出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/05/14 06:52:05」(JST)
Adrenal gland disorders (or diseases) are conditions that interfere with the normal functioning of the adrenal glands.[1] They are characterized by adrenal insufficiencies, where there are deficiencies in the availability of steroids that are produced by the adrenal glands.[2] Adrenal Gland disorder is rather prevalent in small animals including rabbits, ferrets & guinea pigs. They may cause hyperfunction or hypofunction, and it may be congenital or acquired. Adrenal gland disorders are challenging to diagnose, but if left untreated, they are life-threatening and can be very deadly.
There are two parts of the adrenal glands, the adrenal cortex and the adrenal medulla. The adrenal cortex produces cortisol, a hormone that regulates nearly every type of organ and tissue within the body. The adrenal cortex also produces aldosterone. It helps to maintain appropriate proportions of water and salts within the body. When the proportions are disrupted, it results in low blood pressure. Most patients with adrenal insufficiency may experience fatigue, poor appetites, dizziness, weight loss, and nausea.
The adrenal gland is a gland that produces hormones that affects your growth, development and stress, it also helps regulate kidney function.
Symptoms
Pheochromocytoma is a tumor of special cells that arises inside the “adrenal glands’ chromaffin cells”.[3] These chromaffin cells may be found anywhere in the heart and in the area around the bladder, but they are mostly found in the adrenal glands. When adrenaline or hormones are released too much from the adrenal gland, they cause high blood pressure.[4] Pheochromocytomas are found in a person’s body because he has inherited these from his parents.[4] With “autosomal dominant inheritance,” men and women are equally likely to inherit the disease.[4] However, they are more common in women than in men. This syndrome can occur in any age, but mostly in between the ages of 30 to 60.[3] The most common symptoms of pheochromocytoma are hypertension or high blood pressure.[4] These symptoms usually occur in a sudden attack. The other symptoms of the disease are “headaches, excess sweating, racing heart, rapid breathing, anxiety, nervousness, pain in the lower chest or upper abdomen, nausea, or heat intolerance.” [4] In between attacks, people with the syndrome can experience weight loss or increased sweating. The attacks occur frequently in a week and they may last up to 15 minutes.[4]
Causes
The main cause for most pheochromocytoma is not yet known. Inherited pheochromocytoma is a 10 to 20 percent chance of causing the disease. It is from an inherited autosomal dominant trait. According to some research patients recently diagnosed with hypertension have pheochromocytoma. It is seen in both sexes and usually between the age of 30 and 40.[5]
Treatments
Pheochromocytoma is a rare disease where the tumor forms in the chromaffin cells of the body. There are many ways to treat the pheochromocytoma. One of which is by surgery. The first step in doing so is to find out where the tumor is and then they surgically remove it.[6] During this process one or two adrenal glands can be removed and this is known as adrenalectomy. The lymph nodes and tissues maybe removed if the cancer has started to spread.[7] If one does not want to do surgery then they can do chemotherapy where drugs are used to kill the cancer cells. In this process one can take pills or they can take it intravenously which is a bag that drips solutions into the vein. The way this treatment works is the drugs flow through the body killing cancer cells that are located in the body. The last method for this treatment is radiation therapy. In this they use high energy x-rays that destroys the cancer cells and reduces the size of the tumors.[7] Pheochromocytoma has no methods for prevention.
Description
Cushing’s syndrome is the result of the excessive production of corticosteroids by the adrenal glands. An overproduction of corticotrophin, the hormone that controls the adrenal gland by the pituitary gland, which stimulates the adrenal glands to produce the corticosteroids, could be of one cause. It also can be in excessive cortisol levels in the blood which may be the result of a tumor of the pituitary glands, adrenal glands or from tumors or cancer arising elsewhere in the body. Cushing’s disease refers to specifically to excessive ACTH secretion by a pituitary tumor. The cause of Cushing’s syndrome is a pituitary adenoma in over 70% of adults and approximately 60-70% of children and adolescents. Cushing’s disease is relatively rare, affecting ten to fifteen in every million people each year and most commonly affected adults between the ages of 20 to 50 years. Women however, account for over 70% of the case.
