Adrenal gland Disease

The Correct option is Answer: c



The treatment of adrenal tumors is primarily surgical removal. Although pharmaceutical agents are useful in preparing the patient for surgery or in palliating the patient with recurrent adrenal carcinoma, no agents render definitive therapy for adrenal tumors. Congenital adrenal hyperplasia stands alone among the primary, hyperfunctioning adrenal syndromes that are amenable to medical therapy for definitive treatment. Functioning benign lesions of the adrenal cortex that are not ACTH dependent, such as adenomas or macronodular hyperplasia, respond to metyrapone and aminoglutethimide, which are inhibitors of enzymes in the adrenal steroidogenic pathway. Both agents can effect a decrease in the production of cortisol when there is no increase in ACTH secondary to feedback stimulation. These drugs are not satisfactory long-term agents because of their high incidence of drug reactions, patient noncompliance, and continued growth of the lesions. They may be useful in patients whose surgery must be delayed. Although malignant, functioning adrenocortical lesions should be debulked whenever possible. Several chemotherapy agents offer adjunct therapy. The most noteworthy is mitotane (o,p,-DDD). This is a cytolytic agent that has a 30% to 70% response rate in terms of decreasing steroid output. Unfortunately, patient survival is not affected. As mentioned, nonoperative treatment with cortisone acetate and possibly fludrocortisone is definitive therapy for congenital adrenal hyperplasia. Cushing disease is best treated by transsphenoidal resection of the pituitary adenoma. Pheochromoctyoma requires definitive surgical resection although the preoperative pharmacologic preparation with catecholamine blockade is required.

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