboembolic disease, coagulopathy. Benign cysts are observed in elderly patients, can be caused by cystic degeneration, vascular disorders, bacterial infection, parasitic invasion (echinococcus). Also, adrenal formations can be caused by hematogenous spread of tuberculosis. Non-functional adrenal carcinoma causes a diffuse infiltrative retroperitoneal process. There may be bleeding causing adrenal hematomas.
Symptoms of the nonfunctioning adrenal structures
Non-functional adrenal formations are usually detected accidentally in CT or MRI, conducted for another reason. Non-functionality is established clinically and is confirmed by determining the level of adrenal hormones, as described above. In adrenal gland adrenal insufficiency is rare, except in cases involving both glands.
Diagnostics of the nonfunctioning adrenal structures
The main signs of a bilateral massive hemorrhage to the adrenal gland are abdominal pain, a drop in hematocrit, signs of acute adrenal insufficiency, suprarenal formations on CT or MRI. Adrenal tuberculosis can cause calcification and Addison's disease. Non-functional adrenal carcinoma usually manifests as a metastatic disease, therefore, it is not subject to surgical treatment, however, chemotherapeutic control can be performed by mitotane with supporting exogenous glucocorticoid therapy.
Small adrenal adenomas (<2 cm) are usually non-functional, do not cause symptoms, do not require specific treatment, only periodic observation is necessary in connection with the possibility of growth and appearance of secretory function (periodic determination of electrolytes and search for clinical signs). With a possible metastatic disease, fine needle biopsy can be used.
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Treatment of the nonfunctioning adrenal structures
If the tumor is solid, adrenal, more than 4 cm, removal is necessary, since biopsy does not always differentiate benign from malignant tumors.
Tumors 2-4 cm in size are a complex clinical problem. If the scan does not involve cancer, the hormonal function is not changed (for example, normal electrolytes and catecholamines, there are no signs of Cushing's syndrome), perhaps periodic observation. However, many of these tumors secrete cortisol in amounts that are not sufficient for the onset of symptoms, hence it is not known whether the symptoms and disease will be caused. Most clinicians rarely observe such patients.