Adrenal dysfunction. Tired Man, continued...

Functions of the adrenal glands

The cortex produces steroid hormones that control energy exchange and metabolism. There are three zones of the cortex, each of which synthesizes different hormones:

• zona glomerulosa - produces aldosterone, which affects water-salt metabolism and maintains blood pressure;
• reticular zone - sex hormones are synthesized that influence the formation of secondary sexual characteristics;
• zona fasciculata - glucocorticoids are produced, which are responsible for regulating protein, carbohydrate, fat metabolism, as well as nucleic acid metabolism. These hormones are also responsible for the body’s adaptation to stressful situations.

Catecholamines (adrenaline, dopamine, norepinephrine) are synthesized in the adrenal medulla. They affect the functioning of the cardiovascular system (change heart rate, increase blood pressure), stimulate the breakdown of fats, and increase blood glucose levels.

It is extremely important for the health of the entire body that the adrenal glands work correctly. Any violation of their function negatively affects the general condition of the patient.

The main causes of adrenal diseases:

• benign formations (adrenal adenomas), which produce certain hormones in excess;
• malfunction of the hypothalamic-pituitary system;
• autoimmune diseases;
• infections;
• tumors;
• uncontrolled use of certain medications.
• malignant neoplasms.

The structure and functioning of the adrenal glands

The adrenal glands are based on two structures:

• Brain matter.
• Cortical substance.

They are regulated by the nervous system.

Brain matter

The medulla is the main source of catecholamine hormones in the body - adrenaline and norepinephrine.

Adrenaline is the main hormone in the fight against stress. An increase in its production occurs during positive and negative emotions, for example, during injury or a stressful situation.

When exposed to adrenaline, the body uses reserves of accumulated hormone, which is manifested by the following reactions:

• a sudden surge of strength;
• increased breathing;
• pupil dilation.

The person feels stronger than usual, and the pain threshold is significantly reduced.

Norepinephrine is also a stress hormone, but its production occurs before the production of adrenaline. The impact is much weaker. Its function is to regulate blood pressure, which stimulates the work of the myocardium - the heart muscle.

Cortex

The adrenal cortex consists of several layers, each of which performs a specific function.

• Mesh zone.
• Bundle zone.
• Zona glomerulosa.

Androgens, sex hormones, are synthesized in the reticular zone. They are responsible for the development of secondary sexual characteristics and influence:

• state of libido - sexual desire in men and women;
• blood cholesterol and lipid levels;
• fat deposition;
• increase in muscle strength and mass.

Regardless of gender, each body produces both male and female sex hormones. The difference is in their quantity. For example, women synthesize estrogen and progesterone, which are responsible for reproductive function - conception and birth of children, but also testosterone in a small amount, which is considered the male hormone.

Salvage adrenalectomy

In 2002, it was 10 years since Michel Gagner first described the experience of successful laparoscopic adrenalectomies in periodicals. In one decade, this minimally invasive surgical technique has rapidly spread throughout the world, developing and improving. Currently, due to its safety and practicality, endoscopic adrenalectomy has become firmly established in the arsenal of adrenal surgery. During the period from November 1996 to May 2004, we performed 152 endoscopic operations in patients with adrenal pathology. Over the past few years, we have preferred extraperitoneal (“posterior”) adrenalectomies, which are more difficult to perform for the surgeon, but much easier to tolerate by the patient. We have extensive experience in these operations. Most of our patients are discharged from the clinic 3-4 days after surgery, and after 2-3 weeks they are allowed full physical activity, which is impossible with “open” operations. Add to this the absence of a large scar, possible weakening of the muscles of the lumbar region in the postoperative period, and the advantages of endoscopic adrenalectomy will become undeniable. After one of the adrenal glands is removed, the second one takes on the entire load. In this case, the patient usually requires lifelong hormone replacement therapy, which should be prescribed by an endocrinologist. In the future, it is necessary to undergo a follow-up examination every six months and consult with a doctor, who will adjust the therapy depending on the test results and the patient’s health condition. Patients who have undergone adrenalectomy also need to avoid physical and mental stress, and not drink alcohol or sleeping pills.

