{"id":499,"date":"2021-05-21T15:08:42","date_gmt":"2021-05-21T15:08:42","guid":{"rendered":"https:\/\/drandre.timemarketing.com.br\/?p=499"},"modified":"2022-01-28T20:46:13","modified_gmt":"2022-01-28T20:46:13","slug":"incidentaloma-adrenal","status":"publish","type":"post","link":"https:\/\/drandre.timemarketing.com.br\/index.php\/2021\/05\/21\/incidentaloma-adrenal\/","title":{"rendered":"INCIDENTALOMA ADRENAL"},"content":{"rendered":"\n

ADRENAIS, TAMB\u00c9M CONHECIDAS COMO SUPRARRENAIS<\/strong><\/h2>\n\n\n\n

As adrenais (tamb\u00e9m conhecidas como suprarrenais) s\u00e3o gl\u00e2ndulas end\u00f3crinas que se localizam acima dos rins e produzem uma s\u00e9rie de horm\u00f4nios importantes para o bom funcionamento do organismo, incluindo o cortisol, aldosterona, horm\u00f4nios sexuais, adrenalina e noradrenalina. Uma s\u00e9rie de doen\u00e7as end\u00f3crinas \u00e9 resultante de disfun\u00e7\u00e3o das suprarrenais. A produ\u00e7\u00e3o exagerada de cortisol, por exemplo, leva a s\u00edndrome de Cushing<\/strong><\/em>, enquanto que a produ\u00e7\u00e3o insuficiente leva a chamada Doen\u00e7a de Addison<\/em><\/strong>.<\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

Uma s\u00e9rie de tumores pode surgir a partir do tecido adrenal e estes s\u00e3o comumente encontrados em exames de imagem durante investiga\u00e7\u00e3o de outras doen\u00e7as n\u00e3o relacionadas, sendo estes os chamados incidentalomas. Essa entidade \u00e9 resultante de avan\u00e7os tecnol\u00f3gicos no campo do diagn\u00f3stico por imagem (notadamente tomografia computadorizada e resson\u00e2ncia magn\u00e9tica) e seu uso disseminado na pr\u00e1tica cl\u00ednica atual. A frequ\u00eancia estimada de incidentalomas na popula\u00e7\u00e3o geral \u00e9 algo por volta de 4%, podendo chegar at\u00e9 7% em idades mais avan\u00e7adas (acima de 70 anos).<\/strong>

A descoberta de um n\u00f3dulo ou massa adrenal direciona imediatamente a duas perguntas que determinam o grau da avalia\u00e7\u00e3o e a necessidade de tratamento:
<\/p>\n\n\n\n

  1. A les\u00e3o \u00e9 maligna?<\/strong><\/li>
  2. A les\u00e3o produz algum horm\u00f4nio de forma excessiva?<\/strong><\/li><\/ol>\n\n\n\n

    Felizmente, as les\u00f5es malignas da adrenal (os chamados carcinomas) s\u00e3o bastante incomuns. <\/strong>As s\u00e9ries mais recentes sugerem que cerca de 2% dos incidentalomas representam carcinomas prim\u00e1rios das suprarrenais e menos de 1% representam met\u00e1stases de tumores de outros \u00f3rg\u00e3os. O aspecto radiol\u00f3gico \u00e9 bastante informativo da natureza da les\u00e3o, se benigna ou maligna. Aspectos sugestivos de malignidade nos exames de imagem incluem: massas > 4 cm de di\u00e2metro, bordas irregulares, densidade alta e heterog\u00eanea, presen\u00e7a de calcifica\u00e7\u00f5es e reten\u00e7\u00e3o prolongada do meio de contraste.<\/p>\n\n\n\n

