adrenal medullary hyperplasia
Introduction
Introduction to adrenal medulla hyperplasia Adrenal medulla hyperplasia is also an independent disease of autonomic catecholamine secretion. There are several cases of adrenal medulla hyperplasia in the country with symptom relief after total adrenalectomy. More common in women, the age of onset is mostly young and middle-aged, with an average age of 39 years (24 to 49 years), similar to pheochromocytoma. In addition, the course of disease is longer, and sometimes the condition can be developed for a long period of time. basic knowledge The proportion of illness: 0.0032% Susceptible people: no special people Mode of infection: non-infectious Complications: high blood pressure
Cause
Adrenal medulla hyperplasia
Cause of the disease (30%):
Adrenal medulla is divided into two types: simple adrenal medulla hyperplasia and secondary adrenal medulla hyperplasia. Secondary adrenal medulla hyperplasia secondary to multiple endocrine disease type II (MEN2), in MEN2 In the case of adrenal medulla hyperplasia or pheochromocytoma, medullary thyroid carcinoma or parathyroid lesions occur many years later, and the pathogenesis is still unclear.
Pathogenesis (25%):
The main features of the pathology are: 1 the weight of the adrenal medulla is increased by more than 2 times; 2 the medulla hyperplasia is seen in the adrenal gland and both wings; 3 the ratio of the adrenal medulla to the cortex is increased, and Dobblic reports that the normal adrenal medulla/cortex is the adrenal gland. The head is 1:5, the body is 1:8 to 1:18, the average ratio is 1:11.5, and there is no medulla in the tail. Xie Tong reports that the ratio of normal medulla to cortex is 12.5% on average, and it is considered to be more than 20%. Is a medullary hyperplasia, foreign literature has reported that as long as the adrenal gland can see the medulla can be diagnosed as medullary hyperplasia; 4 adrenal medulla cells proliferate, the medulla extends into the cortex, the cortical cells are divided into islands; hyperplastic medulla The cells are large in volume, rich in cytoplasm, and there are many cells with vacuoles visible in megakaryocytes and binuclear cells, indicating active endocrine function; 5 adrenal gland enlarges in vitro, thickens and widens, borders become straight, blunt Round, surface uplift, loss of normal flat state of the adrenal gland, full of glandular body is cylindrical, and there is sac sexy; 6 surgery should pay attention to the gland easily rupture, medulla easily with blood loss, resulting in pathological examination Finding medulla.
Prevention
Adrenal medullary hyperplasia prevention
Adrenal medulla hyperplasia, which is mostly of the familial onset of MEN-IIa or MENIIb, can be used for genetic testing. Food should be rich in protein, vitamins and carbohydrates to maintain the balance of electrolytes. Eat more fresh fruits and vegetables, avoid eating cold and spicy foods, avoid eating fatty foods, and avoid eating contaminated or degraded foods.
Complication
Adrenal medulla hyperplasia complications Complications
Adrenal medulla hyperplasia can be associated with kidney disease.
Symptom
Adrenal medulla hyperplasia Symptoms Common symptoms Visual agnostic vertigo medulla hyperplasia nausea and vomiting palpitations Hypertension pale
The main symptom of adrenal medullary hyperplasia is hypertension, the patient has no metabolic disorder, and hypertension has paroxysmal characteristics. The episode is often related to mental stimulation and fatigue, and can also be based on persistent hypertension. Sudden paroxysmal aggravation, the performance of the attack is difficult to distinguish from the onset of pheochromocytoma, the typical symptoms are sudden onset headache, palpitations, vomiting, sweating, shortness of breath, anxious, weak, pale, dizzy And pain in the anterior region, blurred vision, etc., the spirit is extremely tense during the attack, emotional anxiety, pulse is weak, heart rate is fast, blood pressure rises to 200mmHg or even 300mmHg or more, the attack usually lasts for tens of minutes, but it can be longer or shorter. Unlike pheochromocytoma, oppression of the abdomen never causes an episode.
Examine
Examination of adrenal medulla hyperplasia
So far, no specific experimental examination of adrenal medulla hyperplasia has been found. Blood, urinary catecholamines and their metabolites are mostly increased, while the content of adrenaline is mainly increased.
1. X-ray abdominal plain film, retroperitoneal inflation imaging and fault.
2. B-ultrasound examination, no tumor image near the adrenal gland and the abdominal aorta and the common peroneal vasculature, even the adrenal gland volume increased.
3. Abdominal CT scan showed bilateral or unilateral adrenal gland boundary. The flat gland showed diffuse density thickening and widening, sometimes with equal density nodules, and the diameter was more than 0.5cm. There was no tumor image.
4. Pathologically, the adrenal medulla is similar to the cortex. The type of hyperplasia can be diffuse, nodular, or adenomatous hyperplasia. Some people call it "pheochromocytoma-like hyperplasia."
Diagnosis
Diagnosis and diagnosis of adrenal medulla hyperplasia
Diagnosis basis: 1 persistent or paroxysmal hypertension, long course, no significant progress for many years, no family history of hypertension and pheochromocytoma, common antihypertensive drug treatment, adrenaline alpha blocker phenol benzyl Amine treatment is effective; 2 can induce high blood pressure after mental stimulation or exertion, press the abdomen, pregnancy or childbirth or urination does not cause symptoms; 3 test blood, urine catecholamine and its metabolites are mostly increased, and the content of adrenaline Increased mainly; 4B ultra-examination, no tumor mass near the adrenal gland and the abdominal aorta and the common peroneal vasculature, even the adrenal gland volume increased; 5CT scan showed bilateral or unilateral adrenal gland boundary flat gland diffuse The density is thickened and widened, and sometimes an equal density small knot appears, and the diameter is about 0.5 cm, and there is no tumor image.
Both adrenal medulla hyperplasia and pheochromocytoma secrete excessive amounts of catecholamines, so they are collectively referred to as "catecholaminergic syndrome". The clinical features and laboratory tests of adrenal medulla hyperplasia and pheochromocytoma are similar, and it is difficult to identify before surgery. CT scan is an ideal method for the diagnosis of adrenal diseases. CT scan can not only confirm the presence or absence of tumor, but also understand the size and side of the gland. Wei Jiahu reported 12 cases of CT scan and found 1 case of bilateral and 11 cases of single The lateral gland enlargement is consistent with the results of surgical exploration. Therefore, CT scan is considered to be the first choice for the diagnosis of adrenal medullary hyperplasia. The final diagnosis depends on the visual observation and pathological examination during surgical exploration.
