Adrenalectomy steroid replacement therapy

The cortex is the part of the adrenal gland that makes cortisol Cortisol - a glucocorticoid that controls glucose production and suppresses the immune system , a hormone that is crucial for life. If the patient does not have enough adrenal cortex left, he or she may develop adrenal insufficiency and may need to take steroid medication. ( See What are the potential complications? ) In cases of bilateral adrenal tumors (. a tumor in both adrenal glands) or tumors that are small and clearly not cancer (like aldosterone Aldosterone - a mineralocorticoid that controls blood pressure producing adenomas), some surgeons may perform a cortical-sparing adrenalectomy Cortical-sparing adrenalectomy - an operation to remove the part of an adrenal gland that has the tumor. Also called a partial adrenalectomy. to keep as much of this normal cortex as possible. This usually involves looking at the entire adrenal gland and cutting out just the tumor with a thin rim of normal tissue.

If the entire tumor is removed, the changes are typically dramatic. “The patient should begin losing weight, hypertension and diabetes should disappear or improve, and the patient will psychologically begin to feel better,” says Kelly. To complement the surgery, the patient is placed on steroid replacement therapy for six to 12 months to help regulate ACTH production. “The pituitary tumor causes ACTH to go into a state of dormancy, and, following surgery, the steroid therapy helps reestablish the connections for proper ACTH production,” says Kelly.

Glucocorticoids are potent anti-inflammatories, regardless of the inflammation's cause; their primary anti-inflammatory mechanism is lipocortin-1 (annexin-1) synthesis. Lipocortin-1 both suppresses phospholipase A2 , thereby blocking eicosanoid production, and inhibits various leukocyte inflammatory events ( epithelial adhesion , emigration , chemotaxis , phagocytosis , respiratory burst , etc.). In other words, glucocorticoids not only suppress immune response, but also inhibit the two main products of inflammation, prostaglandins and leukotrienes . They inhibit prostaglandin synthesis at the level of phospholipase A2 as well as at the level of cyclooxygenase /PGE isomerase (COX-1 and COX-2), [29] the latter effect being much like that of NSAIDs , potentiating the anti-inflammatory effect.

Adrenalectomy steroid replacement therapy

adrenalectomy steroid replacement therapy

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