University of Lucian Blaga, Faculty of Medicine Victor Papilian Sibiu

Adrenal tumors are rare, clinical syndromes with clinical manifestations causing excessive secretion of adrenal hormones. These tumors are reported in 2% of autopsies most common lesion are benign adenoma.

This paper aims to establish a clinical diagnosis and therapeutic protocol of adrenal gland tumors.

We studied a total of 21 cases with adrenal tumors, treated in the urology clinic between January 2001 and March 2011. We used as documentary material of hospital records, patient case report forms and registers transmission protocols. We divided patients by age and studied the relationship between age and adrenal tumors.

Distribution of patients by year:

0 ,0 0 0 ,0 0 0 ,0 0 0 ,0 0 0 0 0 00 0 0 00 0 0 00 0 0 00 0 0 00 0 0 00 0 0 00 0 0 00 0 0 00 0 0 00 0 0 0 Number of patients

Looking over the 10 years case law shows that the number of hospitalizations for adrenal tumors is relatively low which indicates a low incidence of this condition in the population.

Repartition by age and sex of patients:

Women
0, 0 00 % 00 , % 0, 0 00 %
0, 0 00 %

Men
00 % , 0 0, 0 00 %

< 0 0 years 0-0 years 00 0-0 years 00 0-0 years 00

0, 0 00 %

< 0 0 years 0-0 years 00 0-0 years 00 > 0 0 years

0, 0 00 %

Age ranged between 20 and 72 years, with an average of 45 years for women and 46 years for men. There is an increased incidence of this disease with advancing age with a maximum in the sixth decade of life.

An U.S. study shows that indeed, these tumors are very rare and unusual is not very accurate statistics available. But its estimated that 300 adults in the United States are diagnosed each year, with adrenal cancer. This type of cancer is less common than an adrenal adenoma, benign tumor are much more common in middle-aged people and elderly people. The average age of a person diagnosed with adrenal tumor is between 45 and 50 years, however, these tumors can occur at any age, really like us, often with increased incidence in females compared to male. Pheochromocytoma is noticed as a rare disease by the Office of Rare Diseases (ORD), National Institute of Health (NIH) meaning that pheochromocytoma or pheochromocytoma subtypes affects more than 200,000 people in the U.S. population. Cushing's syndrome is also more common in women than in men. The most common forms of endogenous Cushing's syndrome is 80% of Cushing's syndrome in adults and children older than 7 years. A study made in Chisinau in 2009 reveals a predominance of pathology in individuals aged between 25 and 40 years, mean age are 43.7 1.2 years.

Distribution of the environment of origin

0, 0 0 % 0 0, 0 0 % 0

Urban Rural

There was no essential difference in the distribution by place of residence (rural, urban) and type of patients occupation. The study included 12 patients (57.14%) residents of cities and 9 patients (42.85%) in rural areas.

Nosological distribution by type of adrenal tumors:

0% 0

Pheochromocytoma

0% 0

Cushing Sindrom

Patients were divided depending on nosologic form of adrenal tumors: 16 patients with pheochromocytoma (77%) of which (11 patients (53%) benign pheochromocytoma and 5 patients (24%) malignant pheochromocytoma), Cushing's syndrome 5 (23%) which patients (3 patients (13.8%) with benign form and 2 patients (9.2%) as malignant.

Distribution of patients by type nosologic group of adrenal tumors:

0 0 0% 0

0 0

0 .0 % 00

Benign Malign 0% 0 0% 0

0 Pheocromocitom a Cushing Sindrom

Nature clinical onset of adrenal volume formations:

00% , 0 0, 0 00

Acute
0, 0 00%

Subacute Slow

Pheochromocytoma, clinical signs:

Hipercatecolaminemie crisis of paroxysmal hypertension

0% 0 0 ,0 0%

Hypertension permanent form Hypertension, mixed form

0% 0

0 ,0 % 00 0 ,0 0% 00 ,0 % 0 ,0 % 00

Neuropsychiatric disorders and senso -motor Visual disturbances Intestinal transit disorders and abdominal pain Hypertonic crisis

Changes detected in the exam objective:

Exam
0, 0 00 % 0, 0 00 % 0, 0 00 % 00 % , 0 0, 0 00 %
Changes in blood pressure, fever Hyperhidrosis, arrhythmia

Anxiety, Raynaud's phenomenon or livedo reticularis Pupillary dilation, paleness of the face or upper body

Paraclinical examination:

P clinic ara
0% 0 0 ,0 % 00 0 ,0 % 00
Imaging, high levels of catecholamines in blood Determination of free catecholamines in urine and vanilmandelic acid Imaging studies with iodine 000 (metaiodobenzilguanidina)

In all 16 patients the diagnosed was based on imaging (CT, MRI), high levels of catecholamines in blood, was performed in 7 patients in the determination of 24-hour urine free catecholamines and vanilmandelic acid (metanefrin).

