Adrenal Tumor in children

1
Adrenal Tumors in Children

• Adrenal gland is an important gland responsible
  for secreting various hormones required for
  normal body functioning. In pediatric age group
  the tumors of adrenal gland are rare which arise
  from adrenal cortex and adrenal medulla. These
  tumors account for less than 0.2 of all
  pediatric neoplasms and 1.3 of all carcinomas.
• The most common tumor of the adrenal gland in
  pediatric age group is neuroblastoma which arise
  from adrenal medulla , while adrenal carcinoma
  and adenomas, tumors of the adrenal cortex, are
  rare. Pheochromocytoma is a rare and very
  peculiar tumor of adrenal gland which causes
  hypertension. The advance adrenal malignant tumor
  has a poor prognosis.
• The adrenal tumors which secrete various hormones
  (called as functioning adrenal tumors) causes
  various symptoms such as high blood pressure,
  sweating, palpitation, and early puberty.
• The diagnostic work up includes imaging with
  computed tomography and magnetic resonance
  imaging, along with evaluation of hormone levels
  in functioning adrenal tumors.

2

• Neuroblastoma
• Neuroblastoma is a malignant nerve cell tumor and
  is one of the commonest extracranial solid
  malignancy of infancy. The tumor requires
  multimodality approach involving chemotherapy,
  surgery, radiotherapy and bone marrow transplant
  with good outcome.
• Ganglioneuroma and ganglioneuroblastoma forms the
  benign spectrum of neuroblastoma which can be
  cured only with surgical resection.
• Adrenocortical Tumors
• Adrenocortical tumors can be functional or
  non-functional. Functional tumors present with
  features of precocious puberty, obesity,
  hypertension. Cushing syndrome is a result of
  high secretion of cortisol causing central
  obesity, thin arms and legs, moon facies and
  hypertension.
• Adrenocortical tumors are rare malignant tumorbut
  prognosis depends on the stage of disease.
• Pheochromocytoma
• These are catecholamine secreting tumors
  presenting with hypertension, excess sweating,
  palpitation and weight loss. The diagnosis is
  confirmed by raised catecholamine levels in urine
  and blood. The surgical removal is curative but
  requires preoperative stabilisation to avoid
  hypertensive crisis during intraoperative period.

3

• Surgical Management
• After detailed initial evaluation and
  stabilisation the tumors are planned for surgical
  excision. Traditionally these lesions were
  managed by open surgical excision. With the
  advancement in minimal access surgery these
  tumors can be surgically removed
  by laparoscopic or robotic surgery. This approach
  ensures faster recovery and reduces hospital stay
  because of small incion small incisions. The
  approach provides surgeon magnified view which
  ensures fine dissection and minimises blood loss.
  Although the approach may not be suitable for
  large and malignant lesions which will require
  open surgery.