adrenal adenoma resection

Adrenal adenoma lesions, whether caused by tumors or proliferation, are mainly characterized by systemic changes in the production of cortisol-based hormones. If it is a tumor, the course of disease is short and develops rapidly, and the symptoms and signs are typical; if it is caused by bilateral hyperplasia, the course of disease is longer and the development is slow. The clinical features of adrenal hyperplasia caused by pituitary tumors or ectopic ACTH tumors differ from the above two categories in some respects. Since Cushing first reported the disease in 1932, 10 cases were diagnosed in the first 20 years, which is considered rare. However, in fact, this disease is not uncommon. With the improvement of cognition and the perfection and accuracy of the means of diagnosis, the number of cases in China has increased dramatically. According to the etiology analysis, the bilateral hyperplasia was not determined by pituitary-dependent cortisol and the cause was about 65%, adrenal adenoma or cancer accounted for about 20%, and ectopic dermal progesteroma accounted for about 15%. Class 1 requires more adrenal surgery; Class 2 can only perform adrenal surgery; and Class 3 belongs to the scope of surgery for each target organ, such as mediastinum, pelvic organs, secondary to cortical hyperplasia After resection, it will subside on its own, and no need for adrenal surgery. Adenomas are common in adults, and are also seen in a small number of girls. They are solid tumors with intact capsules, ranging in size from 50g to less. Bilateral multiple microadenomas are found only in occasional patients, and the cortex is full of proliferative nodules of varying sizes. The diameter of 0.2 ~ 3.5cm, the bilateral adrenal gland volume increased significantly, there are weights up to 90g, the lesion seems to be between adenoma and proliferation. The surgical treatment of bilateral adrenal glands is satisfactory, and the effect is the same as that of adenomas. Treatment of diseases: adrenal tumors Indication Adrenal adenoma resection is applicable to: Cushing syndrome caused by adrenal functional tumors accounts for 10% to 30%, with an average of about 20%. Among them, adenoma is the main cause, and women are female, male: male is 4 to 5:1. Surgical indications depend on the qualitative diagnosis and localization diagnosis of adrenal adenoma. 1. A variety of imaging diagnosis and radionuclide scanning including 131I-19-Iodocholesterol scan showed a >2cm diameter isolated tumor with a more complete tumor capsule, visible in the periphery of the tumor Normal adrenal tissue. 2. The unilateral or bilateral adrenal gland exhibits multiple nodular proliferation, a so-called micro adenoma, and the entire gland is significantly enlarged. 3. Although imaging diagnosis and radionuclide scanning did not detect adrenal masses, clinical symptoms and signs were typical, and various endocrine biochemical tests showed significant increase in cortisol and its derivatives, while dexamethasone suppression test None of the metyrapone test responses showed a positive result of inhibition. There was no significant increase in corticosteroid value in the ACTH stimulation test. The adrenal gland should be explored first in the pituitary and other organs without ectopic tropism. Preoperative preparation Due to the long-term autonomic secretion of excess cortisol from adrenal adenoma, the function of pituitary secretion of ACTH is inhibited, and the residual adrenal gland or tumor-derived adrenal gland tissue also undergoes compensatory atrophy, in order to enhance the tolerance of surgery and prevent surgery. A sharp in vivo cortisol deficiency that occurs after removal of the adenoma requires adequate preoperative preparation. 1. Give cortisone 50 mg of acetic acid 1 to 2 days before surgery, 4 times a day. Before the tumor is about to be removed, 100 to 200 mg of hydrocortisone is intravenously infused to maintain the basic requirement, and the intravenous infusion is continued until the entire procedure. 2. Supply sufficient calories or supplement enough protein by vein. 3. Due to the different degree of sodium retention in the body, it is generally unnecessary to replenish the crystal solution before surgery. If the heart is overloaded, a permeable diuretic can be given as appropriate. 4. Conventional application of anti-infective drugs. Add a variety of vitamins. Surgical procedure A well-defined single-sided small tumor can be passed through the ipsilateral dorsal or lumbar incision. The location diagnosis is not certain, unilateral or bilateral nodular proliferative microadenomatosis, the upper abdominal arched transverse incision can be used to successfully remove the unilateral tumor and explore the contralateral adrenal gland. It is most suitable for the completion of bilateral microadenomas in the first phase. It is also possible to detect the presence or absence of ectopic dermal pro-melanoma in the para-aortic and pelvic cavity. The adrenal gland is removed through the back incision and the lumbar incision and does not enter the abdominal cavity. After the abdominal incision, the left and right adrenal glands were separately explored after entering the abdominal cavity. The peritoneum and perirenal fascia can be cut along the lateral rim of the colonic liver sac or the spleen of the colon. The colon is turned upside down, the upper pole of the kidney is released, and the kidney is pressed downward to reveal the adrenal gland. On the left side, the adrenal gland can also be reached in the peritoneum of the transverse colon and the upper edge of the pancreas or directly through the mesentery. The left adrenaline of the lesion can also be revealed by cutting the incision between the left lobe of the liver and the stomach, pulling the stomach downward, and pulling the left lobe of the liver upward. If it is an adenoma, there is a complete envelope. The adenoma can be removed from the adrenal gland by blunt or sharp methods. It can also be inserted between the adenoma capsule and the adrenal gland by finger insertion. Pay attention to ligation and adenoma. Blood vessels. If hyperplasia occurs, the adrenal gland should be separated from the upper pole of the left kidney, and the adrenal gland should be carefully removed along the surface of the adrenal gland. Once the dissociation is complete, the adenoma or hyperplastic gland can be removed. On the right side, the ligament between the stomach and the liver is cut, and the peritoneum is cut at the upper lateral edge of the duodenal ring. The right lobe of the liver and the gallbladder are protected together with a gauze pad and then pulled upward. The stomach and the duodenum are respectively pulled inward and downward, that is, the perirenal fat is seen. After the cleaning is performed, the right kidney is pulled downward, that is, The right adrenal gland and tumor can be shown and removed by the previous method.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.