What is the structure and function of the adrenal glands?
The adrenal glands are small dirty yellow (3-5 gr) organs in the shape of a triangular prism on both kidneys. It is defined as adrenal or adrenal glands in medical language. It is made up of two distinct structures: the outer shell part (cortex) and the inner shell part (medulla), each with its own set of functions. Despite their small scale, these organs do enormous work. Because these glands provide many chemical and hormonal balances in the body. Diseases in these glands can cause very serious discomfort.
Cortisol and aldosterone are secreted in the cortex layer, which is the outer shell, and adrenaline and noradrenaline hormones in the inner medulla layer. In addition, these glands excrete sex hormones.
What diseases can be seen in the adrenal glands?
Diseases of the adrenal glands occur according to the function of the hormones that are insufficient or excessively produced in this gland. There are also masses that do not produce hormones. These masses can be benign or malignant (cancer). Below you can find their names and brief descriptions.
Primary adrenocortical insufficiency (Addison’s Disease): It is the inadequate functioning of the adrenal gland. Deepening in skin color is the most common and distinguishable complaint. Furthermore, complaints such as weakness, fatigue, loss of appetite, weight loss, nausea, vomiting, and dizziness are observed in the person.
Congenital adrenal hyperplasia: It is a genetic disease. In girls, it presents as a sexual development disorder. Boys, on the other hand, are recognized by reaching early puberty between the ages of 5-10.
Adrenal Cushing’s syndrome: It is caused by an excess of cortisol secreted by the adrenal gland for different causes and excessive intake of external drugs. Especially weight gain, high blood sugar, hypertension, and hair growth in women are common complaints.
Primary hyperaldosteronism: It occurs due to the high level of aldosterone hormone. It should be suspected in patients with hypertension who present at an early age.
Pheochromocytoma: Hypertension occurs due to excessive secretion of hormone from a tumor in the adrenal gland. When treated, blood pressure also normalizes. It can be fatal if left untreated.
Adrenocortical carcinoma: This name is given to malignant tumors (cancer) in the adrenal gland. They are tumors that worsen over time, despite their rarity.
Adrenal incidentaloma: This name is given to harmless masses found incidentally in the adrenal gland. While surgery is needed for masses larger than 4 cm, follow-up is sufficient for smaller masses.
What kind of symptoms should I have to suspect adrenal gland disorders?
Examining the functions of your adrenal gland is helpful if you have one or more of the following complaints. In this case, you should consult an Endocrinologist.
- Feeling tired and nervous
- Feeling like you are on the run
- Getting angry quickly, yelling with rage
- Difficulty in sleeping or feeling energized and losing sleep when about to fall asleep
- Continuous interruption of sleep
- Constant urge to eat dessert after the meal
- Enlargement of the abdominal area
- Rapid weight gain
- Skin disorders (such as eczema)
- High blood pressure or heart palpitations
- High blood glucose
Overview and treatment of masses in the adrenal gland
Most masses in the adrenal glands are detected incidentally. In other words, films such as Ultrasonography, Tomography, or (MRI) taken for patients who visit a doctor for some cause detect a mass in this region. The appearance of certain symptoms of health deterioration (such as rapid and excessive weight gain, high blood pressure that does not improve with medication) may increase the presumption of an adrenal gland mass, which is then investigated and diagnosed.
Adrenal gland masses are roughly divided into two as benign or malignant (cancer).
A cancer diagnosis is made by looking at some values in films such as tomography and MRI. Masses determined to be cancer should be surgically removed together with the adrenal gland as soon as possible.
On the other hand, benign masses are divided into two categories: 1) harmless masses, and 2) masses that produce excess hormones.
If it is determined that there is a hormone-secreting mass in the blood and urine tests, then the treatment is to surgically remove this adrenal gland together with the mass.
When it comes to harmless (benign and non-hormone-producing) masses, the size of the mass determines whether surgery is necessary. In general, masses smaller than 4 cm are called for intermittent controls and the patient is followed up. For larger masses, surgical removal is the most appropriate treatment. Because the mass grows in size, the chances of it containing tumor cells or causing other issues increase.
When surgery is needed, one of the greatest blessings of today’s technology is laparoscopic surgery, which is done by making 3 or 4 incisions of approximately 0.5-1 cm in length rather than open surgery, which involves cutting almost half of the abdomen.
What are the advantages of laparoscopy?
Open surgery of the adrenal gland is more difficult than kidney surgery. This is due to the fact that these glands are deeper and closer to the main arteries, making them more difficult to reach. Therefore, larger skin incisions are made in this surgery compared to kidney surgery and the operation times are longer.
One of the most significant advantages of laparoscopy is that it uses very small incisions instead of the 30-40 cm incisions used previously. This not only means a good cosmetic appearance, but also a quicker and smoother recovery. This condition becomes even more critical in patients with late wound closure or infection sensitivity, such as diabetics. It also has the benefit of allowing patients to spend less time in the hospital as a result of their faster recovery, the ability to return to their everyday lives more quickly, and the ability to resume work sooner. Again, postoperative patients have the advantage of less pain and less medication use. Operation times are much shorter than open surgeries, particularly in the hands of inexperienced surgeons, and the patient is provided with less anesthesia.