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PubMed1976

beta-adrenergic receptors in rat liver: effects of adrenalectomy.

The response of rat liver adenylate cyclase [ATP pyrophosphate-lyase (cyclizing), EC 4.6.1.1] to catecholamines is enhanced after adrenalectomy. To investigate this phenomenon, we developed an in vitro assay for beta-adrenergic receptors of plasma membranes derived from livers of control and adrenalectomized rats, using [125I]iodohydroxybenzylpindolol (IHYP), a potent beta-adrenergic receptor antagonist. Binding of IHYP reached equilibrium within 30 min and dissociation occurred with a half-time of approximately 60 min. The l-isomers of isoproterenol and propranolol were at least 50 times more potent as inhibitors of IHYP binding than were the corresponding d-isomers. Adrenalectomy did not affect the rates of association or dissociation of IHYP or the dissociation constants of several ligands that are active at beta-adrenergic receptors. The number of binding sites for IHYP was determined in homogenates and in purified membranes of livers from control and adrenalectomized rats. The number of sites increased 3- to 5-fold after adrenalectomy. A similar increase in hormone stimulation of adenylate cyclase was observed. These changes were reversed by the administration of cortisone. The increase in the number of binding sites for IHYP may be a compensatory response to the impairments in gluconeogenesis and glycogenolysis which occur after adrenalectomy.

Adenylyl Cyclases↗
PubMed1984

Corticotropin-releasing factor-immunoreactive neurons of the paraventricular nucleus become vasopressin positive after adrenalectomy.

The immunoperoxidase technique was used to study the effect of adrenalectomy on vasopressin (VP) immunoreactivity in the hypothalamic paraventricular nucleus of rat. In control animals, relatively few VP-immunostained parvocellular neurons were found in addition to a large population of magnocellular VP neurons. Seven to 14 days after bilateral adrenalectomy, VP immunostaining increased markedly in specific subdivisions of the paraventricular nucleus. In contrast to normal animals, VP immunoreactivity was localized in a large number of parvocellular neurons. Colchicine treatment, on the other hand, did not significantly increase the number of VP-immunostained parvocellular neurons found in control rats. These observations suggest that adrenalectomy increases the number of VP-positive neurons and appears to increase the intensity of VP immunoreactivity specifically in parvocellular neurons. VP parvocellular neurons are confined to those paraventricular nucleus subdivisions that are known to project to the external zone of the median eminence. Moreover, their distribution pattern is very similar, if not identical, to that of the corticotropin-releasing factor (CRF) immunoreactive cells. Parvocellular neurons on adjacent thin sections could be stained for both CRF and VP. Thus, adrenalectomy seems to increase VP staining in CRF immunoreactive parvocellular neurons, which innervate the external zone of the median eminence.

Adrenalectomy↗
PubMed1986

Effects of adrenalectomy before weaning in the genetically obese Zucker rat (fa/fa).

1. Lean (Fa/?) and obese (fa/fa) Zucker rats were adrenalectomized or sham-operated at 19 d of age (3 d before weaning). Injection of corticosterone for 3 d after weaning (1.0 mg/d) was necessary to ensure survival of adrenalectomized fa/fa but not Fa/? rats. Intact and adrenalectomized fa/fa rats had a lower rectal temperature than Fa/? animals before and 3 d after adrenalectomy. The post-weaning survival of adrenalectomized fa/fa rats was enhanced by maintenance at an ambient temperature of 30 degrees rather than 22 degrees. 2. Adrenalectomized and sham-operated rats were therefore kept at 30 degrees, fed ad-lib. and killed at 34 d. Adrenalectomy had only small effects on the growth, body composition and appetite of Fa/? rats. The hyperphagia, greater lipid content, reduced protein content and hyperinsulinaemia of fa/fa rats were completely abolished by adrenalectomy. 3. Intact fa/fa rats had higher liver glycogen contents and higher activities of the hepatic enzymes tyrosine aminotransferase (EC 2.6.1.5) and acetyl CoA carboxylase (EC 6.4.1.2) than intact Fa/? animals. Adrenalectomy abolished these phenotypic differences. 4. Injection of adrenalectomized rats with 1.0 mg corticosterone-21-acetate daily from weaning to 34 d restored the abnormal body composition, hyperphagia, hyperinsulinaemia, higher hepatic glycogen and enzyme activities of fa/fa rats. 5. In a second experiment adrenalectomized rats were injected with 1.0 mg corticosterone-21-acetate daily from weaning to 34 d and kept at 22 degrees. fa/fa rats adrenalectomized and injected with corticosterone had a reduced body lipid content compared with intact fa/fa rats but still contained more lipid than intact or similarly treated Fa/? animals. 6. In both experiments adrenalectomized Fa/? and fa/fa rats injected daily with corticosterone had the same plasma concentrations of this hormone when killed 3 h after the last injection at 34 d. It is concluded that corticosterone is required for expression of the abnormal appetite, hyperinsulinaemia and body composition of the fa/fa rat.

