Aldosteroma

Description:

The symptom complex caused by the raised products of mineralokortikoidny hormone of Aldosteronum was for the first time described by D. Conn, and received the name of "primary aldosteronism" or Conn's syndrome. In 70-85% of cases adenomas of adrenal glands, in other cases – a hyperplasia of bark of adrenal glands, tumors of a thyroid gland or ovaries having hormonal activity are the reason of primary hyper aldosteronism.
Under aldosteromy in endocrinology understand aldosteronsekretiruyushchy adenoma of adrenal glands which development is followed by signs of primary aldosteronism. Aldosteroma in most cases have high-quality character, less than in 5% of cases – malignant. Aldosteroma, as a rule, comes to light aged from 30 up to 50 years, and at women by 3 times more often than at men. Cases of development of an aldosteroma at children's age are described.

Aldosteroma reasons:

Aldosteroma origins, as well as many other tumoral formations of bark of adrenal glands, are authentically unknown. Presumably a part in its development is played by heredity.
Aldosteroma is shown autonomous excessive (increased by 40-100 times) by secretion of mineralokortikoidny hormone – Aldosteronum regulating water and electrolytic exchange in an organism. High level of Aldosteronum leads to strengthening of a reabsorption of ions of sodium in renal tubules and the raised excretion of potassium ions, magnesium and hydrogen with urine that promotes a delay of liquid, a hypervolemia, a hypopotassemia and a metabolic alkalosis, pathological changes in various bodies and systems. Feature of primary aldosteronism at an aldosteroma is low activity of a renin in a blood plasma.
The high-quality aldosteroma represents small (no more than 1-3 cm) the tumor of an adrenal gland of yellowy-brown color surrounded with the thin connective tissue capsule. The high-quality aldosteroma can be combined with an atrophy or a hyperplasia of the zones of bark of adrenal glands surrounding it. Primary malignant aldosteroma developing from own elements of bark of adrenal glands is characterized by rapid growth, the big size and weight; sometimes at the small amount of education there can already be innidiation signs. Aldosteroma more often happen single (to 70-90% of cases), in 6% of cases – multiple to bilateral localization. Morphologically aldosteroma have a heterogeneous structure: can consist of the cells similar to cells of a puchkovy or mesh zone.

Aldosteroma symptoms:

Clinical displays of a disease can be combined by three main syndromes - cardiovascular, neuromuscular and renal.

The cardiovascular syndrome is characterized, as a rule, by persistent arterial hypertension, headaches, changes of an eyeground, a hypertrophy of a myocardium of a left ventricle, myocardium dystrophy. Emergence of the called changes is connected with a sodium delay in body tissues, a hypervolemia, intima hypostasis, reduction of a gleam of vessels and increase in peripheric resistance, increase in sensitivity of vascular receptors to influence of pressor factors.

Neuromuscular sindromproyavlyatsya by muscular weakness of various expressiveness, is more rare - paresthesias and spasms that is caused by a hypopotassemia, intracellular acidosis and the dystrophic changes of muscular tissue and nerve fibrils developing on this background.

The renal syndrome caused by a so-called kaliyepenichesky nephropathy is characterized by thirst, a polyuria, a nocturia, an isohyposthenuria, alkali reaction of urine.

Asymptomatic forms meet in 6-10% of observations.

Diagnosis:

In diagnosis of a disease attach significance to the increased arterial pressure in combination with a hypopotassemia, a giperkaliuriya, increase in basal level of Aldosteronum in blood and daily excretion with urine, decrease of the activity of a renin of plasma. Take existence of a hypernatremia, gipokhloremichesky extracellular alkalosis, increase in volume of the circulating blood into account.

In difficult diagnostic cases apply the test with suppression of secretion of Aldosteronum 9a-ftorkortizoly (kortinefy). During 3 days okbolny appoint 400 mkg of drug a day. At autonomous adenoma of an aldosteronprodutsiruyushchea (aldosteroma) of decrease in level of Aldosteronum does not occur, and at idiopathic primary hyper aldosteronism decrease in level of Aldosteronum in blood is noted. Use also mid-flight test (at an aldosteroma the reduced level of a renin does not increase, the increased level of Aldosteronum decreases or does not change).

For specification of nature of damage of adrenal glands (an aldosteroma, a hyperplasia) use ultrasonography, KT or MPT which sensitivity, i.e. ability to reveal changes at their existence, reaches 70-98%.

Functional activity of adrenal glands can be estimated at the selection flebografiya by determination of level of Aldosteronum and cortisol in the blood flowing from the right and left adrenal gland. Fivefold increase in a ratio Aldosteronum/cortisol can be considered as confirmation of existence of an aldosteroma.

Treatment of an aldosteroma:

Treatment of patients from aldosteromy consists in carrying out a radical oncotomy together with the affected adrenal gland – adrenalectomies. If localization of an aldosteroma is known, at an operative measure is applied lumbar or thoracolumbar accesses on the relevant party if localization is not defined - transabdominal access to both adrenal glands is used.
In the preoperative period (within 7-10 days) appoint a diet with restriction of content of sodium, potassium administration of drugs (potassium chloride) and antagonists of Aldosteronum - Spironolactonum (Aldactonum or a veroshpiron). For prevention of development of acute insufficiency of bark of adrenal glands owing to surgical intervention concerning an aldosteroma therapy is shown by glucocorticoids (a cortisone, a hydrocortisone). After operation control of level of electrolytes and indicators of an ECG is necessary.