Symptoms
The symptoms and signs of Cushing’s syndrome are: change in body habitus; weight gain in the face, above the collar bone and on the back of the neck, skin changes with easy bruising, excess hair growth on the face, neck, chest, abdomen, and thigh, generalized weakness and fatigue, loss of muscles, menstrual disorders in women, decreased fertility and/or sex drive, high blood pressure, and high blood sugar. These symptoms are brief descriptions of what can be found in patients with Cushing’s disease and each individual may experience symptoms differently.
Causes
People can develop Cushing's syndrome by taking glucocorticoids or their body is exposed to high levels of cortisol. Glucocorticoids are steroid hormones that are chemically similar to the cortisol produced by our bodies. Someone can also develop chushings syndrome if their body produces too much cortisol naturally. Cortisol is used for many important tasks in the body. It helps to maintain blood pressure and cardiovascular function. It breaks down glucose for energy by balancing the effects of insulin. Its main purpose is to help the body with stress. Depression, alcoholism, malnutrition, and panic disorders all increase levels of cortisol. This increases the chances of getting Cushing's syndrome.[8]
Treatments
Treatment of Cushing’s syndrome can vary depends on the cause of cortisol excess. People with Pituitary Adenomas can treated with several kinds of treatments. Most preferably is to use a surgical method called transphenoidal adenomectomy. The surgeon uses a microscope and other instrument to get to the gland. In order to get to the gland they would either have to make an opening below the upper lip of the patient or they would have to go through the nostril. The success rate for this type of treatment is above 80 percent and can be performed more than once if necessary. The level of ACTH within the patient should temporary drop about 2 levels below normal. The patient would also be given a synthetic cortisol such as hydrocortisone. The end results usually are less than a year for the treatment to take effect. For people who do not qualify for transphenoidal adenometomy or if the treatment didn’t work, they could use radiotherapy to treat the disease. By using radiation to treat the gland for 6 weeks, about 40 percent to 50 percent of adults and a possible 80 percent of children improved. They also use a drug called Miotane to decrease plasma or urine hormone levels. Other drugs such as aminoglutethimide, metyrapone, trilostane and ketoconazole can be use as a replacement for Miotane or to be use along with Miotane. It is up to the doctor’s discretion because each one of these drugs has its own side effects.
People who have an Adrenal tumor as a result of Cushing syndromes can use a procedure called laparoscopic adrenalectomy. It is only use for Adrenal tumors that are less than 6 cm. This treatment is strongly recommended because the patient can recover much quicker and experience less pain than other open procedures.
Ectopic ACTH syndrome can be cured by destroying all ACTH cancer tissue. Depends on the type of cancers, surgery, chemotherapy, radiotherapy, immunotherapy, or combination of these treatment can be used to cure the disease.
Symptoms
The pituitary is a “small, pea-sized gland” located at the base of the brain [9] The pituitary adenoma disease affects hormones which regulate growth and the activity of other glands in the body. However, with an abnormal growth or tumor in the master gland, the pituitary adenomas do not spread to other body parts and are not cancerous.[10] This disease is found most likely in adults than in children and increases during adolescent years.[11] They also tend to grow slowly, but too many hormones can cause significant problems in the body. Pituitary adenomas can cause “disturbance of vision and growth and change in hormonal balance”.[10] Other general symptoms may be headache, infertility, fatigue, low or high blood pressure, or growth failure . Some pituitary hormones which impact the sex hormones can “make a woman produce breast milk even though she is not pregnant or nursing, or cause a man to lose his sex drive or lower his sperm count”.[9] Because these symptoms can be indicative of so many other diseases, these tumors often go undiagnosed.[9]
Causes
Pituitary adenoma is in the form of a tumor, pituitary tumor. Prolactinomas is the most common form of a pituitary tumor. It causes amenorrhea, galactorrhea, and infertility in females. Gigacromegaly is caused by tumors that secrete excess growth hormones.[12]
Treatments
The small organ called pituitary adenoma helps make hormones for the growth of the body. This is a tumor that grows in the pituitary gland.[13] There are many ways to treat this problem one being surgery. This is the common treatment used in order to get rid of that tumor. If the pituitary gland is accidentally damaged in the surgery then the way to treat it is by taking pills which replaces the hormones created. Another method for treatment is medications, which helps to shrink tumors. The two types of medicines are bromocriptine and ocreotide. Bromocriptine helps lower the prolactin levels and minimize the size of the tumor. The ocreotide is used when tumors release growth hormone and when surgery is not going to cure.[14] The last option for treatment is radiation therapy. In this process it uses radiation to kill the tumor cells. There are three types of radiation therapy the first which is conventional therapy. In this the radiation is intended for the pituitary. The second is stereotactic radiosurgery. The tumor has a radiation beam that is intended to be serious from stereotactic radiosurgery. The last one is the proton beam radiotherapy which is a ray of protons that is directed only on the tumor. Pituitary adenoma has no procedures or preventions for this small organ.[13]
Description
In hyperaldosteronism, there is a primary and secondary condition. Primary hyperaldosteronism are conditions in which the adrenal gland releases too much of the hormone aldosterone. Primary hyperaldosteronism used to be considered a rare condition, but some experts believe that it may be the cause of high blood pressure in some patients. Most cases of primary hyperaldosteronism are caused by a noncancerous tumor of the adrenal gland. The disease is common between the ages of 30 and 50. In secondary hyperaldosteronism, the excess aldosterone is caused by something outside the adrenal gland that mimics the primary condition. Secondary hyperaldosteronism is generally related to high blood pressures, it also can be related to: cirrhosis of the liver, heart failure and nephritic syndrome.
