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Adrenal cancer
Symptoms and signs
Functioning tumors
Approximately 60% of patients present with symptoms
related to excessive hormone secretion (cortisol, aldosterone,
androgens and estrogen). Functioning tumors may present with any of the following hormonal
syndromes:
- Hypercortisolism (Cushing's syndrome)
is the most common presentation (30%). It is characterized by rapid onset
of development of symptoms of Cushing's syndrome
(3 months). Symptoms include: weight gain, muscle weakness, easy
bruising, irritability, and insomnia. Other symptoms may include
those related to the androgenic effects of cortisol.
- Virilization (30%): hirsutism, acne, and irregular menses or
amenorrhea in women. They may be more marked and include
male-pattern baldness, deepening voice, breast atrophy, clitoral
hypertrophy, decreased libido. In males manifestations of androgen
excess are less noticeable. It can lead to precocious puberty in
males.
-
Feminization (10%): Feminizing tumors in women cause breast
tenderness and dysfunctional uterine bleeding. It can cause
precocious puberty in females. These tumors in men are associated
with gynecomastia, breast tenderness, testicular atrophy, and
decreased libido.
- Hyperaldosteronism
(2.5%):
Aldosterone-producing adrenal cortical carcinomas are extremely
rare. Patients present with hypertension and hypokalemia, which are
typical clinical manifestations of primary aldosteronism. Compared
to patients with benign aldosteronesecreting adenomas, those with
carcinoma have larger tumors, higher aldosterone levels, and more
severe hypokalemia. Evaluation should include measurement of serum
electrolytes, aldosterone, and plasma renin levels. Findings include
severe hypokalemia with potassium levels below 2.5 mEq/L,
hypernatremia, and metabolic alkalosis. Serum aldosterone levels are
high, and plasma renin levels are suppressed.
- Combined hormonal excess (35%).
Nonfunctioning tumors
40% of cases are nonfunctioning carcinomas and thus may be heralded by symptoms of local
invasion by tumor or by metastases. Most present with large abdominal
masses, abdominal pain or weight loss.
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Metastasis
- Lung 45%
- Liver 42%
- Lymph nodes 24%
- Bone 15%
- Pancreas 12%
- Spleen 6%
- Diaphragm 12%
- Miscellaneous (brain, peritoneum,
skin, palate) 12%
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