The formations of the adrenal glands are often detected accidentally during instrumental methods of examination of the abdominal cavity and retroperitoneal space, performed for some other reasons. Over the past 2 decades, the frequency of detection of adrenal gland formations has increased 10-fold, and most of them are diagnosed in old age. The tactics of observation and treatment depend both on hormonal activity and on the malignant potential of the detected formation. Up to 58% of patients with adrenal incidentalomas have a malignant nature, with a higher risk in young patients, with a size of more than 4 cm, as well as with a history of other malignant neoplasms. The frequency of detection of the classical clinical and laboratory picture of hypercorticism, hyperaldosteronism or catecholamine-producing tumor is less than 15%, however, the phenomenon of functionally autonomous cortisol production according to the results of studies conducted in the last few years is much more common up to 3050% of patients. Despite the absence of vivid clinical symptoms in some cases, autonomous cortisol secretion is associated with increased cardiovascular morbidity and metabolic disorders, therefore, all patients with adrenal incidentalomas need to exclude this condition. This article presents clinical cases of patients with adrenal gland formations, describes in detail the examination algorithm and the choice of treatment tactics, taking into account the results of studies conducted since the release of the latest clinical recommendations for the management of patients with adrenal gland incidentalomas in 2016.
Coronavirus disease 2019 (COVID-19) can manifest with a wide range of extrapulmonary symptoms and have longterm consequences (so-called post-covid syndrome (PCS) or “long COVID-19”). Manifestations of PCS show a wide clinical spectrum and include cardiac, pulmonary, neurological, gastrointestinal, dermatological, mental symptoms, vascular thrombosis and avascular necrosis (AVN) of the bones.We present our own observations of the development of bone’s AVN in 3 patients who underwent COVID-19 with bilateral lung disease, in whom after 4–6 months the first signs of AVN were noted and characterized by a progressive multifocal lesion, which was accompanied by an increase of C-reactive protein concentration.The pathogenetic mechanisms of AVN development in the framework of PCS are discussed. The importance of conservative and surgical methods in the treatment of the disease are considered. Since the development of AVN of various localizations with a long latent period is possible after COVID-19, long-term monitoring of patients is required. Further study of the problem of PCS in general and AVN in particular is required.
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