Beam zone

This zone is responsible for the synthesis of glucocorticosteroids. They are responsible for protein, carbohydrate and fat metabolism in the body. Closely related to the production of insulin and catecholamines.

Glucocorticosteroids reduce the immune response, inhibit inflammatory processes, gradually suppressing them.

One of the hormones in the zona fasciculata is cortisol. It takes part in carbohydrate metabolism and preserves the body's energy resources. The level of cortisol in the body is constantly changing - there is more of it in the morning than in the evening or at night.

Algorithm for diagnosing adrenal adenoma

• If an adrenal tumor is detected, the first question that should be answered is “is it a benign adenoma or adrenocortical cancer?”
• The second question: “is there hormonal activity or not?”

This is where a computed tomograph comes to the rescue. It is important to use a multislice tomograph that makes at least 64 slices. The examination of the adrenal glands is performed with intravenous contrast. As a result of the study, it is necessary to obtain the size of the tumor and determine its density. A non-malignant adenoma has a small density, the contours are clearly visible, the size is not large - usually about 3 cm, sometimes larger. At the second stage, after the administration of a contrast agent, the tumor is examined in the venous or arterial phase to determine the rate of accumulation and washout of the contrast, which in a benign tumor occurs quickly and completely.

• Sometimes, to clarify diagnostic issues, it can be used, but less often than CT.
• If the task is to find out whether the adrenal gland is affected by a metastasis of a tumor that developed from another organ, an adrenal biopsy is performed. However, the method is traumatic and is rarely used.
• L are of great diagnostic value for hormonally active tumors.laboratory research

  . The level of cortisol, as well as adrenocorticotropic hormone (ACTH) in the blood fluctuates throughout the day; it cannot be used to clearly determine how the adrenal glands are working. But determination of cortisol in daily urine gives an idea of ​​their basic function.

• A small
  dexamethasone test
  reveals even vague manifestations of hormonal disorders in Itsenko-Cushing syndrome. The test is carried out within one day. First, the level of cortisol in the patient’s blood is determined. At 24 hours on the same day, 1 mg of dexamethasone is administered. The next morning, cortisol is again detected in the blood. A normal indicator (positive test) is a decrease in cortisol by 2 or more times. If this does not happen (negative test), then the tumor produces cortisol on its own, and this process is not controlled by the body.
• Of great importance in the differential diagnosis between the syndrome and Itsenko-Cushing’s disease is large dexamethasone test

  . It is carried out according to the same scheme as the small one, however, the dose of dexamethasone is not 1 mg, but 8 mg. If there is a cortisol-producing adrenal tumor, the test will be negative, and if it is Cushing's disease (pituitary adenoma), the test will be positive - cortisol will decrease by 2 or more times.

• Patients with adrenal adenoma should also have their blood tested for chromogranin A, calcitonin, parathyroid hormone, blood ions, adrenocorticotropic hormone, aldosterone and renin.

Zona glomerulosa

The zona glomerulosa of the adrenal cortex is responsible for mineral metabolism in the body. The hormones produced here normalize the functioning of the renal tubules, so excess fluid leaves the body, which, in turn, keeps blood pressure levels normal.

The following hormones are secreted in the zona glomerulosa:

• Aldosterone. Its function is to maintain the balance of sodium and potassium ions in the blood. The hormone takes part in water-salt metabolism, improves blood circulation, and increases blood pressure.
• Corticosterone is a hormone with low activity and is involved in mineral balance.
• Deoxycorticosterone also regulates water-salt balance, gives strength to the skeleton and muscle tissue.

Where are the adrenal glands located?

