Hyperplasia of the adrenal gland - what is it? Symptoms and treatment of ailment

Doctors-endocrinologists in their practice often face pathologies in the work of the kidneys. Hyperplasia of the adrenal gland - what is it? The kidneys are a paired organ, just above are the adrenals, which have a glandular shape. Here, the hormones necessary for the human body( adrenaline, norepinephrine, glucocorticoids, and also sex hormones) are formed. Hyperplasia disrupts the proper production of hormones, and this is accompanied by various symptoms.

Adrenal Hyperplasia - What Is It?

With adrenal hyperplasia, the cellular tissue of the male gland progressively grows, the organ considerably increases in size, although it retains its own form. The adrenal gland consists of a brain substance and a cortex.

Usually hyperplasia affects the adrenal cortex, and the pathological process develops there. Various tumors are often diagnosed in the brain substance.

The disease occurs at any age in women, men and children.

Congenital adrenal hyperplasia occurs most commonly in medicine. It usually carries a hereditary character, but it can also arise from a number of unfavorable internal or external factors. As a concomitant pathology, it appears in patients with Cushing's syndrome( in 40% of cases).This syndrome is usually diagnosed in the elderly and senile age.

This serious pathology can not be neglected. At a hyperplasia development of necessary hormones is broken. In women, it often causes infertility. There are several types of the disease: nodal adrenal hyperplasia, nodular, diffuse, congenital and micronodular, as well as hyperplasia of the medial pedicle. More often this ailment occurs in women.

Causes of the disease

The causes of the symptoms that appear when hyperplasia of the adrenal cortex in children, men or women will vary. Everything will depend on the type of the disease. Hyperplasia refers to one of the species, it can be hypertonic, salting, viril.

In the hypertensive type, active development of androgens and mineralocorticoids occurs, this process has a bad effect on the vessels of the kidneys and the fundus, often leads to hypertensive syndrome.

With soltering type of hyperplasia, the production of androgens is increased, with a shortage of other hormones produced by the adrenal cortex. There is hyperkalemia or hypoglycemia. The danger is that the body is dehydrated, weight is lost.

With the viral type of hyperplasia, the secret of androgen is superactive. The external genitalia greatly increase in size, acne appears in large quantities, the hairiness is increased, the musculature is too developed.

First of all, the pathology begins to progress because of the increased secretion of steroid hormones. Acquired form of the disease has a number of main reasons for which it arose:

• metabolic disorder;
• strong stress;
• Cushing's Disease;

Congenital adrenal hyperplasia is associated with the fact that even during pregnancy, during gestation, functional changes developed. Another assumption is the transmission of the disease at the genetic level. Factors provoking the manifestation of the symptoms of the disease: a malfunction in the hypothalamus and pituitary gland, anomalies at the genetic level, congenital autonomy of the bark of the paired glands, inherited from ancestors.

Nodular hyperplasia

Physicians share the progression of hyperplasia of the adrenal cortex into several groups according to the clinical picture, and also by the type of flow.

Nodal hyperplasia of the adrenal glands. This form is hereditary. It is more often diagnosed in old age, with time it is aggravated. When performing the diagnosis, a characteristic feature is revealed - on the adrenal cortex the nodules that have formed are formed. They can be plural( lobular structure) and single, up to 4-5 cm in size. Cushing's syndrome develops. Pathology is due to a strong stimulation of adrenocorticotropic hormones, synthesized in the pituitary gland. The main signs of nodular hyperplasia with Cushing's syndrome are:

• headache;
• "flies" before the eyes;
• convulsions;
• dizziness;
• general malaise;
• increase in body weight( mainly the stomach, neck, face);
• increased appetite;
• stretch marks on the skin;
• acne;
• excess hair( in women);
• poor regeneration;
• hyperpigmentation;
• increased blood pressure;
• frequent fractures;
• depression.

