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In the human body, adrenal glands basically sit at the top of the kidneys, one on each side, and have an inner core (called medulla) surrounded by an outer shell (called cortex). The inner medulla develops adrenaline, the “fight or flight” stress hormone. While the non-appearance of the adrenal medulla does not cause complications or disease, the cortex is quite critical. It develops the steroid hormones that are crucial for life: cortisol and aldosterone. Cortisol mobilises nutrients, allows the body to fight inflammation, stimulates the liver in order to produce blood sugar and also contributes in order to control the amount of water in the body. Aldosterone regulates the level of salt and water which affect blood volume and blood pressure. The adrenal cortex also creates sex hormones called adrenal androgens; the most important of these is a hormone called DHEA (dehydroepiandrosterone).

Functions of Adrenal Glands

The adrenal glands may be tiny, but they play a crucial role in the way you feel, think and respond to stress. The adrenal glands are organs that develop and secrete hormones. The hormones created by these small powerhouses affect the way every organ, tissue, and gland in our body works. The adrenal medulla forms a chemical named epinephrine that is also known as adrenaline. Epinephrine is responsible for blood pressure regulation, blood flow and the body’s acute response to stress.

The adrenal cortex creates a different types of hormones including:

Mineralocorticoids (such as aldosterone) that help in order to regulate blood pressure and the fluid and maintain the level of salt in the body.

Glucocorticoids (such as cortisol) are released by the adrenal cortex in order to help the body to cope with long term stress. Glucocorticoids help in order to regulate the level of sugar and fat stored in the body and act as anti-inflammatory agents.

Hormones associated to sex hormones. While apt sexual development and function is regulated by the “real” sex hormones secreted by the gonads (testis and ovaries), there is no definite function assigned to sex hormones secreted by the adrenal cortex.

How Adrenal Glands Work to Produce Cortisol? 

For the adrenal gland to produce cortisol, hypothalamus produces corticotropin-releasing hormone (CRH) occurs, which stimulates the pituitary gland in order to secrete the adrenocorticotropin hormone (ACTH). ACTH then stimulates the adrenal glands in order to develop and release cortisol hormones into the blood.

Cancer of Adrenal Glands

In our body, cells that continue to grow and divide without control turns into mass or tumor. This mass will at the end affect the mechanism of an organ. The original abnormal cell growth site is named the cancer’s “primary site.” In adrenal cancer, the primary site is the adrenal gland.

Abnormal or out of controlled cells can also grow and invade surrounding or nearby organs and structures. This spreading is named metastasis. Tumors that invade and spread are named malignant or cancerous, while benign adrenal tumors never spread or invade other organs.

Tumors of the adrenal medulla: Tumors in the adrenal medulla are not common. There are two types named pheochromocytomas and neuroblastomas.

Tumors of the adrenal cortex: The non-cancerous tumors of the adrenal cortex are named adenomas. These are tiny tumors that are usually detected on a CT scan or MRI of the abdomen. They are a kind of most common type of adrenal tumors and are quite often silent tumors that cause no signs and symptoms. Some address these tumors incidentalomas because they are very often found incidentally when x-ray studies are performed for other reasons.

The cancerous tumors that occurred in the adrenal cortex are named adrenal cancer or a bit specifically, adrenocortical cancer. These are the primary adrenal cancers, meaning they haven’t started somewhere else in the body and spread to the adrenal glands. These cancers are very rare.

Symptoms of Adrenal Cancer

The adrenal cancers act in 1 of 2 ways: they can cause signs and symptoms related to hormone production, or they can cause signs and symptoms from tumor size and compression of other organs. Symptoms include:

  • Pain in the back or side (called the flank)
  • Early puberty in children
  • Excess body/facial hair growth in females
  • Easy bruising
  • Muscle weakness
  • Diabetes
  • Osteoporosis
  • Mood changes
  • Excess breast tissue in men
  • Weight gain and fluid retention
  • High blood pressure (more common in adenomas and pheochromocytomas)
Diagnosis of Adrenal Cancer
The adrenal cancers are often detected when a person seeks treatment for the signs and symptoms caused by the cancer. Although, some tumors are detected when a health specialist orders imaging testing for any other condition. Individuals with signs/symptoms that suggest adrenal cancer will undergo tests in order to determine the exact cause of these symptoms. The initial step is a thorough medical history and physical exam to specify the extent of signs and symptoms and their probable causes.
Further evaluation can include the following:
  • Blood and urine tests 
  • Computed Tomography (CT) scan
  • Magnetic Resonance Imaging (MRI) scan
  • Positron Emission Tomography (PET) scan
Stages of Adrenal Cancer
Generally, patients with Adrenal Cancer are divided into four groups or stages of adrenal cancer. The four stages of adrenal cancer are:
Stage1: The cancer is smaller than 5 cm (2 inches) and has not reached beyond the adrenal gland.
Stage 2: The cancer is larger than 5 cm and has not spread beyond the adrenal gland.
Stage 3: The cancer has reached into the fat surrounding the adrenal gland or adjacent organs or has spread to the lymph nodes or other organs near the adrenal gland.
Stage 4: The cancer has reached other parts of the body.
Because adrenal cancer is quite uncommon, there are various staging systems that can be considered. The most common system is the ENSAT (European Network for the Study of Adrenal Tumors) staging system.
Treatment of Adrenal Cancer
The International consensus conferences have recently favoured standardized approaches for the treatment of adrenal cancer. In general, these cancers confined to the gland need to be surgically eliminated. Those with spread to nearby or distant organs can be treated with surgery along with certain other therapies, or may be not eligible for surgical elimination or removal. Adrenal cancer can be quite aggressive cancer. The prognosis is good when the cancer can be surgically eliminated or removed.
Surgery: Adrenal cancer is quite aggressive cancer. The only known cure is complete surgical elimination/removal of the cancer. In numerous cases, individuals come to their health specialist after the cancer has spread to other organs, or the cancer has spread to places that cannot be eliminated, and the cancer is considered inoperable. In case the tumor can be eliminated, it is very necessary that the elimination is performed by a surgeon experienced in the treatment of adrenal cancer (most surgeons see 1 adrenal cancer patient in a lifetime). There are a couple of types of surgery for adrenal cancer: laparoscopic and open.
Radiation therapy: Radiation therapy (also can be known as radiotherapy, x-ray therapy, or irradiation) is the use of a beam of energy (named ionizing radiation) in order to destroy cancerous cells and shrink tumors. The radiation therapy injures or destroys cells in the target tissue by destroying their genetic material (DNA), making it almost impossible for these cells to continue to grow and divide.
In general, radiation therapy is considered in a couple of different settings for adrenal cancer. It may be used for certain circumstances including: 
  • Treatment following surgery in order to decrease the probability of local recurrence; or
  • Managing or controlling areas of tumor metastasis. This is particularly useful in order to treat bones affected by adrenal cancer.
 The radiation therapy is usually delivered daily, Monday through Friday for five to seven weeks. The adverse reactions can include diarrhea, fatigue, skin reactions such as redness and irritation, and nausea.
Chemotherapy: Chemotherapy is the therapy of cancer with promising medicines that can kill cancer cells. These drugs often are named anticancer drugs. Chemotherapy is the therapy of choice for adrenal cancer that cannot be cured with the help of surgery. This stage of cancer of the adrenal is usually metastatic. Chemotherapy medications can have an effect on the cancer by inhibiting the growth of cancerous cells or their ability in order to multiply. The goals of treatment with chemotherapy are to control the cancer, keep it from spreading by resisting the cancer’s growth and improve or decrease the signs and symptoms of the disease. The most common chemo used for the treatment of adrenocortical cancer is:
Mitotane: Mitotane, available under the brand name Lysodren. It is specifically a steroidogenesis inhibitor and cytostatic antineoplastic medication. It comes in the form of tablets as dosage strength of 500 mg. The lysodren 500 mg drug has been prescribed the longest in the treatment of adrenal cancer and acts by inhibiting the hormones produced by the cancer, destroying adrenal cancer cells.
Mitotane is a chemotherapy tablet taken orally in several doses throughout the day. It is necessary to take each and every dose exactly as prescribed/scheduled and to have blood levels regularly monitored.
Individuals after mitotane uses, must be closely assessed by their health specialist for common side effects. These may include extreme drowsiness and abnormalities in blood work. Treatment with Mitotane can also lead to adrenal insufficiency, a condition in which the adrenal glands do not develop apt amounts of steroid hormones. Thus, it is recommended that patients receive cortisol replacement together with Mitotane treatment.
A number of chemotherapy medicines can be combined either with each other or along with Mitotane in order to treat patients with adrenocortical cancer. These include a combination regimen with doxorubicin, etoposide and cisplatin or streptozocin.
A couple of combinations have been evaluated in order to treat patients with advanced adrenal cancer: a regimen known as EDP/M (etoposide, doxorubicin, cisplatin, & mitotane) and a combination therapy of medicines Mitotane &  streptozotocin.
In general, adrenal cancer can be aggressive and resistant to maximum chemotherapy. Several studies have demonstrated RR of 30% to 50%. Studies or trials of newer chemotherapy agents are ongoing.
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Where do I get this medication?
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Storage and Handling: Store this medication in a closed container at room temperature. Avoid it from moisture, heat and direct light. Do not store this medicine in a bathroom because of the humid environment. Keep this medication away from children.
Nitin Goswami

Nitin Goswami joined us as an Editor in 2020. He covers all the updates in the field of Pharmaceutical, Business Healthcare, Health News, Medical News, and Pharma News.

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