Paired endocrine glands (adrenal glands) are located in the space behind the peritoneum, above the right and left kidneys. It is noteworthy that the left adrenal gland has the shape of a hemisphere, the right one has the shape of a pyramid. These glands consist of 90% cortex, and 10% medulla. The adrenal medulla produces catecholamine hormones (adrenaline, dopamine, norepinephrine), and the cortex produces glucocorticoids, sex hormones, and mineralocorticoids. Diseases of the adrenal glands can cause excess, deficiency, or no hormonal function.

How do adrenal gland diseases manifest?

When the balance of hormones in the body is disturbed, its functioning occurs. Symptoms appear according to a dependence pattern, that is, a specific substance produced in the adrenal glands is responsible for a symptom unique to it. For example, with aldosterone deficiency, sodium is excreted from the body along with the urine, which lowers blood pressure and significantly increases the potassium content in the blood.

To avoid serious consequences, you need to consult a doctor at the first signs of adrenal disease. These include:

• muscle weakness;
• constant fatigue;
• severe weight loss is a consequence of decreased appetite;
• low stress resistance;
• high irritability;
• rapid and constant fatigue;
• sleep problems;
• dizziness, headaches.

Next, the most common diseases of the adrenal glands, which have their own symptoms and causes, require specific treatment tactics.

Incidentally discovered tumors

With the introduction of ultrasound examination and high-resolution radiological methods of topical diagnostics, such as computed tomography and magnetic resonance imaging, into medical practice, formations in the adrenal glands began to be detected in patients examined for various reasons, which had not previously manifested themselves clinically. In most cases, we are talking about relatively small neoplasms ranging in size from 0.5 to 6 cm in diameter. These tumors became known as incidentalomas. The incidental discovery of an adrenal tumor should prompt the physician to more carefully examine the patient for symptoms of adrenocortical, adrenomedullary disease, or malignancy. Tactics regarding adrenal incidentaloma depend, firstly, on whether it is a source of excess production of any hormone, and, secondly, whether it is a malignant tumor. Hypersecretory formations of the adrenal glands require specific therapy and, most often, surgical intervention. In general, the approach to adrenal incidentalomas is such that hypersecretory and malignant formations require removal, as well as tumors of large sizes (more than 5 cm) and suspicious for malignancy, while formations that have been proven to be benign, such as a simple adrenal cyst, myelolipoma and Adrenal hematoma requires only regular (every six months) CT monitoring.

Addison's disease

Other names for Addison's disease are primary adrenal insufficiency and hypocortisolism.

A rare pathology, accounting for 50–100 cases per million per year. It is diagnosed in both women and men. Average age is from 20 to 40 years.

The disease affects all three zones of the adrenal cortex. Characterized by a deficiency in the production of corticosteroids. Violation of hormone synthesis causes serious complications in the body.

The cause of destruction of the adrenal cortex is pathogenic microorganisms that have entered the body - viruses, bacteria, fungi, as well as immune disorders.

Manifestations of Addison's disease:

• decreased blood pressure;
• fatigue, weakness, lack of physical strength;
• lack of appetite;
• disruption of the digestive system;
• pigmentation of the skin, the appearance of dark spots on the mucous membranes;
• chills;
• increase in body temperature.

To identify the disease, it is necessary to take tests to measure the level of cortisol in the blood. The condition of the adrenal cortex and the functioning of the glands are examined.

Treatment is taking medications containing corticosteroids throughout life. It is possible to administer hydrocortisone intramuscularly.

