ADRENO-CORTICAL CARCINOMA

DEFINITION
Adreno-cortical carcinoma is a rare disease in which malignant (cancer) cells form in the
outer layer of the adrenal gland. Having certain genetic conditions increases the risk of
adreno-cortical carcinoma.
ADRENAL ADENOMA

An adrenal adenoma is a benign (noncancerous) tumor that forms in your adrenal

glands. It's the most common type of adrenal gland tumor. Most adrenal adenomas don't
produce symptoms or require treatment. However, some adenomas may cause your
adrenal glands to secrete excess hormones, like cortisol.
PATHOPHYSIOLOGY
Abnormal conditions result when there is an overproduction of hormones
from the cortex or catecholamines in the case of the medulla. These may be
the result of an increased release of hormone from the hypothalamus or
pituitary gland with increased stimulation of the adrenal cortex.
CAUSES / RISK FACTORS
The causes of adrenal tumors are not fully understood, although we know
that some rare genetic conditions increase the risk. These include multiple
endocrine neoplasia type 2, von Hippel–Lindau syndrome, familial
paraganglioma syndrome, Carney complex, and Li–Fraumeni syndrome.
CLINICAL MENIESTATIONS

•Weight gain.
•Muscle weakness.
•Pink or purple stretch marks on the skin.
•Hormone changes in women that might cause excess facial hair, hair
loss on the head and irregular periods.
•Hormone changes in men that might cause enlarged breast tissue
and shrinking testicles.
•Nausea.
 Pituitary tumors
DEFINITION
Pituitary tumors that make adrenocorticotropic hormone
are called corticotroph adenomas. Adrenocorticotropic
hormone, also called ACTH , causes the adrenal glands to
make the hormone cortisol. ACTH tumors trigger the
adrenal glands to make too much cortisol. This causes a
condition called Cushing disease.
 DISORDERS OF ADRENAL MEDULLA

PHEOCHROMOCYTOMAS
Pheochromocytoma is a type of neuroendocrine tumor that grows from cells called
chromaffin cells. A type of cell that makes neurohormones (chemicals that are made
by nerve cells and used to send signals to other cells) and releases them into the
blood. Chromaffin cells make epinephrine (adrenaline) and norepinephrine
(noradrenaline). They are found in the adrenal glands or in groups of nerve cells called
ganglia.
PATHOPHYSIOLOGY
It is mediated by excessive secretion of catecholamines and subsequent
stimulation of adrenergic receptors.
It does not depend on the histological
subtype. Malignant and benign pheochromocytomas share the
same biochemical and histological features. 
The exact mechanism responsible for surge in catecholamine secretion
remains unclear but it has been postulated that certain medications (such
as opiates, metoclopramide or beta blockers) and changes in tumor blood
flow and pressure could be responsible factors.
CAUSES / RISK FACTORS
Inherited syndromes and gene changes. Up to 40% of
Pheochromocytomas are linked to hereditary syndromes
 Age
Gender
Race
Carney triad

CLINICAL MANIFESTATIONS

High blood pressure

Headache
Sweating
Symptoms of a panic attack

COMPLICATIONS
Disease of your heart muscle (cardiomyopathy)
Heart muscle inflammation (myocarditis)
Bleeding in your brain.
Fluid buildup in your lungs (pulmonary edema)
Stroke.
Heart attack.
Kidney failure.
Nerve damage in your eyes.
Pheochromocytoma multisystem crisis (PMC) is a fatal condition characterized
by multiple organ failure, severe blood pressure variability, high fever, and
encephalopathy.
 DIAGNOSTIC TESTS AND EVALUATION

1) Three first-line diagnostic tests are currently used to screen for CS

 Measurement of free cortisol in 24-hour urine (UFC)
 Cortisol suppressibility by low doses of dexamethasone (DST
 Assessment of cortisol circadian rhythm using late-night serum
and/or salivary cortisol.

2) If Addison's disease is suspected, blood tests will be carried out to

measure the levels of sodium, potassium and cortisol in your body.
A low sodium, high potassium or low cortisol level may indicate
Addison's disease.
3) Hyperaldosteronism (Conn's Syndrome) 
The ARR Screening Test 
Oral salt loading test
Abdominal CT scan
ECG (electrocardiogram)
Blood aldosterone level
Blood renin activity
Blood potassium level
4) A computed tomography (CT or CAT) scan or a magnetic resonance imaging
(MRI) scan may be useful in diagnosing an adrenal gland tumor and determining
whether it is cancerous. 

5) Blood test for pheochromocytoma is the plasma free metanephrine test.

6) ACTH Stimulation Test  for diagnosing adrenal insufficiency.

 MEDICAL MANAGEMENT
pheochromocytoma surgery to remove the tumor.
Noncardioselective beta blockers, such as propranolol (Inderal) or nadolol
(Corgard), are the usual choice; however, cardioselective agents, such as
atenolol (Tenormin) and metoprolol (Lopressor), also may be used.

Addison's disease Hormone replacement therapy corrects the levels of

steroid hormones the body isn't making enough of. Some treatments include
oral corticosteroids such as: Hydrocortisone (Cortef), prednisone (Rayos) or
methylprednisolone (Medrol) to replace cortisol.

The first-line treatment for endogenous Cushing's syndrome be the removal

of the tumor.
Medications to control excessive production of cortisol at the adrenal gland
include ketoconazole, mitotane (Lysodren) and metyrapone (Metopirone).

Medications that can help treat hyperaldosteronism include:

•Spironolactone (Aldactone).
•Eplerenone (Inspra)
•Amiloride (Midamor)
Treatment of adrenal insufficiency requires a daily dose of a
glucocorticoid and mineralocorticoid pills, usually for life.
Androgen replacement may be recommended for women. The
goal of treatment is to stabilize hormone levels and relieve
symptoms

Surgery( adrenalectomy ), hormone therapy, chemotherapy,

radionuclide therapy (injection of a radioactive substance into the
tumor), or other therapies.
Mitotane is the drug most often used for people with adrenal
cancer. It blocks hormone production by the adrenal gland and also
destroys both adrenal cancer cells and healthy adrenal tissue. This
drug can also suppress the usual adrenal steroid hormone production
from your other, normal adrenal gland.
 NURSING DIAGNOSIS

Fluid volume excess

Risk for Infection
Disturbed body image
Risk for Imbalanced Nutrition
Decreased cardiac output
Activity Intolerance
Altered mental status
 NURSING INTERVENTIONS

Monitoring fluid and electrolyte balance, promoting adequate fluid volume, and
monitoring for hypoglycemia and hypotension.
Assess vitals.
Assess heart and lung status (hypertension and fluid overload are common)
Perform 12 lead ECG.
Assess neurovitals (tumor is in the brain)
Check electrolytes (low potassium and high sodium are common)
Weight patient (Weight gain is common)
Check-ins and outs (fluid retention is common)
Monitor for hypertensive crisis: >180 systolic or >120 diastolic.
Anxiety release therapy
Collaborative care
Supportive therapy