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PubMed1996

Laparoscopic bilateral adrenalectomy following failed hypophysectomy.

BACKGROUND: Laparoscopic adrenalectomy has recently been shown to be a safe and effective means of treating adrenal pathology with much lower morbidity than the traditional approach. The majority of reports in the literature involve removal of adrenal tumors. Although open bilateral adrenalectomy has been utilized for persistent Cushing's syndrome following attempted hypophysectomy, there is little data available describing the application of laparoscopic adrenal surgery to this problem. METHODS: Four patients with persistent Cushing's syndrome after attempted treatment with hypophysectomy underwent laparoscopic bilateral adrenalectomy at our institution. One procedure was done transabdominally in the supine position. Three procedures were done transabdominally using sequential lateral decubitus positions. RESULTS: All procedures were completed laparoscopically. The mean operative time was 4.6 h (range 3.9-5.25). Repositioning and reprepping the patients resulted in a slight increase in operative time, but visualization was improved using the lateral decubitus position. Average blood loss: 156 cc (range 50-300). One patient required early reoperation for bleeding from the left adrenal bed, which was controlled laparoscopically. Three patients were eating the following day and were discharged on postoperative days 1, 2, and 5. The fourth patient remained hospitalized for 18 days due to problems unrelated to surgery. After a mean follow-up of 10 months, all patients have done well and have no clinical or biochemical evidence of recurrent disease. CONCLUSION: Our clinical experience indicates that laparoscopic bilateral adrenalectomy is a viable treatment option for Cushing's syndrome following failed hypophysectomy.

Adrenalectomy↗

PubMed1999

Laparoscopic adrenalectomy. A review of 30 initial cases.

BACKGROUND: Laparoscopic adrenalectomy is a good option for removal of the adrenal gland that is becoming preferred over the conventional open technique. METHODS: We reviewed the initial 30 laparoscopic adrenalectomies (in 27 patients) that were performed at our institution from 1995 to 1998. We used the lateral decubitus transperitoneal approach in 26 cases and the retroperitoneal approach in only one case. The indications for adrenalectomy were Conn's adenoma in eight patients, pheochromocytoma in six, Cushing's syndrome in five, nonfunctional adenomas in seven, and metastasis in one case. RESULTS: Only two patients (7%) were converted to laparotomy. Operating time ranged from 75 to 240 min. Average adrenal gland size was 6.1 cm (range, 4-9 cm). There was no mortality, and morbidity occurred in only two patients (8%)-one case of self-limited gastrointestinal bleeding and one case of hypercapnia and subcutaneous emphysema (in the only patient operated by the retroperitonal approach). Mean hospital stay was 3 days (range, 1-6). CONCLUSIONS: Laparoscopic adrenalectomy is a safe and useful procedure for nearly all adrenal pathologies. Lateral decubitus transperitoneal approach is the procedure of choice in most cases.

Adenoma↗

PubMed2002

Laparoscopic adrenalectomy: alternative or new standard?

Laparoscopy has become a standard approach for adrenalectomy because of its safety, low invasiveness, and less demanding technical nature and the readily removable size of tumor through trocar incision. Comparative studies between open and laparoscopic adrenalectomy document less blood loss, shorter hospital stay, and lower incidence of complication. These reports also show that the patients have less pain, use fewer narcotics postoperatively, and have quicker resumption of oral intake after surgery with the laparoscopic approach. The techniques for laparoscopic adrenalectomy started with the transperitoneal approach and developed into the retroperitoneal approach. Further technical development and recognition yielded three transperitoneal and two retroperitoneal approaches. Characteristics of each approach are discussed. Due to technical developments and experiences in laparoscopic surgery, application of the laparoscopic approach has been expanded to include excision for adrenal cancer and laparoscopic partial adrenalectomy for bilateral pheochromocytoma in certain cases and in selected institutes.

Adrenal Gland Neoplasms↗

PubMed2003

Transabdominal laparoscopic adrenalectomy.

