CASE OF SUCCESSFUL SURGICAL TREATMENT OF LARGE LEFT ADRENAL ADENOMA

The article presents a case of successful surgical treatment of the patient with the «big» hormonally inactive adrenal adenoma left. Due to the lack of hormonal activity of adenoma is not marked characteristic clinical manifestations of the disease prior to the acquisition of large size and compression of the surrounding structures. In this regard, he noted the delay in diagnosis of education. Initially, the patient appealed to the City Maternity Hospital №2 Department of Health Dushanbe complaining of aching pain in the left upper quadrant and the lower abdomen. During the ultrasound examination of the abdominal cavity, retroperitoneal space and pelvis in the institution determined the formation of the left adrenal gland, and the patient was sent for consultation vascular surgeon. The specialized center after a thorough clinical examination and the use of a complex of modern methods of research, including the study of hormonal and adrenal computed tomography, the patient to determine the exact diagnosis. According to the ultrasound adenoma it had an average echogenicity, clear and smooth contours, thin capsule and Large sizes – 109×81 mm. Detailed topographic and anatomical characteristics of the tumor was carried out using CT, which revealed a large heterogeneous formation, coming from the projection of the left adrenal gland native density of 7-14 units. N., dimensions 112×80 mm, compressing the left kidney. Functional activity of adenomas determined by determining the level of concentration of hormones in the venous blood, where the rates were within the normal range [cortisol morning portion – 310 nmol/l (normal 140-600), ACTH – 32,3 pg/ml (normal 8,3-57,8), metanephrine – 45,2 mg/day (normal – 6-115), Normetanephrine – 47,1 mg/day (normal – 10-146)]. A patient in a planned way under endotracheal anesthesia adrenalectomy was performed with a tumor of the thoraco-FRESNES lyumbotomnogo access X-intercostal space. Dimensions remote macropreparations totaled 11,5×9,5 cm. In the near and long-term postoperative complications were noted. Histological study revealed macropreparations pattern characteristic of mixed-cell adrenocortical adenoma. If repeated control examinations and examinations of tumor recurrence is not registered.