Symptoms
Symptoms in hyperaldosteronism includes: fatigue, headache, low serum potassium, high blood pressure, intermittent paralysis, muscle weakness, and numbness.
Causes
Hyperaldosteronism can be caused by adrenal cancers and hyperplasia but it is usually caused by the invasion of adenoma. Increased cell production can increase the bulk of an organ, which can cause hyperaldosteronism. It can also be caused by a tumor in the adrenal gland.[15]
Symptoms
Each adrenal gland in a body contains what is called a medulla, covered in a coating called the cortex. When the cortex breaks down, it causes a cascade of symptoms known as Addison's disease.[16] It is primarily the cortex which is responsible for regulating how much water regulation in the body and blood from the liver. This disease usually is asymptomatic until the cortex is degraded completely.[16] Negative symptoms of Addison's disease include: major weight loss, sudden dizziness, low blood pressure, stomach pains and occasionally nausea and vomiting.[17]
Causes
Addison’s disease is caused when there is a failure to produce adequate levels of cortisol. This can be caused by a disorder of the adrenal glands, autoimmune disorder. The disorder causes the body’s immune system to gradually destroy the adrenal cortex.[18]
Treatments
With medications, such as replacement corticosteroids, its symptoms can be controlled. However, these drugs must be taken for life. People often receive glucocorticoids (cortisone or hydrocortisone) and mineralocorticoids (fludrocortisone) to control their symptoms.[19] In Addison’s disease, the adrenal glands do not produce enough cortisol and aldersterone; therefore, the drugs replace these missing hormones.[20] For immediate treatment, hydrocortisone, salt water, and sugar can help in the adrenal crisis. An adrenal crisis is an extreme form of adrenal insufficiency, therefore, hydrocortisone must be injected immediately if one were to experience it.[19]
For the evaluation of adrenal disorders, CT is the primary imaging method. When characterizing the enhancement pattern of lesions on portal venous phase images, intravenous contrast can be useful. For patients who cannot tolerate intravenous contrast, MRI can be an alternative to CT.[21]
When too much adrenaline or noradrenaline is produced from the adrenal gland, a tumor is suspected and therefore, an adrenal gland scan is required. One situation where a tumor is suspected is when high blood pressure does not respond to the medication. On the first day of the scan, a radiopharmaceutical is injected into the patient. On the second, third, and fourth day, the camera scans the pelvis, lower abdomen, and lower chest.[22]
John F. Kennedy, the 35th president of the United States was diagnosed with Addison’s Disease while on a trip in London as a Congressman. A common symptom of Addison’s Disease was the discoloration or bronzing of the skin. Many observers have noticed that he had a deep tan and his skin had a green tinge. When he was asked about his year-round tan, he answered that it was because of “exposing a part of his anatomy that had not been burned by the sun.” This was not proof of a natural tan, for Addison’s Disease usually consists of the bronzing of the areas of the skin that is exposed.[23] Jane Austen, an English novelist, was thought to have died from Addison’s Disease. Her descriptions of her illness seemed to have fit Addison’s Disease, but a recent study has shown it is a possibility that lymphoma, such as Hodgkin’s Disease, could have caused her death.[24]
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