Medullary hyperplasia

Introduction Medulla hyperplasia is an independent disorder in which autonomic catecholamines are secreted. It is more common in women. The age of onset is mostly young and middle-aged. The average age is 39 years old (24 to 49 years old). The course of disease is long, and sometimes the disease can develop for a long period of time.

Cause

Adrenal medulla is divided into two types: simple, primary adrenal medulla hyperplasia and secondary adrenal medulla hyperplasia. Secondary adrenal medulla hyperplasia is secondary to multiple endocrine disease type II (MEN2). In MEN2, medullary thyroid carcinoma or parathyroid lesions occur after adrenal medullary hyperplasia or pheochromocytoma for many years, and the pathogenesis is still unclear. Due to defects in the enzymes necessary for the biosynthesis of adrenocortical hormones, corticosteroid synthesis is not normal.

an examination

Related inspection

Bone and joint MRI examination CT plain scan

1 persistent or paroxysmal hypertension, long course, no significant progress for many years, no history of hypertension and pheochromocytoma, common antihypertensive drug treatment, adrenaline alpha blocker phenethylamine treatment effective .

2 After mental stimulation or fatigue, it can induce high blood pressure, and it does not cause symptoms when pressing the abdomen, pregnancy, or urinating.

3 detection of blood, urine catecholamines and their metabolites are mostly increased, while the content of adrenaline is mainly increased.

4B ultra-examination, no tumor mass near the adrenal gland and the abdominal aorta and the common iliac vessels, and the adrenal gland volume was found to increase.

5CT scan showed bilateral or unilateral adrenal gland boundary. The flat gland showed diffuse density thickening and widening, sometimes with equal density nodules, and the diameter was more than 0.5cm. There was no tumor imaging.

Differential diagnosis

Need to identify adrenal hyperplasia and adrenal medullary adenoma.

Congenital adrenal hyperplasia is also known as adrenal genital syndrome or adrenal hypermutation. Mainly due to defects in the enzymes necessary for the biosynthesis of adrenocortical hormones, resulting in abnormal cortical hormone synthesis. In most cases, the adrenal gland secretes glucosamine and physiochemical hormones and the male hormone is too much. Therefore, there are different degrees of adrenal insufficiency in the clinic, accompanied by masculinization of the girl, while the boy is sexually precocious, and there may be hyponatremia. Or a variety of syndromes such as high blood pressure.

Adrenal medullary adenomas vary in size, but the average diameter is only 5 to 6 cm, usually 50 to 200 g, but several kilograms have been reported. Rarely symptoms that are large enough to cause or cause compression or obstruction. Tumors usually have intact capsules, and the morphology of the cells under the microscope is malignant. These cells have many weird shapes with dense, large or multinuclear. Regardless of the histological morphology, if the tumor does not invade the capsule or metastasis, it can be regarded as benign. In addition to the adrenal gland, the tumor can be found in the pharyngeal tissue along the sympathetic chain of the para-aortic, the carotid body, the Zuckerkandl (located in the aortic bifurcation), the gastrointestinal-urinary system, the brain, the pericardium and the skin. Like a cyst.

Adrenal medullary adenoma is a component of the familial polyendocrine tumor, type IIA (Syper syndrome), which may be associated with medullary thyroid carcinoma and parathyroid adenoma (see Section 10). Type III syndrome has been Described, including adrenal medullary adenoma, mucosal (oral and ocular) neuroma and medullary thyroid carcinoma. With a concomitant (10%) with multiple neurofibromatosis (vonRecklinghausen disease), hemangiomas can be found, as in vonHippel-Lindau disease.

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