Laparoscopic adrenalectomy has become the standard technique for the surgical removal of the adrenal gland at many centers worldwide. Functional adrenal tumors such as aldosteronoma, glucocorticoid, androgen/estrogen-producing adenomas, and small-to-moderate sized solitary pheochromocytomas are amenable to removal via a laparoscopic approach. The advantages of laparoscopic adrenalectomy over open adrenalectomy are well documented and include a shorter hospital stay, a decrease in postoperative pain, shorter interval between surgery and return to preoperative activity level, and improved cosmesis. Various laparoscopic approaches to the adrenal gland have been described. Among these are the lateral transabdominal, anterior transabdominal, lateral retroperitoneal, and posterior retroperitoneal approaches. Each of these methods has specific advantages and disadvantages. This article reviews the transperitoneal approach to laparoscopic adrenalectomy, and discusses indications, operative technique, and a survey of the available literature.

Adrenalectomy↗

PubMed2005

Retroperitoneal laparoscopic adrenalectomy.

Laparoscopic adrenalectomy is considered to be the standard of care for the surgical excision of the adrenal gland. Since the initial report of laparoscopic adrenalectomy in 1992, it has evolved into a feasible and reproducible minimally invasive procedure for benign adrenal tumors. Transperitoneal and retroperitoneal approaches are the two principal laparoscopic routes to the adrenal gland. Both have proven to be safe and effective when compared with open adrenalectomy, offering the benefits of decreased blood loss, less postoperative pain, shorter hospital stay, rapid convalescence, and improved cosmetic effect. Although the transperitoneal approach is used more widely, the retroperitoneal approach offers distinct advantages that make it a valuable alternative route to the adrenal gland. This article describes retroperitoneal laparoscopic adrenalectomy including indications, operative technique, and a review of the literature.

Adrenal Gland Neoplasms↗

PubMed1976

Bilateral adrenalectomy in treatment of disseminated breast cancer.

Forty-three patients underwent bilateral adrenalectomy for advanced breast cancer at the Hospital of the University of Pennsylvania from 1960 to 1974. Fourteen patients (32 per cent) experienced an objective remission. There was no difference in the initial free interval between the responders and nonresponders. Premenopausal patients who improved after surgical castration or androgen therapy and postmenopausal patients who responded to estrogen therapy and its subsequent withdrawal had a greater response to adrenalectomy. Twenty-three of the forty-three patients who underwent bilateral adrenalectomy had evidence of metastatic involvement in at least one of the excised adrenal glands. Results show that patients who responded to previous therapy had a longer survival after adrenalectomy.

Adrenalectomy↗

PubMed1991

Effect of adrenalectomy and dexamethasone on neuropeptide content of dorsal root ganglia in the rat.

Neuropeptides, including substance P (SP), calcitonin gene-related peptide (CGRP) and somatostatin (SS) in dorsal root ganglia (DRG) may play a role in neurogenic inflammation and pain transmission. Adrenal corticosteroids regulate neuropeptide synthesis in some areas of the CNS and may modulate neurogenic inflammation and sensory perception. We have investigated the effects of adrenalectomy and dexamethasone (0.2 mg/kg/day) treatment on neuropeptide content of rat cervical DRG using specific and sensitive radioimmunoassays. In control animals, a differential distribution of neuropeptide was found; SP and CGRP content increased from C4 to C7 in contrast to SS content, which decreased from C4 to C7. Ten days following adrenalectomy, the mean SS content of cervical DRG decreased significantly to 79.6 +/- 4.5% of sham-operated controls. In contrast, SP and CGRP content increased significantly 10 days after adrenalectomy to 134.6 +/- 6.9% and 132.0 +/- 11.6% of sham-operated controls, respectively. The effects of adrenalectomy on CGRP and SS were reversed by administration of dexamethasone. These results suggest that glucocorticoids affect the neuropeptide content of DRG in the adult rat.

Adrenalectomy↗

PubMed1992

Adrenalectomy increases phosphoinositide hydrolysis induced by norepinephrine or excitatory amino acids in rat hippocampal slices.