... and a man into a woman

Corticoestroma is a hormonally active tumor of the adrenal cortex, emanating from the zona reticularis and zona fasciculata, excessively producing estrogens, and in some cases, glucocorticoids. Corticoestromas are most often malignant with pronounced expansive growth. Clinically, corticoestroma is characterized in males by the appearance of bilateral gynecomastia, redistribution of fatty tissue and female-type hair growth, testicular hypotrophy, increased timbre of voice, decreased potency up to its loss. Oligospermia is often observed. Some patients experience pigmentation of the areolas of the mammary glands and even discharge from the nipples when pressing on them. In boys, signs of the disease include gynecomastia and premature bone maturation. A feminizing tumor of the adrenal cortex in girls is accompanied by a clinical picture of premature puberty: enlargement of the mammary glands and external genitalia, pubic hair growth, accelerated body growth, premature skeletal maturation, vaginal bleeding. In women, this tumor does not manifest itself in any way and can only be accompanied by an increase in the level of estrogen in the blood. Adrenal tumors that manifest only pure feminization are extremely rare. Treatment is only surgical (removal of the tumor along with the affected adrenal gland). To prevent possible adrenal insufficiency in the postoperative period, glucocorticoid replacement therapy is prescribed.

Itsenko-Cushing's disease

Refers to neuroendocrine pathologies. The reason is a malfunction of the hypothalamic-pituitary system as a result of brain injury or infections suffered by a person. Characterized by the production of excessive amounts of corticosteroids by the adrenal glands.

Itsenko-Cushing's disease is a rare pathology. It is diagnosed mainly in women aged 30 to 45 years.

A malfunction in the hypothalamic-pituitary system provokes disturbances in the body. The connection between the adrenal glands, hypothalamus and pituitary gland is lost. Signals sent to the hypothalamus provoke excess production of hormones that release adrenocorticotropic hormone (ACTH) in the pituitary gland, which stimulates the release of the substance into the blood. Excessive amounts of ACTH affect the adrenal glands, which begin to increase the production of a lot of corticosteroids.

As the pathology progresses, there is a visible increase in size of the pituitary gland and adrenal glands.

Signs of Itsenko-Cushing's disease:

• headaches, migraines;
• progressive hypertension;
• amyotrophy;
• formation of a moon-shaped face;
• lack of menstruation in women;
• development of osteoporosis;
• facial hair growth in women.

To identify the disease, blood and urine tests are prescribed, which determine excess amounts of ACTH and cortisol. Additionally, an instrumental examination is carried out.

The goal of therapy is to restore impaired metabolism, normalize the functioning of the hypothalamus, and normalize the synthesis of corticosteroids.

Causes of adrenal gland diseases

Pathologies in the functioning of the adrenal glands can be caused by the following factors:

• excessive production of the hormone (ACTH);
• ACTH hormone deficiency;
• excessive production of hormones by the adrenal glands themselves;
• insufficient production of hormones in the adrenal glands themselves;
• brain dysfunction;
• the presence of tumors in the adrenal gland;
• congenital pathology;
• inflammatory and infectious processes (including chronic);
• circulatory disorders in the adrenal gland.

Treatment of the disease depends on where exactly the pathological process began. An endocrinologist determines the clinical picture for each patient, which is necessary to determine the cause of the ailment. But full treatment is prescribed only after completing a diagnostic course and collecting all the information about the patient.

The first meeting with an endocrinologist is an opportunity for the patient to voice the problem as fully as possible (complaints, symptoms, causes, etc.) and an opportunity for the doctor to collect all the necessary information (history, examination, measurement of height, weight, blood pressure, background hormonal tests). research and functional tests).

Diagnostics includes:

• Ultrasound of the adrenal glands (screening method);
• general clinical tests;
• blood and urine analysis for hormone levels and all necessary hormonal studies;
• CT scan;
• consultations with a gynecologist, urologist.

Repeated appointment

At a follow-up appointment, the doctor draws up a treatment plan based on the results of diagnosing adrenal disease and the patient’s individual symptoms of the disease.

The course of treatment may include one or more methods:

• conservative treatment;
• hormone replacement therapy (prescribing a synthetic hormone to replace what is not produced by the adrenal glands);
• surgery.