Cushing's syndrome-clinical signs

Clinical sig ns

excessive production of cortisol, neuropsychiatric disorders Hypertension syndrome

0, % 00 0, % 00 0% 0 00 % , 0

0, % 00 0% 0 0, 0 00 %

Endocrine syndrome hyperglycemia to normal installation type 0 diabetes Kidney manif estations as pyelonephritis Nephrolithiasis

Headache pronounced

Reproductive dysf unction (menstrual disorder in f emale and male sexual potency disturbance)

Changes detected in the exam objective:

C a g sd t c e int ee a o je t e h n e e e t d h x m b c iv
0 0 0 0 0 0 0 0 % 0 0 0% 0 0% 0 0% 0 C a g sd te te inth hne e c d e e a o je tiv xm b c e

Therapeutic protocol:

Emergency treatment of hypertensive crisis as if pheochromocytoma. Surgical: Removal of tumor Preoperative drug preparation. Conservation of adrenal function.
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 C ra p rp s u tiv u o e P llia e p rp s a tiv u o e

N m e o p t ns u b r f aie t

00 % 00 , 0
N m e o p tie ts u br f a n

00 , % 0

We investigated the treatment of patients under study. After preoperative evaluation of all the 21 (100%) patients with adrenal tumors in the study underwent surgical treatment.

Treatment: Surgical

Surgical Procedures

0 ,0 % 00 0 ,0 % 00

Toracofrenolapar otomy Lombotomy

Of the 21 patients studied, 16 patients (76.19%) surgical intervention was Toracofrenolaparothomy and to 5 patients (23.80%) was intervened by Lumbothomy.

Surgical techniques used in interventions on the adrenal:

0 0 0 0 0 0 0 0 0

0,0% 00

0,0 0% 0,0% 00 00 ,0

Adrenalectomy Resection of adrenal Tumor enucleation

Pheocrom ocitom a

Cushing sindrom

Intraoperative complications in surgery for adrenalectomy:

0, 0 0 % 0 0 0 , 0 0 0 , 0 0 0 , 0 0 0 ,0 % 00

0 00 , % 0

T ransabdominal
T n a dom a ra s b in l

Lumbar

Complications described in literature as parenchymal infarction after ligation of the remaining adrenal vessels and development of acute adrenal insufficiency. The Urology Clinic sibiu not had such complications.

1.Adrenal tumor clinically manifested in 13 (61.90%) cases and asymptomatic in 8 (38.09%) cases. 2.Diagnostic algorithm of adrenal tumors include the consecutive binding and functional tests (hormonal and pharmacological), diagnostic imaging for viewing topic glands (CT or MRI) to determine functional status of all organs and organ systems. 3.All formations hormonal inactive adrenal volume larger than 2 cm, and the active hormone required to be ectomizate, while smaller than 2 cm needs to be seen in dynamic imaging with screening and hormone obligatory. 4.Preoperative preparation of patients with hormonally active tumors is mandatory and is to compensate hemodynamic disorders, endocrine and related pathologies and is strictly individual basis for each nosologic form.

5.Surgical approach in adrenal volume formations located on the right is preferred in urology clinic Sibiu its toracofrenolaparothomy, and for those located on the left is subcostal left lumbothomy. 6.Pathology analysis revealed only the type of cells that developed tumors (cortical or medullary) and their level of differentiation, but does not allow us to appreciate their secretory function, which leads us to establish a definitive diagnosis only after data duplication Clinical and biochemical investigations of hormone level in blood. 7.Quality of life in patients with adrenal tumor surgery returned to normal in 95% cases patients reintegrate into social life and professional. 8.After some authors, the evolution in the forms of malignant pheochromocytoma, survival is about 2 years after the occurrence of liver or lung metastases is only 20 years if bone metastases.

SCHWARTZ: ANGELESCU

Principiile chirurgiei,Editura Teora Vol II,pag.1783-1784.

NICOLAE: Tratat de patologie chirurgical,Editura Medical 2003,Vol II pag.2919-2933. I., GLUCK G., HRZA M. : Urologie Oncologic, Editura Universitar Carol Davila , Bucureti , 2006. Dr. IOANEL SINESCU Dr. BOGDAN SERBNESCU Conf. Dr. MIHAI HRZA, Dr. CRISTIAN SURCEL,Dr. MIHAELA MIHAI- AFECIUNILE GLANDELOR SUPRARENALE.
SINESCU Prof. SINESCU

I-Urologie clinic, Editura Medical Amaltea, Bucureti, 1998.

BUJAC MARIANA -ATITUDINEA DIAGNOSTICO-CURATIV N FORMAIUNILE DE VOLUM ALE GLANDELOR SUPRARENALE CHIINU, 2009.

Oxford Handbook Of Urology (1st Edition). Atlas of Clinical Oncology - Endocrine Tumors. Advanced Urologic Surgery, 3rd ed. Conf. Univ. Dr. Nicolae Grigore , Prof univ. dr. Ilie- Craciun Urologie Clinica.