Phosphoinositide hydrolysis induced by norepinephrine, quisqualate, or trans-1-amino-1,3-cyclopentanedicarboxylic acid (ACPD), but not by carbachol, was approximately 50% greater in hippocampal slices from adrenalectomized (14 days) rats compared with controls. These changes appeared to be selective for the hippocampus because no effects of adrenalectomy on phosphoinositide hydrolysis were detected in cortical or striatal slices. The enhanced response to norepinephrine in hippocampal slices after adrenalectomy was observed throughout the effective concentration range of norepinephrine, was not influenced by in vitro addition of corticosterone, was not mimicked or altered by incubation with dibutyryl cyclic adenosine 3',5'-monophosphate (AMP), and did not appear to be due to impaired inhibition of the response to norepinephrine which was elicited by activation of protein kinase C or by inclusion of an inhibitory concentration of quisqualate. These findings indicate that adrenalectomy either removes an inhibitory influence of glucocorticoids on the phosphoinositide system in the hippocampus or that the neurodegeneration of granule cells in the dentate gyrus following adrenalectomy is associated with neurotransmitter-selective increases in phosphoinositide hydrolysis. These data provide further evidence that glucocorticoids modify signal transduction in the brain and extends their known influence to the phosphoinositide second messenger system.

Adrenalectomy↗

PubMed1978

Effects of adrenalectomy and adrenal steroids on norepinephrine synthesis and monamine oxidase activity.

Rat heart norepinephrine (NE) tunover was increased 6--10 days after bilateral adrenalectomy. This increase was prevented by administration of deoxycorticosterone acetate (DOCA) but not by either hydrocortisone or corticosterone. Blood pressure decreased following adrenalectomy. This decrease was prevented by DOCA, hydrocortisone and corticosterone. Monoamine oxidase (MAO) activity increased in the heart but not in the liver following adrenalectomy. DOCA prevented the increase in heart MAO activity whereas hydrocortisone and corticosterone were ineffective. In intact animals, heart and liver MAO activity were not changed by 5 days of cold exposure, a procedure which increases NE turnover. It is suggested that the increase in heart NE turnover may be related to the increase in MAO activity seen after adrenalectomy.

Adrenal Cortex Hormones↗

PubMed1988

Vasopressin and adrenalectomy-induced sensitivity to morphine.

Arginine vasopressin, vasopressin antiserum and a specific vasopressin pressor antagonist were injected intracerebroventricularly into adrenalectomized rats before morphine-induced antinociception was tested. In these experiments we have exploited previous findings which showed that the antinociceptive effect of opioids was potentiated after adrenalectomy; rats that were adrenalectomized in the morning under basal resting conditions of the pituitary-adrenal system displayed significantly higher response latencies after morphine administration than rats adrenalectomized in the evening. These effects were measured 7 days after adrenalectomy. The same conditions were used in this study. Both, the vasopressin antiserum and the vasopressin antagonist abolished the morning adrenalectomy-induced hypersensitivity to centrally injected morphine and were not effective when administered to rats that had been adrenalectomized in the evening. The reverse was observed after intraventricular administration of vasopressin. The peptide significantly raised the sensitivity to morphine-induced antinociception of rats that had been adrenalectomized in the evening whereas it did not affect antinociception in animals that had been adrenalectomized in the morning. Vasopressin levels determined by radioimmunoassay in the cerebrospinal fluid were significantly higher in adrenalectomized animals. We propose that vasopressin is a critical neuropeptide factor involved in the adrenalectomy-induced hypersensitivity to morphine antinociception.

Adrenalectomy↗

PubMed1989

Bilateral adrenalectomy worsens gastric mucosal lesions induced by indomethacin in the rat. Role of enhanced gastric motility.

The mechanism by which bilateral adrenalectomy worsens indomethacin-induced gastric lesions was investigated in rats. In sham-operated rats subcutaneously administered indomethacin produced gastric lesions at doses of 10 mg/kg body wt or greater, in association with lowering of blood glucose levels. In a parallel study, indomethacin induced gastric hypermotility at the same dose levels but had no effect on acid output or mucosal blood flow even at 25 mg/kg body wt. Adrenalectomy (2 wk) itself significantly reduced the blood glucose levels (approximately 50%) and markedly potentiated the ulcerogenic and motility responses caused by indomethacin; the ED50 values dropped to approximately 10 times lower than those in sham-operated rats. Both acid output and mucosal blood flow were significantly reduced by adrenalectomy, but these values were increased after indomethacin treatment (3 mg/kg body wt). The ulcerogenic and motility responses caused by indomethacin were significantly reduced by acute infusion of glucose (25% wt/wt, 1.2 ml/h) intravenously in both sham-operated and adrenalectomized rats, and by subcutaneous administration of hydrocortisone acetate (10 mg/kg body wt for 2 wk) in the latter group. When the motility and the ulcer score were determined in the same animals, a highly significant relationship was found between these two factors in both sham-operated and adrenalectomized rats. These results suggest that (a) the increased gastric motility may be a key element in the pathogenesis of indomethacin-induced lesions and in the mechanism for aggravation of the lesions and in the mechanism for aggravation of the lesions by adrenalectomy, and (b) abrasion of adrenal glands by inducing hypoglycemia may sensitize the system to indomethacin and increase gastric motility.