As a rule, treatment is aimed at eliminating hormonal imbalance (if necessary, surgical removal of the affected adrenal gland is carried out) and other signs of adrenal disease. It is also possible to prescribe special programs for weight loss and normalize blood pressure, and regular visits to a psychotherapist’s office are also possible.

Pheochromocytoma

Pheochromocytoma is a tumor that develops in the adrenal medulla. It is based on chromaffin bodies, which contribute to the synthesis of large amounts of catecholamines.

The cause is arterial hypertension and catecholamine crises.

Symptoms of pheochromocytoma:

• high blood pressure, hypertensive crises;
• headache;
• increased sweating;
• dyspnea;
• dehydration of the body;
• convulsions;
• cardiomyopathy;
• high blood sugar.

To diagnose the disease, tests are prescribed to determine catecholamine metabolites in the urine and blood. To identify the formation, hardware methods are used - MRI and ultrasound scanning.

Treatment is medicinal, aimed at reducing the severity of paroxysmal attacks.

Diagnostics

The main methods for diagnosing adrenal diseases are:

General blood analysis. Provides general information about the patient's health and condition.

Blood chemistry. The most important thing here is to study the level of blood electrolytes (potassium, sodium), as well as assess the function of the kidneys and liver.

1. Blood test for hormones. The main laboratory method for identifying pathologies of the adrenal glands.
2. Daily urine analysis. It is carried out to assess the functioning of the adrenal glands.
3. Computed tomography (CT). Today it is the gold standard for diagnosing adrenal tumors.
4. Ultrasound of the adrenal glands and kidneys. Currently, it is not used so often, since it is not always possible to visualize the adrenal glands on ultrasound.
5. Radiography. Today it is practically not used for the study of the adrenal glands. Instead of radiography, CT is performed, since this method is more informative.

Hyperaldosteronism

Another name for the pathology is Kohn syndrome. A condition in which the adrenal cortex produces excessive amounts of aldosterone and deoxycorticosterone.

The causes of hyperaldosteronism are a malignant formation in the adrenal cortex or hyperplasia of cortical tissue.

Kohn syndrome has primary and secondary degrees of development. Symptoms of the primary degree of the disease:

• increased blood pressure;
• headache;
• heart rhythm disturbance;
• cardialgia – pain in the left side of the chest;
• decreased visual acuity.

Secondary symptoms result from excess potassium and sodium deficiency:

• swelling;
• chronic renal failure;
• fundus deformation;
• arterial hypertension.

Diagnostic measures include determining the level of potassium and sodium, aldosterone in the blood and urine.

Therapy depends on the results of the examination. More often this is drug treatment with the prescription of hormonal drugs. If a tumor is present, surgery may be performed.

Most common diseases

Hyperaldosteronism

This is a pathology in which too much of the hormone aldosterone is synthesized in the cortex. The cause of primary hyperaldosteronism is neoplasms in the adrenal glands themselves. Secondary hyperaldosteronism occurs as a complication of other diseases (liver cirrhosis, heart failure, chronic nephritis).

Symptoms:

• increased fatigue;
• general and muscle weakness;
• increased blood pressure and its malignant nature (early onset, difficult to correct with medication) is the leading symptom of primary hyperaldosteronism;
• headache;
• decreased potassium levels in the blood;
• cramps, numbness;
• kidney damage;
• heart damage.

Adrenal insufficiency

Manifested by decreased secretion of hormones from the adrenal cortex. It develops either as a result of autoimmune damage to the organ, or as a complication of other diseases (tuberculosis, metastasis to the adrenal gland), as well as with long-term use of glucocorticosteroids, in which the own secretion of the hormone cortisol is irreversibly suppressed. Symptoms:

• sudden loss of strength;
• loss of appetite;
• decreased blood pressure;
• weight loss;
• nausea, vomiting;
• intestinal dysfunction;
• low blood glucose levels;
• skin hyperpigmentation;

Itsenko-Cushing syndrome

A disease in which autonomous increased secretion of the hormone cortisol occurs by the adrenal cortex.