Adrenalectomy↗
PubMed1999

Long term experience after subtotal adrenalectomy for multiple endocrine neoplasia type IIa.

OBJECTIVE: To evaluate the long-term results after subtotal adrenalectomy in patients with multiple endocrine neoplasia type IIa (MEN IIa). DESIGN: Retrospective study. SETTING: University Hospital, Sweden. SUBJECTS: Five patients who underwent partial adrenalectomy between 1985 and 1989. INTERVENTIONS: Subtotal adrenalectomy with a rim of cortical tissue left in situ. MAIN OUTCOME MEASURES: Follow up by interview, measurement of cortisol and catecholamine excretion in urine, and cortisol concentration in serum in response to stimulation with ACTH. RESULTS: Three patients took no corticosteroids regularly, but during upper respiratory tract infections, or periods of severe stress they took 25 mg cortisone acetate daily. This is confirmed by their normal values of 24 hour urinary cortisol excretion and subnormal responses to an ACTH-stimulation test. The fourth and fifth patients had low concentrations of endogenous corticosteroids postoperatively, which is being replaced with 25 mg cortisone acetate daily. Postoperatively all five patients had low urinary adrenaline excretion. CONCLUSION: Subtotal adrenalectomy in patients with MEN IIa resulted in basal endogenous corticosteroids within the reference range in three of five patients. There was no evidence of reduced adrenocortical function with time, nor were there any signs of recurrence of the pheochromocytoma.

Adrenal Gland Neoplasms↗
PubMed2002

Laparoscopic transperitoneal adrenalectomy using a remote-controlled robotic surgical system.

BACKGROUND AND PURPOSE: Laparoscopic adrenalectomy is considered the standard method for removal of benign adrenal tumors. Although laparoscopic surgery provides clear patient benefit, laparoscopic adrenalectomy using conventional instrumentation is complex. Our objective was to evaluate whether the da Vinci trade mark Surgical System, a comprehensive robotic endoscopic surgical device, could be used effectively to perform laparoscopic adrenalectomy. PATIENTS AND METHODS: Through a transperitoneal approach, three right and one left adrenal tumors were removed in four patients using this method. RESULTS: There were no complications, and the clinical results were excellent. CONCLUSION: We demonstrate the feasibility of performing laparoscopic adrenalectomy exclusively by using robotic telepresent technology from a remote workstation. The da Vinci System enables conventionally trained urologic surgeons to perform complex minimally invasive procedures with ease and precision. Therefore, we are convinced that the system helps the urologist to adapt the whole spectrum of laparoscopic procedure in this field.

Adrenal Gland Neoplasms↗
PubMed1996

Laparoscopic adrenalectomy for nonfunctioning adrenal tumors.

Thirteen patients who underwent laparoscopic adrenalectomy for nonfunctioning adrenal tumors were compared with seven patients who underwent open adrenalectomy. Although a longer operating time was required for laparoscopic surgery, postoperative recovery was significantly more rapid. Performance of adrenalectomy for nonfunctioning adrenal tumors is controversial, but we cannot exclude the possibility of malignancy and the potential for hormone overproduction by presumably nonfunctioning small tumors. The minimally invasive nature of laparoscopic surgery may widen the indications for adrenalectomy in patients with nonfunctioning adrenal tumors.

Adolescent↗
PubMed2005

Laparoscopic adrenalectomy: a single-center experience of 43 cases.

PURPOSE: To evaluate the surgical feasibility of laparoscopic adrenalectomy and what laparoscopy offers for the surgeon and the patient. PATIENTS AND METHODS: From March 1996 to June 2004, 43 transperitoneal laparoscopic adrenalectomies were performed for various pathological states. Functioning adrenal masses and solid masses>5 cm were the most common indications. The mean size of the masses on abdominal CT was 6.8 cm in the largest diameter. All patients were assessed regarding the operative time, blood loss, complications, and conversion to open surgery. The postoperative course was reported with special attention to the complications and hospital stay. RESULTS: The mean operative time was 125 minutes with a mean blood loss of 60 mL. Intraoperative complications occurred in 3 cases (6.9%), necessitating conversion to open surgery in 2 to control bleeding from the avulsed right adrenal vein. A third case of conversion was elective because of difficult dissection of a large left pheochromocytoma from the renal hilum, so there was a 6.9% rate of conversion to open surgery. All patients showed early ambulation, early start of eating, and a short hospital stay (mean 2.6 days). CONCLUSION: Laparoscopic adrenalectomy is surgically feasible and can be applied for different adrenal pathologies. The procedure can be performed with a reasonable operative time, minimal blood loss, and an acceptable rate of complications. Laparoscopic adrenalectomy provides excellent postoperative recovery and convalescence with a short hospital stay.