Adrenalectomy↗

PubMed1989

Adrenalectomy does not influence basal secretion of testosterone in rat in vivo.

We have studied the effect of adrenalectomy on the testicular secretion of testosterone in the rat. In the acute period following adrenalectomy plasma testosterone levels were reduced but this was no different from those levels in appropriate sham-operated controls. This reduction in plasma testosterone levels is probably a result of direct effects of anaesthesia and surgical stress. Whilst studies on the late effect of adrenalectomy avoided this problem, plasma testosterone levels were normal in both adrenalectomised and sham-operated animals. Resetting of anterior pituitary-gonadal relationships may mask the absence of any contribution made by the adrenal gland to testicular steroidogenesis. In contrast to previous data we were unable to demonstrate that adrenalectomy influenced the secretion of testosterone in the male rat.

Adrenalectomy↗

PubMed1985

Adrenalectomy fails to alter radial maze performance of rats at retention intervals of 24 hours or less.

Evidence suggests that the behavioral actions of adrenalectomy and glucocorticoid replacement therapy result from changes in the binding of corticosterone to specific receptors in the hippocampus. Efficient foraging for bait on the radial maze has been demonstrated to require a functionally intact hippocampal system. The present experiment examined the effect of adrenalectomy on the ability of rats to locate unexplored arms in the radial maze after various retention intervals midway through completion of the maze. Rats were very proficient at locating the unexplored arms after retention intervals of 3 hours or less; significantly more trials were required to locate all of the previously unvisited arms at retention intervals of 8 and 24 hours. However, adrenalectomy failed to alter maze performance at any retention interval tested. It was concluded that the neural substrates involved in the performance of this spatial/working memory task are not dependent upon the neuromodulatory effects of physiological levels of adrenal corticosteroids. The results are discussed in terms of behavior/contingency conflicts and innate versus learned responses as factors which may be important for revealing behavioral actions of adrenalectomy or corticosteroid therapy.

Adrenal Cortex Hormones↗

PubMed1991

Regional patterns of brain growth during the first three weeks following early adrenalectomy.

Day 11 adrenalectomized (ADX) and sham-operated control rats were compared with respect to overall and regional brain growth and DNA content at 1, 2, and 3 weeks postsurgery. Possible treatment effects on the rate of postnatal cell loss were also assessed by injecting the animals with 3H-thymidine on day 2 postnatal (9 days prior to surgery) and subsequently measuring the amount of radiolabelled DNA remaining in various brain regions at each time point. Adrenalectomy led to reliable increases in cerebral cortex and midbrain-diencephalon weights within 1 week postsurgery, whereas cerebellum, hippocampus, and overall brain weights were not significantly elevated until 1 or 2 weeks later. The effects of adrenalectomy on tissue DNA content were likewise regionally dependent. According to the 3H-thymidine results, there was no significant influence of adrenalectomy on the loss of previously labelled DNA. In conclusion, the timing of brain growth acceleration following adrenal removal is regionally specific, with the most rapid effects occurring in the cortex and midbrain-diencephalon. Furthermore, adrenalectomy-induced increases in brain cell number appear to depend primarily on increased cellular genesis (as previously demonstrated) rather than decreased cell death.

Adrenal Glands↗

PubMed1991

Influence of adrenalectomy on the odor detection performance of rats.