Symptoms:

• obesity, redistribution of subcutaneous fat mainly in the upper part of the body;
• increased blood glucose, prediabetes and diabetes mellitus develop;
• arterial hypertension;
• damage to bone tissue, development of steroid osteoporosis, leading to low-traumatic fractures;
• dry skin;
• hirsutism (increased hair growth);
• bright stretch marks on the body;
• dysfunction of the gonads;
• menstrual irregularities in women;
• muscle atrophy, tendency to fall;
• tendency to bruise with minimal trauma.

Most often, the disease is diagnosed in women aged 25-40 years. As a rule, the cause is a hormone-producing adenoma or nodular hyperplasia of the adrenal gland.

Pheochromocytoma

This is a tumor that develops from the adrenal medulla and leads to an increase in the synthesis of catecholamines. The main symptom of this disease is high blood pressure, which is difficult to correct with medication.

Against the background of arterial hypertension, symptoms such as headache, excessive sweating, pale skin, convulsions, nausea, vomiting, attacks of unreasonable fear and a number of others may appear.

Acute adrenal insufficiency

The reasons for the development of this pathological condition of the body are chronic adrenal insufficiency, infectious diseases, injuries, heavy physical activity, severe psychological stress, sudden climate change, sepsis, meningitis, burn disease, severe blood loss and a number of others.

Symptoms:

• a sharp decrease in blood pressure;
• weakness, coldness in the extremities;
• increased sweating;
• arrhythmia;
• stomach ache;
• diarrhea, nausea, vomiting;
• rare urination;
• confusion, hallucinations;
• fainting, coma.

This condition requires urgent hospitalization of the patient and provision of qualified medical care in intensive care.

Hyperplasia of the adrenal cortex

This is an increase in the size of the adrenal cortex, which leads to increased synthesis of androgens. The main reason is genetic, that is, the disease is congenital.

There are three main forms of hyperplasia:

• Simple virilizing. There is an increase in the synthesis of androgens, as a result of which the genitals and muscle tissue become enlarged, and hair grows rapidly all over the body, regardless of the gender of the sick person.
• With salt loss syndrome. Characterized by excess potassium and deficiency of other hormones.
• Hypertensive. Excessive production of androgens and corticosteroids occurs, as a result of which arterial hypertension develops and visual function deteriorates.

Symptoms of adrenal hyperplasia:

• early hair growth on the body and genitals;
• growth is less than normal;
• rough voice;
• memory problems;
• frequent psychoses;
• weakness of the muscular system.

Signs appear in childhood. To clarify the diagnosis, tests and laboratory tests are prescribed.

Treatment is medicinal and includes constant use of hormonal drugs. In severe cases of the disease, surgical intervention is indicated.

Why do “flies” fly before my eyes?

Clinical manifestations of primary hyperaldosteronism (PHA): arterial hypertension (headache, dizziness, appearance of “floaters” before the eyes); disorders of neuromuscular conduction and excitability (muscle weakness, parasthesia, convulsions, bradycardia); changes in renal function (polyuria, polydipsia, nocturia). These signs are not always present simultaneously; An oligosymptomatic and even asymptomatic course of the disease is often observed. Approximately two-thirds of all cases of PHA are caused by aldosteroma. Another possible cause of PHA is nonadenomatous bilateral adrenal hyperplasia, which occurs in one third of patients with symptoms of idiopathic primary hyperaldosteronism. The main treatment method for aldosteroma and nodular adrenal hyperplasia is surgery - removal of the altered adrenal gland along with the tumor (adrenalectomy). Performing organ-saving operations (tumor enucleation, adrenal resection) by most surgeons operating on endocrine organs is considered inappropriate due to the high rate of relapse of tumors in the remaining tissue (up to 50%). Already in the immediate postoperative period, in most cases, normalization of blood pressure, a decrease in the concentration of aldosterone in plasma, a gradual increase in renin activity, and normalization of potassium are noted.

