Adrenocortical carcinoma is a rare entity. However, it is the most common type of cancerous adrenal gland tumor with poor prognosis. Approximately 4 to 12 per 1 million people develop this type of tumor, which begins in the adrenal cortex. Adrenocortical carcinoma can occur at any age. Women tend to be diagnosed slightly more often than men. In most cases, the cause of cancerous adrenal gland tumor remains unknown. However, people with certain hereditary conditions have a higher risk. Adrenocortical carcinoma can be a functional or nonfunctional tumor. If the tumor is functional, it may produce hormones causing symptoms such as high blood pressure, low potassium level, heart palpitations, nervousness, feelings of anxiety or panic attacks, excessive perspiration, diabetes, Cushing syndrome, unexplained weight gain or weight loss, weakness, abdominal stretch marks, excessive hair growth, changes in genitalia, change in libido, etc. If the tumor is nonfunctional, symptoms occur because the tumor has grown so large that it exerts pressure on the nearby organs, causing abdominal pain or a feeling of fullness. To diagnose adrenocortical carcinoma, in addition to thorough physical examination, the following tests are used: blood and urine tests to help determine whether the tumor is functional or nonfunctional, and imaging tests (computed tomography scan or magnetic resonance imaging). The treatment depends on cancer stage. Two major staging systems are used: the American Joint Committee on Cancer (AJCC) TNM staging system and the ENSAT (European Network for the Study of Adrenal Tumors) staging system. Both are based on the same TNM categories. The main types of treatment for adrenal cancer are surgery (the main treatment), chemotherapy and targeted therapy. Radiation therapy is not used often as the main initial treatment for adrenal cancer because the cancer cells are not easy to kill with x-rays. Radiation may be used as adjuvant therapy. By definition, adrenal incidentaloma is an asymptomatic adrenal mass detected on imaging not performed for suspected adrenal disease. In most cases, adrenal incidentalomas are nonfunctional adrenocortical adenomas, but may also represent conditions requiring therapeutic intervention (e.g., adrenocortical carcinoma, pheochromocytoma, hormone-producing adenoma, or metastasis).
{"title":"[ADRENOCORTICAL CARCINOMA].","authors":"K Kranjčević","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Adrenocortical carcinoma is a rare entity. However, it is the most common type of cancerous adrenal gland tumor with\u0000poor prognosis. Approximately 4 to 12 per 1 million people develop this type of tumor, which begins in the adrenal cortex.\u0000Adrenocortical carcinoma can occur at any age. Women tend to be diagnosed slightly more often than men. In most cases,\u0000the cause of cancerous adrenal gland tumor remains unknown. However, people with certain hereditary conditions have a\u0000higher risk. Adrenocortical carcinoma can be a functional or nonfunctional tumor. If the tumor is functional, it may produce\u0000hormones causing symptoms such as high blood pressure, low potassium level, heart palpitations, nervousness, feelings\u0000of anxiety or panic attacks, excessive perspiration, diabetes, Cushing syndrome, unexplained weight gain or weight loss,\u0000weakness, abdominal stretch marks, excessive hair growth, changes in genitalia, change in libido, etc. If the tumor is\u0000nonfunctional, symptoms occur because the tumor has grown so large that it exerts pressure on the nearby organs,\u0000causing abdominal pain or a feeling of fullness. To diagnose adrenocortical carcinoma, in addition to thorough physical\u0000examination, the following tests are used: blood and urine tests to help determine whether the tumor is functional or\u0000nonfunctional, and imaging tests (computed tomography scan or magnetic resonance imaging). The treatment depends on\u0000cancer stage. Two major staging systems are used: the American Joint Committee on Cancer (AJCC) TNM staging system\u0000and the ENSAT (European Network for the Study of Adrenal Tumors) staging system. Both are based on the same TNM\u0000categories. The main types of treatment for adrenal cancer are surgery (the main treatment), chemotherapy and targeted\u0000therapy. Radiation therapy is not used often as the main initial treatment for adrenal cancer because the cancer cells are not\u0000easy to kill with x-rays. Radiation may be used as adjuvant therapy. By definition, adrenal incidentaloma is an asymptomatic\u0000adrenal mass detected on imaging not performed for suspected adrenal disease. In most cases, adrenal incidentalomas\u0000are nonfunctional adrenocortical adenomas, but may also represent conditions requiring therapeutic intervention (e.g.,\u0000adrenocortical carcinoma, pheochromocytoma, hormone-producing adenoma, or metastasis).