Adenomas: what they are and how they can evolve
An in-depth analysis on adenomas and their management in the European healthcare context
What are adenomas?
Adenomas are small non-cancerous growths that form in the gland cells. These benign tumors can appear in various parts of the body, such as the colon, thyroid, pituitary gland, and adrenal glands. While not cancerous, many adenomas require careful monitoring and sometimes treatment. This prevents them from developing into malignant or cancerous growths. The most common adenoma is the tubular adenoma found in the colon. Villous and tubulovillous adenomas have a higher risk of becoming cancerous.
Symptoms and causes of adenomas
Adenomas can cause different symptoms depending on where they grow. For example, adrenal gland adenomas can cause Cushing’s syndrome due to excess cortisol or hyperandrogenism due to excessive androgen production. The exact reasons for adenoma development are often unknown. However, risk factors include advanced age, genetics, and certain hereditary conditions. Genetic mutations and diseases like familial adenomatous polyposis increase the risk of adenoma.
Diagnosis and treatment of adenomas
Doctors diagnose adenomas through physical examination, medical history, and imaging tests such as CT scans or MRI. Sometimes a biopsy confirms the type of adenoma. Treatment depends on the function and size of the adenoma. Non-functioning and small adenomas may only require monitoring over time. But functioning or large adenomas often require surgical removal.
Management of adenomas: European clinical practices
In Europe, doctors follow detailed guidelines for adenoma treatment, especially pituitary adenomas. These guidelines include the use of steroid medications and monitoring cortisol levels after surgery. However, different medical centers have different approaches. For example, in 25% of centers, surgery is the first choice for prolactinomas (adenomas that produce too much prolactin). 20% of centers prefer pharmacological therapy as the initial treatment for growth hormone-secreting adenomas. For the diagnosis of Cushing’s disease (a condition caused by excess cortisol), most centers rely on dynamic MRI. However, techniques like petrosal sinus blood sampling and 7T MRI are less commonly used.
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