Adrenal insufficiency

This is a dysfunction of the adrenal glands of an autoimmune nature. There are two types - acute and chronic.

Chronic insufficiency of the adrenal cortex occurs as a result of destructive changes in the glandular tissues of the organ. The main causes are previous infectious diseases, a pituitary tumor or macroadenoma, necrosis or inhibition of the anterior lobe of the pituitary gland.

The acute form develops against the background of the chronic form. It almost never occurs on its own, with the exception of sepsis or sudden hemorrhage in the adrenal glands.

Symptoms of adrenal insufficiency:

• weakness, constant loss of strength;
• loss of appetite, resulting in a sharp decrease in body weight;
• hyperpigmentation of the skin;
• arterial hypotension;
• decreased blood sugar levels;
• frequent urination;
• nausea turning into vomiting;
• uncharacteristic stool.

Extra pounds, hump and stretch marks...

The main and only treatment method for hypercortisolism caused by a tumor of the adrenal cortex or nodular hyperplasia of the adrenal cortex (Cushing syndrome) remains removal of the affected adrenal gland with the tumor. The clinical picture of hypercortisolism is very specific, therefore, in a significant proportion of patients, nosological diagnosis does not present any great difficulties. obesity, a “hump” on the back of the neck, wide purple “striae”, arterial hypertension, impaired carbohydrate metabolism and sexual function, osteoporosis and hypokalemia allow us to suspect overproduction of cortisol by the adrenal glands. At the next stage of diagnosis, especially in the absence of clear external clinical signs, the most important, and sometimes decisive, importance is the assessment of laboratory hormonal parameters. Ultrasound examination of the adrenal glands has relatively high sensitivity, it is non-invasive, relatively harmless, and accessible. The sensitivity of the ultrasound method in detecting adrenal tumors depends on their size and averages 50-90%. Corticosteroma is detected as a round formation of various sizes, with an indistinct capsule. Acoustic density appears to be slightly reduced compared to normal adrenal gland. CT is highly effective in diagnosing diseases of the adrenal glands. For adrenal adenomas, the sensitivity of the method reaches 98%. With benign corticosteromas, the prognosis is favorable. Already in the first 1.5-2 months after tumor removal, a gradual regression of clinical symptoms is noted: the patient’s appearance changes, metabolic processes are normalized, blood pressure decreases to normal, stretch marks and the face turn pale, sexual function is restored; diabetes mellitus observed before surgery disappears. In the first months after surgery, patients' body weight decreases significantly (sometimes by more than 20 kg); hirsutism usually disappears after 3-8 months. X-ray signs of bone tissue restoration are recorded after 10-12 months, but bone pain disappears within 1-2 months after surgery.

Inflammation of the adrenal glands

Inflammatory processes in the adrenal glands most often occur against the background of tuberculous damage to their cortex. The peculiarity of the pathology is its slow development.

Characteristic symptoms of inflammation:

• feeling of constant fatigue;
• low stress resistance;
• regular nagging headaches;
• bad breath;
• nausea turning into vomiting.

With an advanced form, there is a high probability of developing a chronic inflammatory process.

Adrenal tuberculosis

Adrenal tuberculosis is a rare pathology. It is characterized by the accumulation of calcifications in the tissues of the adrenal glands.

More often diagnosed in childhood and adolescence. The reason is the penetration of the tuberculosis bacillus from the infected lungs into the adrenal glands through the general bloodstream.

Symptoms of adrenal tuberculosis:

• low blood pressure;
• disruption of the gastrointestinal tract, expressed by diarrhea, nausea with vomiting attacks;
• hypoglycemia;
• constant weakness, feeling tired;
• myocardial dystrophy.

Cyst

This is a benign formation in the tissues of the adrenal glands. The tumor appears rarely and becomes dangerous only when it degenerates into malignant. A dangerous condition is when an adrenal cyst ruptures.