    A avalia\u00e7\u00e3o da produ\u00e7\u00e3o hormonal \u00e9 feita por meio da dosagem de alguns horm\u00f4nios no sangue e, em alguns casos, tamb\u00e9m na saliva e na urina. A produ\u00e7\u00e3o excessiva de cortisol leva ao quadro de s\u00edndrome de Cushing, que \u00e9 a altera\u00e7\u00e3o hormonal mais frequente no caso de incidentalomas adrenais (cerca de 6% dos casos nas s\u00e9ries mais recentes). Entretanto, a s\u00edndrome de Cushing costuma representar o maior desafio diagn\u00f3stico para os cl\u00ednicos que acompanham este tipo de condi\u00e7\u00e3o, tendo uma avalia\u00e7\u00e3o cl\u00ednica criteriosa por um especialista papel fundamental nesse esclarecimento. Tumores produtores de aldosterona levam ao quadro de hiperaldosteronismo prim\u00e1rio, que cursa com hipertens\u00e3o arterial de dif\u00edcil controle, muitas vezes associado a n\u00edveis baixos de pot\u00e1ssio no sangue. Os chamados feocromocitomas s\u00e3o tumores que se originam a partir da regi\u00e3o da medula adrenal (regi\u00e3o mais central da gl\u00e2ndula) e se caracterizam clinicamente por produ\u00e7\u00e3o exagerada e secre\u00e7\u00e3o peri\u00f3dica de catecolaminas (adrenalina, noradrenalina e \u00e0s vezes dopamina), podendo levar a quadro de picos hipertensivos graves, dor de cabe\u00e7a, sudorese excessiva e palpita\u00e7\u00f5es.<\/span>

    Como regra geral, uma resposta positiva a qualquer uma das duas perguntas acima j\u00e1 indica a extra\u00e7\u00e3o cir\u00fargica desses tumores, salvo algumas exce\u00e7\u00f5es<\/strong>. Les\u00f5es que n\u00e3o tenham indica\u00e7\u00e3o cir\u00fargica inicial devem ser acompanhadas ao longo do tempo para observa\u00e7\u00e3o de crescimento ou produ\u00e7\u00e3o hormonal, sendo a frequ\u00eancia de acompanhamento vari\u00e1vel de acordo com as caracter\u00edsticas cl\u00ednicas e radiol\u00f3gicas de cada caso, e determinadas por um endocrinologista experiente no tema.<\/p>\n","protected":false},"excerpt":{"rendered":"

    ADRENAIS, TAMB\u00c9M CONHECIDAS COMO SUPRARRENAIS As adrenais (tamb\u00e9m conhecidas como suprarrenais) s\u00e3o gl\u00e2ndulas end\u00f3crinas que se localizam acima dos rins e produzem uma s\u00e9rie de horm\u00f4nios importantes para o bom funcionamento do organismo, incluindo o cortisol, aldosterona, horm\u00f4nios sexuais, adrenalina e noradrenalina. Uma s\u00e9rie de doen\u00e7as end\u00f3crinas \u00e9 resultante de disfun\u00e7\u00e3o das suprarrenais. A produ\u00e7\u00e3o […]<\/p>\n","protected":false},"author":1,"featured_media":501,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[9],"tags":[],"class_list":["post-499","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-adrenais"],"yoast_head":"\nINCIDENTALOMA ADRENAL - Dr. Andr\u00e9 Faria<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/drandre.timemarketing.com.br\/index.php\/2021\/05\/21\/incidentaloma-adrenal\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"INCIDENTALOMA ADRENAL - Dr. Andr\u00e9 Faria\" \/>\n<meta property=\"og:description\" content=\"ADRENAIS, TAMB\u00c9M CONHECIDAS COMO SUPRARRENAIS As adrenais (tamb\u00e9m conhecidas como suprarrenais) s\u00e3o gl\u00e2ndulas end\u00f3crinas que se localizam acima dos rins e produzem uma s\u00e9rie de horm\u00f4nios importantes para o bom funcionamento do organismo, incluindo o cortisol, aldosterona, horm\u00f4nios sexuais, adrenalina e noradrenalina. 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