Diffuse hyperplasia

With this form of hyperplasia, the glands do not change their shape, the increase occurs gradually. But at the same time they form nodules. Identify this type of disease is difficult. With the standard method of diagnosing on ultrasound, there is no result. Changes in the organ are detected only on MRI or CT.Often develop mixed forms that occur with the following symptoms: hyperplasia of the adrenal cortex in women often leads to increased hairiness, panic attacks, hypertension, obesity. In some, the glomerular zone is affected and bilateral hyperplasia develops.

The pathology of idiopathic hyperaldosteronism is based on increasing the secretion of aldosterone. When hyperplasia of the glomerular zone, the following symptoms manifest themselves: arterial hypertension, convulsions, muscle weakness, limitation of movements, stiffness until paralysis, thirst, increased diuresis, nocturnal urination. Infringements are caused by increase in a blood of a potassium, an acidosis. Increase in blood pressure is observed constantly.

Nodular and congenital forms of

The nodular form of usually progresses in children and adolescents. It can appear because of violations of the adrenal glands or because of overdoses of glucocorticoids. The main signs of nodular form: uneven fat deposits, muscle atrophy, skin pigmentation, signs of diabetes, damage to the nervous system and cardiovascular, osteoporosis. If the children have symptoms of the disease on time, hormonal treatment has been performed, then the prognosis is favorable. Hyperplasia of the left adrenal gland - what is it? In this case, hyperplasia does not depend on the action of hormones. When the tumor grows more than 3 cm, surgery is required. Laparoscopy or the Fedorov method with lumbotomic access to the peritoneum on the left side is used.

Congenital adrenal hyperplasia of the adrenal cortex ( VDKN) is diagnosed more often than other species. In newborns is detected with a frequency of 1 to 12 thousand. In this state, the child has metabolic and appearance disorders. There are three main forms( nonclassical, simple classical, virilic and salt-losing.)

The most common form is soltering form, it appears in girls as false hermaphroditism, in boys the skin around the scrotum darkens, the penis increases in size. The patients are characterized by low growth and such symptoms,such as drowsiness, nausea, lethargy, low blood pressure, dehydration, poor appetite. Disease must be treated from the first days of manifestation, otherwise a fatal outcome is possible.

With the classical form there is no abovebut there is an increase in the synthesis of male sex hormones. If the disease is not treated, then women continue to have sexual and psychiatric problems

The non-classical form is manifested in adult women and adolescents. The main complaints are infertility, menstrual irregularities, hirsutism andacne rash

Adrenal hyperplasia: symptoms common

Very often in children, men and women there is an erased form of the disease, when there is no pronounced symptomatology, in such cases the layerbut to diagnose the illness. The congenital form is determined in children already in the first-second year of life.

In general, hyperplasia of the adrenal gland( what it is, we have already explained) has the following main symptoms:

• unstable blood pressure( low or high);
• progressed rates of diabetes mellitus;
• increase in weight;
• manifestations of osteoporosis;
• numbness of the muscles, their subsequent atrophy;
• for women is characterized by a "moonlike face";
• memory degradation;
• nervous breakdowns;
• pigmentation;
• stretch marks on the skin;
• disorders in the functioning of the gastrointestinal tract;
• immunosuppression;
• nighttime urinary excretion;
• strong thirst;
• psychoses;
• infertility;
• amenorrhea;
• is not age-appropriate high growth;
• bald patches in the temporal region;
• hirsutism.

In men and women, the clinical signs of the disease vary.

Principles of treatment of

The basis of the treatment, of course, is hormone therapy. Scientists have not yet decided how to most effectively affect adrenal hyperplasia. Treatment is often combined. For adolescents, funds are prescribed that normalize the manifestation of secondary sexual characteristics, girls are shown estrogens, and boys - androgens.

Used in the treatment of a combination of the following glucocorticoids:

• cortisone acetate;
• hydrocortisone;
• dexamethasone;
• prednisolone.

For a day, the patient receives 2 or 3 doses of hormones( in equal amounts).Prescribed and 5% solution of glucose. Girls, unlike boys, have to take necessary preparations all their life.

