Adrenal tumor

** Where tumor easily meta?
"3L,2B,1A"
lung, liver, lymph node.brain, bone.adrenal gland

Adrenal tumor




Surgical indication:
1.Size >4cm-->suspect maligancy(primary or secondary)
2.Symptom:
  - functional:
     Cushing's syndrome: appearance,cortisol↑ACTH↓
        手術照顧:
         due to cortisol ↑->immunosupressed
         術後tumor removal,易造成病人adrenal insufficiency->hyponatremia->IICP
         所以術前就要給prednisolone 10mg QD,titrate slowly
     Conn's disease: HTN.aldosterone ↑,K+↓,renin↓
         pre-op:control HTN,use spiralactone or slow K+ supply
         20%術後仍須用ACEi control HTN
     Pheocrumocytoma: triad(headache, sweating, tachycardia) 5P, catecholamine↑.80% VMA,epi,nor-epi↑
        10% rule:familial, bilateral, extra-adrenal, maligancy, non-symptom,related to MEN-2,children
        Dx:MRI T2 enchancement
        Pre-operation:
           control BP,HR to normal range才可以op(alpha-blocker,beta-blocker titrate use)
        術前一天給4000ml IV,to prevent BP drop during operation(小心pulmonary edema->pink-foamy sputums)
       
     Hirrsutism: 多毛(因5alpha-reductase->DHT↑)


  -non-functional:-->OBS,多合併cushing's syndrome