</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35507731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Increasing the proportion of patients with controlled hypertension implies understanding and systematic approach to patients with resistant hypertension. In the past decades, an increase in the prevalence of resistant arterial hypertension (RAH) has been observed and the incidence of this problem is becoming greater in the practice of family physicians. Patients with RAH have a higher prevalence of target organ damage as compared with patients having achieved target blood pressure values, and their risk of an adverse cardiovascular event is tripled. RAH is defined as hypertension in which there is no satisfactory control of blood pressure despite compliance to lifestyle changes and taking at least three drugs in full doses, one of which has to be a diuretic. The most important risk factors for resistance to treatment are older age, obesity, smoking, excessive intake of salt and alcohol, the presence of left ventricular hypertrophy, chronic renal failure, diabetes, inadequate baroreflex pathway, chronic stress and associated mental states, use of some drugs, and all forms of secondary hypertension. One-fifth of patients with RAH have primary aldosteronism. Obstructive sleep apnea is a common cause of RAH, and literature reports point to its increasing frequency. Optimal treatment involves a combination of three drugs, one of which is a diuretic. Use of mineralocorticoid antagonist as the fourth drug has shown significant efficacy even in patients who do not have elevated levels of aldosterone. New invasive methods of treatment include renal denervation and permanent electrical stimulation of the carotid sinus. The aim of this paper is to emphasize the importance of RAH as a cardiovascular risk factor, along with early detection and treatment at the family medicine level and timely referral to additional procedures to treat the specific forms of RAH.
{"title":"[RESISTANT ARTERIAL HYPERTENSION – APPROACH TO PATIENT IN FAMILY\u0000MEDICINE].","authors":"I Diminić-Lisica, L Bukmir, I Lisica","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Increasing the proportion of patients with controlled hypertension implies understanding and systematic approach to\u0000patients with resistant hypertension. In the past decades, an increase in the prevalence of resistant arterial hypertension\u0000(RAH) has been observed and the incidence of this problem is becoming greater in the practice of family physicians.\u0000Patients with RAH have a higher prevalence of target organ damage as compared with patients having achieved target\u0000blood pressure values, and their risk of an adverse cardiovascular event is tripled. RAH is defined as hypertension in which\u0000there is no satisfactory control of blood pressure despite compliance to lifestyle changes and taking at least three drugs\u0000in full doses, one of which has to be a diuretic. The most important risk factors for resistance to treatment are older age,\u0000obesity, smoking, excessive intake of salt and alcohol, the presence of left ventricular hypertrophy, chronic renal failure,\u0000diabetes, inadequate baroreflex pathway, chronic stress and associated mental states, use of some drugs, and all forms of\u0000secondary hypertension. One-fifth of patients with RAH have primary aldosteronism. Obstructive sleep apnea is a common\u0000cause of RAH, and literature reports point to its increasing frequency. Optimal treatment involves a combination of three\u0000drugs, one of which is a diuretic. Use of mineralocorticoid antagonist as the fourth drug has shown significant efficacy even\u0000in patients who do not have elevated levels of aldosterone. New invasive methods of treatment include renal denervation\u0000and permanent electrical stimulation of the carotid sinus. The aim of this paper is to emphasize the importance of RAH\u0000as a cardiovascular risk factor, along with early detection and treatment at the family medicine level and timely referral to\u0000additional procedures to treat the specific forms of RAH.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35558687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}