[LARGE ADRENAL CORTEX NEOPLASMS].
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The data of remote observations of 39 operated patients with adrenal cortex tumors were analyzed as well as the functional state of the hypothalamo-hypophysial system and morphological investigations of the adrenals removed. In the light of the results obtained the questions of surgical methods and choice of the operation volume are discussed which can liberate the patients of the Itsenko-Cushing syndrome.
Two cases of adrenal cortical carcinoma in the pediatric age group are reported: the first case regards a fourteen month old female patient which presented with virilization and Cushing's syndrome: the second case regards a twelve year old boy with severe hypertension. Histopathologic distinction between benign and malignant adrenal cortical neoplasms is difficult: the usual cytologic criteria of benignity and malignancy in relation to prognosis are not very helpful while tumor size and tumor invasion appear to be the more important prognostic factors. Therefore early diagnosis, which is easier in the pediatric age because of the more frequent presentation of these neoplasms with hormonal effects, is essential.
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Neoplasms of the adrenal gland may cause increased hormone activity, which has profound effects on the growing child. The adrenal gland should be viewed as two functionally separate glands: the adrenal medulla and adrenal cortex. Neoplasms of the adrenal cortex secrete excess glucocorticoids, mineralocorticoids, or androgens. Adrenal medulla neoplasms generally secrete excess catecholamines. Understanding the anatomy, embryology, and physiology of the adrenal cortex and medulla allows surgeons to diagnose these tumors, prepare the patients for surgery, and treat them effectively after resection. Because adjuvant therapy for adrenal cortical and medullary tumors is of limited effectiveness, the surgeon's role in the treatment of these neoplasms is extremely important.