Tumor symptoms:

• pain in the lower back, back, sides;
• impaired renal function;
• an increase in the size of the adrenal glands;
• increased blood pressure as a result of compression of the renal artery.

Diagnosis of an adrenal cyst is difficult due to its small size. Pathology can only be detected when the tumor progresses and grows.

Dangerous tumors

If the cyst is a benign formation, then there are a number of tumors prone to malignancy.

The most common of them:

• aldosteroma;
• andosteroma;
• glucocorticosteroma;
• corticoestroma.

The exact reasons for the development of formations are difficult to establish, but there is a high probability of their hormonal activity against the background of the following provoking factors:

• cell hyperplasia and proliferation of adrenal tissue;
• excessive amounts of hormones produced;
• thyroid cancer;
• diseases associated with congenital pathologies of the skin, eye membrane, and cerebral vessels.

The localization of tumors varies. They can form in both the medulla and cortical layers. Characteristic symptoms:

• high blood pressure;
• delay in the process of sexual development;
• frequent nausea, turning into vomiting;
• pain in the abdomen, chest area;
• change in skin color on the face - turns pale, red, acquires a bluish tint;
• a sharp change in blood glucose levels;
• dry mouth;
• convulsions;
• tremor of the limbs;
• increased irritability, excitability;
• increased anxiety, constant feeling of fear.

"Crisis" tumor

Pheochromocytoma is a tumor of chromaffin cells that produces excess amounts of catecholamines (adrenaline, norepinephrine and dopamine). Pheochromocytoma may develop from chromaffin tissue of the adrenal medulla (90%) and may be non-adrenal in location. The disease occurs at any age. The main symptoms of the disease in the vast majority of patients are arterial hypertension, hypermetabolism and hyperglycemia. The classic clinical picture is considered to be periodic rises in blood pressure, accompanied by some vegetative symptoms, reminiscent of the effects of the administration of adrenaline or norepinephrine. In the initial period of the disease, these attacks, or crises, occur rarely - once every few months or even years. Over time, the frequency, duration, and severity of attacks usually increase. The onset of a crisis is quite often characterized by the appearance of unaccountable fear, sometimes a feeling of chilliness, paresthesia, marbling or pallor of the skin. Sometimes, on the contrary, there is pronounced redness of the facial skin, shiny eyes, dilated pupils, and frequent urge to urinate. A crisis can begin with paresthesia, convulsions, and vasoconstriction of the extremities. The crisis ends as suddenly and quickly as it began. Blood pressure returns to its original values, the pallor of the skin gives way to redness, and sometimes profuse sweating and excessive secretion of the salivary glands are observed. After an attack, general weakness and weakness persist for a long time. The diagnosis of pheochromocytoma is established when elevated amounts of catecholamines or their metabolites are detected in 24-hour urine. The most reliable is urine analysis collected within 3 hours after the attack. The accuracy of the method reaches 95%. It is recommended to conduct such studies several times. Tumor detection is usually carried out using ultrasound, CT and MRI. If the diameter of the tumor is more than 10 mm, then the sensitivity of these methods approaches 100%. Ultrasound is important in establishing the location of pheochromocytoma. However, its effectiveness largely depends on the experience of the specialist; Moreover, for tumors of extra-adrenal localization, the method is not very informative. Treatment of tumors that produce catecholamines is only surgical. However, surgical interventions for pheochromocytoma are classified as very complex, primarily due to the high degree of surgical risk associated with the likelihood of severe hemodynamic disturbances. In this regard, the cooperation of the surgeon and anesthesiologist and the choice of the most rational method of preoperative preparation and anesthesiological care are of particular importance. During preoperative preparation, the main attention should be paid to the prevention and relief of hypertensive crises. After surgery, hormone replacement therapy is often prescribed - a constant intake of adrenal hormones.