Adrenocortical adenoma

Adrenocortical Adenoma
Other names	Adrenal cortical adenoma, adrenal adenoma
Conn syndrome
Specialty	Endocrinology, oncology

An adrenocortical adenoma or adrenal adenoma is commonly described as a

. In contrast, "Cushing's syndrome" refers specifically to "primary hypercortisolism" classified as "ACTH-independent Cushing's syndrome" caused by adrenocortical adenomas.

Presentation

Medical condition

Hypercortisolism
Specialty	Endocrinology, oncology
Symptoms	Adrenal Lesion

Adrenal adenomas are often categorized as endocrine-inactive tumors considering that majority of them are non-functioning and

• Osteopenia
• Muscle weakness/muscle atrophy

Cardiovascular

• Hypertension

Endocrine and Metabolic

• Obesity

→More prevalent in males

• virilization

→More prevalent in females

• Hyperandrogenism
• Irregular
  menstrual cycles

Neuropsychological

• Sleep disorders
• Depression

Skin

• Easy bruising
• Stretch marks
• Hirsutism
• Acne

Cause

Adrenal Glands Zonations
Specialty	Endocrinology, oncology

Adrenal Glands Zonations
Specialty	Endocrinology, oncology

Study of the reported cases indicate that most adrenocortical adenomas occur due to neoplastic proliferation of adrenal cortical cells within the three distinct layers of adrenal cortex. In humans, the adrenal cortex comprises three concentric zones including the zona glomerulosa, zona fasciculata, and zona reticularis that under normal conditions respond to body's physiological demands for steroid hormones. The adrenal cortex is considered a dynamic organ in which senescent cells are replaced by newly differentiated cells. This constant renewal facilitates organ remodeling which contributes to dynamic characteristics of the adrenal cortex.

Diagnosis

Due to their asymptomatic nature, most reported cases of adrenal adenomas have been discerned fortuitously through

• Computed Tomography (CT scan
  )
• MRI
  )

Laboratory Tests

• CRH Stimulation Test
• High-dose dexamethasone suppression test

Gross Description

• Well-circumscribed lesion
• Size ≤ 5 cm
• Weight ≤ 50 grams
• often appear as golden-yellow color mass

(may have focal dark regions corresponding to

The microscopic histopathology analysis of the tissue samples obtained from the adrenal cortex of individuals presenting with adenoma-associated symptoms such as primary aldestronism (PA) indicates that adenoma cells are relatively larger with different cytoplasm, and increased variation in nuclear size. This indication is based on comparison between the healthy (normal) and affected (adenoma-associated) adrenal cortex tissue samples. ^{[citation needed]}

• 
  Adrenocortical adenoma with focal high grade nuclear atypia
• 
  Adrenocortical adenoma with focal necrosis
• 
• 
• 

Adrenocortical adenomas are most commonly distinguished from adrenocortical carcinomas (their malignant counterparts) by the Weiss system,^[10] as follows:^[11]

Total score indicates:^[11]

• 0-2: Adrenocortical adenoma
• 3: Undetermined
• 4-9: Adrenocortical carcinoma

Treatment

• Non-functioning cases of adrenocortical adenoma can be managed through long-term followups and monitoring.^{[citation needed]}
• The treatment approach for the functioning cases of adrenocortical adenoma depends on the type of disorders they induce and their advancement. Surgical excision may be required if its presence is resulting in atrophy of the adrenal glands and the surrounding tissues.^{[citation needed]}

In order to acquire better treatment strategies, it is important to further examine, study and discern the distinct molecular mechanisms involved in the formation of

A 2018 Cochrane Systematic review compared two different types of surgery: laparoscopic retroperotenial adrenalectomy and laporoscopic transperitoenal adrenelectomy in different types of adrenal tumors.^[14] Laparoscopic retroperotenial adrenalectomy appeared to reduce late morbility, time to oral fluid or food intake and time to ambulation, when compared to laparoscopic transperitoenal adrenalectomy.^[14] However there was uncertainty in these findings due to low-quality evidence, as well as inconclusive findings about effects of either surgery on all-cause mortality, early morbidity, socioeconomic effects, duration of surgery, operative blood loss, conversion to open surgery.^[14]

Prognosis

• The long-term outlook for individuals diagnosed with non-functional adrenocortical adenoma is usually excellent.
• The long-term outlook for individuals diagnosed with functional adrenocortical adenoma is good with early diagnosis and treatment.

Epidemiology

• Prevalence: Female > Male
• More common in adults
• Relatively earlier onset in females (ages ≤ 20) than males (ages ≤ 30)
• Most common cause of
  ACTH-independent Cushing's syndrome

• Hyperplasia
• Adrenal tumor
• Cushing's syndrome
• Conn's syndrome
• Hypercortisolism
• Hyperaldosteronism
• Hyperandrogenism
• Adrenal gland
• Adrenal paraganglioma
• Adrenal Pheochromocytoma
• Adrenal ganglioneuroma

References