What is adrenal lipoma

The adrenal gland is an organ belonging to the urinary system. Adrenal lipoma is like a fat particle growing on it. Interestingly, the adrenal gland itself is not large in size, but the size of the lipoma can be several times or even ten times its size. There is now a very good treatment method for this disease, which is laparoscopy. Not only is the treatment effective, but the area is also clearer during the operation.

1. Overview

The adrenal gland is an important endocrine organ in the body. Due to its close relationship with the kidneys, it is traditionally classified as a urological disease. The human body has one adrenal gland, one on the left and one on the right, located behind the peritoneum, with its lower and outer sides closely attached to the upper and inner sides of the kidneys on both sides. At first glance, the shape and size of the adrenal gland resemble the slightly bent last finger of an adult. Its head, body and tail also look like the last finger from base to tip. But if you analyze them carefully, you will find that the right adrenal gland is triangular and the left adrenal gland is crescent-shaped. The former straddles the inner side of the upper pole of the right kidney, while the latter hangs on the inner side of the upper pole of the left kidney. Their length, width and thickness are 4.0 cm to 6.0 cm, 2.0 cm to 3.0 cm and 0.3 cm to 0.6 cm respectively. The normal adrenal gland weighs about 4.0 to 5.0 grams.

Although the adrenal gland itself is very small, the size of the tumors it grows varies greatly. Those with a diameter of less than 3 cm are usually called small tumors. The smallest is less than 1 cm, and the largest can be more than 10 to 30 centimeters. The shape of the tumor can be like a bean, peach, plum, apple, cantaloupe, pillow, etc.

Physiological functions of the adrenal glands

People have invested a lot of interest and energy in research in this field. Relevant biochemical and pharmacological research has achieved rapid progress. We know that the adrenal medulla can not only produce adrenaline, but also norepinephrine and dopamine. Their side effects are smaller than those of adrenaline, and their blood pressure-raising and life-saving effects are often better. More importantly, in terms of adrenal cortex function, through nearly half a century of research, we know that there are more than 40 kinds of corticosteroids (chemically called steroid hormones or steroids) produced and secreted by the adrenal cortex, plus some available intermediates or derivatives. There are more than 70 species. Corticosteroids can be broadly divided into three categories, which are briefly described below:

1. The hormones that regulate sugar and protein metabolism - corticosteroids are represented by cortisol, and cortisone is commonly used in clinical practice. This type of hormone promotes the deamination of amino acids into sugars, that is, it promotes gluconeogenesis and maintains blood sugar concentration. Lack of this hormone can easily lead to hypoglycemia. When there is too much of this hormone, glycogenolysis is enhanced, which can destroy protein or prevent its synthesis, causing excessive increase in subcutaneous fat, increased blood sugar, thinning of the skin, purple lines, muscle weakness, and osteoporosis. In addition, glucocorticoids have an impact on the metabolism of various substances. Together with insulin, growth hormone, adrenal medullary hormone, etc., they regulate the body's material metabolism and energy supply, so that the physiological activities in the body are coordinated and balanced with each other.

2. The hormone that regulates salt and water metabolism - mineralocorticoids is represented by aldosterone, and the clinical user is deoxycorticosterone acetate. This hormone causes the renal convoluted tubule to absorb sodium and chloride and excrete potassium and phosphorus. In the absence of this hormone, the sodium concentration in the plasma decreases, resulting in water loss, blood concentration, and increased blood potassium. If there is too much of this hormone, the opposite situation will occur, that is, blood sodium will increase and potassium will decrease. Mineralocorticoids may also have a certain effect on the metabolism of sugar and protein, but the effect is relatively mild. Under physiological conditions, the production and secretion of mineralocorticoids are mainly regulated by the renin-angiotensin system, followed by the influence of blood potassium, adrenocorticotropic hormone, etc.

3. The adrenal cortex also secretes weaker androgens such as hydroepiandrosterone, androstenedione, and trace amounts of testosterone, which do not play an important role in adult marriage and reproductive life. However, it can promote the appearance of the earliest secondary sexual characteristics of male and female adolescents, such as axillary hair and pubic hair, as well as the maturation of the hypothalamus-pituitary-gonadal axis, thereby enabling their healthy development during puberty. The adrenal cortex also secretes trace amounts of estrogen, which is generally of no practical significance. However, in patients with adrenal tumors, increased estrogen levels can cause impotence and infertility in male patients and menstrual disorders in female patients.

These corticosteroids are secreted in the human body through the regulation of the hypothalamus-pituitary-adrenal axis and the neurohumoral feedback system. Under normal circumstances, their secretion shows rhythmic changes with the time of day and night. Therefore, the hormone content in the human blood also varies with time. For example, the cortisol content is highest at 8-9 o'clock in the morning and the lowest at around midnight. In this way, the human body's metabolism, growth and development, and physiological activities can be maintained in a normal and orderly manner. However, when encountering an unexpected emergency, that is, when the human body or mind is suddenly subjected to some kind of strong stimulation or blow, such as encountering some huge difficulty that must be overcome immediately, bravely breaking through when surrounded, tenaciously competing to defeat the opponent, difficult labor, major surgery, heavy bleeding, etc., even oneself are often puzzled afterwards: how could one be so quick-witted at that critical moment, how could one have such extraordinary perseverance, and how could one survive such a great opportunity. In fact, this is also due to the fact that the secretion of adrenal cortex hormones also has a stress-related characteristic. Experiments have shown that when major surgery or heavy bleeding occurs, cortisol levels can rise several times or even more than ten times. At the same time, through the negative feedback regulation mechanism, it promotes the release of adrenocorticotropic hormone from the pituitary gland, thereby enhancing the body's stress resistance and extraordinary abilities.

Three disease treatment

Currently, laparoscopic surgery has become the most commonly used method for resection of adrenal tumors. Its advantages are obvious. First, it is minimally invasive, that is, only a few small holes with a diameter of 1 cm are needed on the skin to complete the tumor removal, and the postoperative recovery is very fast. The incision of traditional open surgery is often more than ten centimeters, which slows the patient's postoperative recovery and affects the appearance. Second, it is clear. Due to the magnifying effect of the laparoscope, the deeply located adrenal glands are right in front of the eyes, achieving a clear field of vision that open surgery cannot match. In addition, the use of supporting advanced cutting and separation instruments makes the surgical dissection very delicate and bleeding is very little.