The influence of adrenalectomy (ADX) on the odor detection performance of male Long-Evans rats was assessed using high-precision olfactometry and a go/no-go operant signal detection task. Nonparametric signal detection measures of sensitivity and responsivity, as well as measures of S+ response latency, the number of aborted trials, and session time, were obtained in daily 250-trial test sessions prior to and after adrenalectomy. Four ADX animals were tested using the odorant pyridine, three using the odorant eugenol, and two using the odorant ethyl acetate. Nine other rats served as sham-operated controls. Neither odor detection nor related nonsensory performance measures were influenced by adrenalectomy or sham-operation procedures. These results imply that adrenalectomy has little or no influence on the odor detection performance of the rat.

Adrenal Cortex↗

PubMed1986

Opposite effects of adrenalectomy on eicosanoid release in rat peritoneal macrophages and spleen.

The effect of adrenalectomy on the formation of cyclo-oxygenase and lipoxygenase products by activated peritoneal rat macrophages was determined and compared with that of the spleen. After isolation, the cells and tissues were incubated with [1-14C] arachidonic acid and the Ca-ionophore A23187 and the metabolites isolated by HPLC chromatography. The main components formed in the macrophages of the controls are 6-keto-PGF1 alpha, TxB2 and 12-HETE. One peak represents 5, 12 di HETE. Smaller amounts of PGF2 alpha, PGE2, PGD2, LTB4 and 15-HETE are also present. After adrenalectomy, a considerable increase occurs in the amounts of LTB4, 15-HETE and 12-HETE. The increase in the PG is smaller. The compounds formed from endogenous arachidonic acid are also determined. In the cells of the controls, the formation of LTB4 is considerably increased after adrenalectomy. In the spleen, PGD2 and 12-HETE are decreased after adrenalectomy. The effect of the macrophages is most probably related to a diminished amount or inactivation of lipocortin, a glucocorticosteroid induced peptide with PlA2 inhibitory activity in adrenalectomized animals. In the decrease in formation in the spleen, the absence of the permissive effect of glucocorticosteroids on the hormone-induced lipolysis may play a role.

Adrenalectomy↗

PubMed1984

Adrenalectomy reduces alcohol-stimulated activity: blood and brain alcohol content.

It has been shown that adrenal glucocorticoids have a permissive role in some of the actions of alcohol. To determine if an intact adrenal was necessary for the stimulation of locomotor activity, 24 female C3H mice were tested for open field activity with ethanol or saline. Two weeks after adrenalectomy or sham surgery, animals were tested for activity again with ethanol or saline. One week later, alcohol disappearance curves were generated for blood and brain. Adrenalectomy reduced but did not abolish the alcohol-stimulated locomotor activity. In addition, adrenalectomy significantly reduced estimated peak alcohol levels in blood and brain but significantly reduced the disappearance rate for alcohol only in brain. These data suggest that adrenalectomy significantly changes alcohol distribution, with greater impact on brain alcohol levels than on blood levels, and that this may be responsible, at least in part, for the reduction in stimulated locomotor activity.

Adrenalectomy↗

PubMed1990

Effect of adrenalectomy on ethanol-associated immunosuppression.

The alterations in lymphoid cell numbers and lymphocyte function due to administration of ethanol was found to be associated with high levels of circulating corticosteroids. The role of corticosteroids in the ethanol-induced alterations in the immune system was studied by administering ethanol to adrenalectomized rats. The results of these experiments showed that the ethanol-induced loss of cells from the thymus was not completely prevented by adrenalectomy and the ethanol-induced loss of cells from the spleen was not affected by adrenalectomy. Likewise the ethanol-induced decrease in antibody production to the T-cell-dependent antigen sheep erythrocytes were not affected by adrenalectomy. The ability of animals to produce antibodies of the T-cell-independent antigen, TNP-Ficoll, was not affected by ethanol regardless of whether the animals had adrenal glands or not. These data indicate that adrenal corticosteroids are responsible for some but not all of the thymic involution due to ethanol intoxication. Also, adrenalectomized rats did not show as much impairment in lymphocyte proliferation as sham adrenalectomized animals after ethanol administration. However, this loss of cells from peripheral lymphoid organs such as the spleen and the decreased ability to respond to T-cell-dependent antigens is not influenced by adrenalectomy indicating mechanisms other than corticosteroids mediate these effects of ethanol.

Adrenalectomy↗