For each patient, the doctor must find a special approach, prescribe his own treatment strategy( everything depends on his experience and knowledge).There is no single therapy in the treatment of this disease.

Congenital hyperplasia of the adrenal cortex of a severe form is treated by surgeons. There are cases when the sexual organs can not be differentiated as feminine or masculine. For girls, plastic is recommended in case of an irregular shape of the labia. Already in the first year of life such an operation is shown, sometimes( in severe condition) it is carried out later. They also perform surgery for tumors.

If the body lacks salt, the patient should increase the daily dose by 1-3 grams. Appointed in such cases and mineralocorticoids.

With diffuse hyperplasia, drug therapy does not have much effect. Adrenalectomy is required in such cases. Ineffective treatment and the combination of aldosteroma with diffuse hyperplasia. The forecast will be unfavorable. The subject of choice is drug therapy and with bilateral hyperplasia of the glomerular zone( idiopathic hyperaldosteronism).The operation in this case is an extreme measure.

The basis for the treatment of IGA is the administration of spironolactone, it is an aldosterone antagonist. Also effective is the drug eplerenone. Often spironolactone is taken in combination with calcium antagonists. If there is an arterial hypertension in the symptomatology, ACE inhibitors are included in the treatment.

In the case of virilization, it is required to receive supportive medications on an ongoing basis. If the type of adrenal hyperplasia refers to the virilizing, the administration of cortisol is necessary. It can be used as an intramuscular injection. The dose is chosen by the attending physician. For older children, prednisolone may be used.

If proper treatment is not available, then hyperplasia can lead to the development of Cohn's disease or Cushing's disease. After the correct diagnosis, treatment should begin immediately.

Diagnosis of the disease

Hyperplasia of the adrenal gland - what is it? How is the disease diagnosed? Nodular and diffuse hyperplasia is detected during instrumental and laboratory studies. Diagnosis includes: a patient's questionnaire, a physical examination, a clinical examination, an X-ray examination or a magnetic resonance imaging, a radionuclide scan. The results assess the magnitude, as well as the shape of both adrenal glands. A radioimmunoassay laboratory test is performed. The content of cortisol in urine and blood is determined. To assess the hormonal status, an enzyme immunoassay is performed. Sometimes it is necessary to perform aspiration puncture.

The doctor diagnoses and prescribes the most suitable method of treatment.

Hyperplasia in adults: what to do?

Usually hyperfunction of the adrenal cortex is diagnosed in infancy, but adults also show signs of the disease. Hyperplasia of the adrenal glands in women is characterized by increased growth of pubic hair, low voice, acne, pain in the occipital part, nocturnal cramps, undeveloped breast, elevated blood pressure, adrenogenital syndrome.

If you find yourself experiencing these symptoms, do not try to diagnose yourself. In these cases, people's means will not help either. Urgently address to physicians. It is necessary hormonal treatment. Usually women with a similar diagnosis are not recommended to plan pregnancy. In many cases, even forbidden to give birth. Sometimes the optimal solution to the problem is the complete elimination of the diseased kidney, as well as all its appendages.

Prevention

What is adrenal hyperplasia - this is especially important for those couples who have planned the birth of a child, and in the genus they( genetically) have cases of congenital hyperplasia. It is necessary to turn to geneticists - qualified, knowledgeable specialists. To prevent the disease, it will be necessary to make perinatal diagnosis( at a time when the baby is still developing and is in the womb of the mother).In the first trimester of pregnancy, a chorionic biopsy is performed. In the second half, an analysis of the amniotic fluid, which will determine the level of hormones, is needed.

The possible option - IVF.In this case, you can make a preliminary genetic analysis of the sex cells before they are fertilized.

During gestation of a woman with a diagnosis of hyperplasia should be under the constant supervision of a doctor, regularly take all the required tests. It is necessary to exclude from life all possible poisonous substances and the effects of radiation.

For prevention of adrenal hyperplasia, an important role is played by screening tests conducted in a newborn child. For analysis, it is necessary to take blood from the capillary( the spot for the puncture is chosen by the heel of the baby).