Introduction: What is nodular disease of the adrenal gland?


Nodular adrenal lesions of surgical interest are numerous. Some of them, called "functional adrenal lesions" (e.g. Adenomas, carcinomas, pheochromocytomas, etc.) can manifest with certain hormone syndromes (e.g. Cushing's syndrome, Conn's syndrome, pheochromocytoma syndrome). ). Others do not secrete any hormone and are therefore called "non-functioning adrenal lesions" (e.g. Non-functioning adenomas and carcinomas, myelolipomas, cysts, etc.).



Symptoms: How can I know I am suffering from a nodular disease of the adrenal gland?


The signs and symptoms of nodular lesions of the adrenal gland are multiple and depend on 1) the possible hypersecretion of hormones and 2) the size of the mass. In many cases, however, this disease is diagnosed incidentally during radiological investigations beyond the suspicion of adrenal disease (incidentalomas). Among the clinical syndromes associated with hormone hypersecretion are included:


  • Cushing's syndrome: causing hypersecretion of cortisol by adenoma, cancer or micro/macro nodular hyperplasia on one or both sides, characterized by central obesity, dorsal hump, a full moon (rounded) face, high blood pressure, muscle weakness, osteo-penia/porous, psychiatric events, hirsutism, acne, striae rubrae , fragile skin with easy bruising, menstrual disorders, decreased libido, impotence, impaired glucose tolerance or diabetes mellitus, immunosuppression and predisposition to infection, the risk of thrombosis;
  • Primary hyperaldosteronism: causing hypersecretion of aldosterone supported by a unilateral adrenal adenoma (Conn's syndrome) or a nodular, mono or bilateral hyperplasia, which is typically manifested by high blood pressure, often resistant to drug treatment, and hypokalemia (which is not a prerequisite for diagnosis), resulting in cramps, paresthesias, muscle fatigue;
  • Pheochromocytoma syndrome: causing hypersecretion of catecholamines, characterized by high blood pressure associated with the crisis of palpitations, headache, sweating, paleness, nausea, anxiety, tremor, and hyperglycemia;
  • Virilization syndrome (acquisition of male characteristics by women including hirsutism, acne, hypertrophy of the muscles, hair loss, enlargement of the clitoris) or feminization (increase in breast volume, or gynecomastia, beard reduction and body hair in males) due to the presence of lesions that secrete male (androgens) or female (estrogen) hormones.


Epidemiology: How common is nodular disease of the adrenal gland?

The adrenal nodules are a very frequent incidental finding. It is estimated that 3-5% of the "healthy" population is unwittingly a carrier of one or more adrenal nodules. In the great majority of cases these nodules are small in size and are not of clinical significance nor require removal. The secreting hormones or malignant adrenal lesions are rare. For example, Cushing's syndrome has an annual incidence of 4-5 new cases per million population per year.


Treatments for nodular adrean disease