By David E. Schteingart (auth.), Gary D. Hammer, Tobias Else (eds.)
This first version of the textbook “Adrenocortical Carcinoma: easy Sciences and scientific recommendations” offers a concise compilation of appropriate facts advancing our present realizing of this infrequent melanoma. Chapters are devoted to a variety of facets of either the elemental biology and the medical technology when it comes to adrenocortical carcinoma (ACC). specialist clinicians introduce the reader to present state of the art medical care of sufferers with ACC. As a substantial physique of data on ACC has gathered during the last many years, professional scientists have authored extra sections that function a reference resource for the skilled researcher in addition to an advent for the trainee within the laboratory or medical institution. medical issues span the epidemiology, analysis and treatment of ACC. medical subject matters parts span the pathology and pathophysiology of ACC with a different specialize in experimental types of adrenocortical tumors and up to date advances within the genetic elements and signaling pathways in ACC. The content material of this booklet used to be compiled and edited with the motive of facilitating the interpretation of information into destiny diagnostic and healing instruments that may finally increase sufferer care.
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Extra info for Adrenocortical Carcinoma: Basic Science and Clinical Concepts
Although imaging methods have improved significantly in the past decades, in some patients disease recurrence may be first detected by an increase of circulating hormones. (4) From a clinical perspective, the probably most relevant reason to search for autonomous hormone secretion is the identification of patients with (subclinical) cortisol excess. If significant cortisol secretion is present and remains undiagnosed, complete resection may lead to life-threatening adrenal insufficiency peri- or postoperatively due to suppression and atrophy of the contralateral adrenal.
Thompson) 1. Adequate steroid preparation and maintenance in patients with Cushing’s syndrome or while on long-term mitotane therapy. 2. In case of a high suspicion of an ACC, needle biopsy is contraindicated pre-operatively; spillage of tumor cells will prevent cure (Fig. 1a, b). 3. Incisions allowing wide local exposure of the tumor and intra-abdominal metastases, making every effort to avoid rupturing the tumor capsule when it is localized and potentially curable. 4. Avoidance of laparoscopic techniques.
Appearance of psychiatric symptoms like profound depression or acute psychosis warrants immediate attention to avert suicide. Massive hypercortisolism may lead to hypertension and severe hypokalemia, requiring replacement doses of potassium of >120 mmol/day due to excessive renal potassium loss. The pathophysiological basis is incomplete renal inactivation of cortisol by 11beta-dehydrogenase type II, and hence grossly elevated mineralocorticoid receptor activation . On the other hand, due to the low efficiency in steroid production per cell, clinical abnormalities in functioning ACC may be subtle and often require an astute physician for early recognition of CS.