Adolescent↗
PubMed2005

Laparoscopic adrenalectomy for large adrenal tumors.

BACKGROUND AND PURPOSE: Laparoscopic adrenalectomy remains a controversial procedure for large tumors. We examined the outcome and complications of laparoscopic adrenalectomy for such lesions. PATIENTS AND METHODS: A total of 178 patients underwent laparoscopic adrenalectomy, of whom 29 patients had large (>or =5 cm) tumors. Their mean age was 47.9 years (range 21-72 years), and the mean tumor size was 6.5 cm (range 5.0-11.0 cm). They were compared with patients whose adrenal tumors were <5 cm. RESULTS: The large-tumor group had a mean operating time of 176 +/- 48 minutes (range 84-278 minutes) and a mean blood loss of 136.6 mL (range 10-800 mL) and required a mean of 1.8 days before starting oral intake. None of these values is significantly different from the results in the control group (P > 0.05). The length of recovery was significantly longer in the large-tumor group (5.4 v 4.5 days; P < 0.05), but this was not true if a patient with a 23-day postoperative stay is excluded. The overall incidence of complications was 12% in the large-tumor group, which was not significantly different from that in the control group (P > 0.05). CONCLUSIONS: The operating time, blood loss, and incidence of complications after laparoscopic adrenalectomy did not differ between the patients with large and small adrenal tumors, indicating that experienced surgeons can safely and effectively use laparoscopy for larger tumors. However, it is necessary to consider carefully whether laparoscopic surgery is indicated for tumors that show infiltration on preoperative imaging or for patients who have undergone previous upper-retroperitoneal surgery.

Adrenal Gland Neoplasms↗
PubMed1999

Laparoscopic adrenalectomy in the elderly.

Laparoscopic adrenalectomy has recently been shown to be a safe and effective procedure for treating a variety of benign adrenal tumors. Advanced age, with its concomitant comorbid conditions, has been believed to be associated with more postoperative complications in laparoscopic procedures. The purpose of this study was to evaluate the outcome of laparoscopic adrenalectomy in patients age 65 and older. From June 1992 to February 1998, 14 patients (4 men and 10 women) with a mean age of 69 years underwent 17 laparoscopic adrenalectomies. In 12 procedures, a transperitoneal lateral decubitus flank approach was used. The lesion was a nonfunctioning adenoma in three patients, aldosterone adenoma in four, Cushing's syndrome in four, and pheochromocytoma in one. A retroperitoneal lateral decubitus approach was used in five procedures. The lesion was a nonfunctioning adenoma in one patient, aldosterone adenoma in one, Cushing's adenoma in one, and pheochromocytoma in two. Seventy-eight percent of these patients had comorbid conditions, including hypertension, diabetes, chronic obstructive airway disease, coronary artery disease, and cardiac dysrhythmia. The preoperative physical status was as ASA Class II in 11 patients and ASA III in 3. Two of the 17 laparoscopies were converted to open surgery (11%), in one because of difficulties in dissecting extraperitoneally a mass >8 cm, and in the other because of difficulties in localization of a 3-cm mass. The median surgical time was 95 +/- 33 minutes. The mean analgesia requirements were 3 doses of (range 2-7) ketorolac. There were no deaths. Postoperative morbidity consisted of pulmonary atelectasis in one patient and urinary tract infection in two patients. The median hospital stay was 3 days (range 2-4 days). We conclude that laparoscopic adrenalectomy in the elderly population is safe and offers low morbidity, fast recovery, and a short hospital stay. Age alone should not be a contraindication to treating adrenal tumors laparoscopically.

Adrenal Gland Neoplasms↗
PubMed1983

Energy balance, diet-induced thermogenesis and brown adipose tissue in lean and obese (fa/fa) Zucker rats after adrenalectomy.

Five-week-old male, lean (+/?) and genetically obese (fa/fa) Zucker rats received either bilateral adrenalectomy or sham operations, and energy balance was measured over the subsequent 21 days. Body weight and energy intake were similar for intact lean and obese rats, but the latter group showed a marked increased in body energy gain and energetic efficiency, and reduced energy expenditure. Adrenalectomy did not significantly influence energy balance in lean rats but caused decreases in food intake and body weight gain in obese rats, and restored their energetic efficiency and body energy gain to the level of lean animals. The lower thermic response to a single meal (40 kJ) in intact obese rats was restored to normal by adrenalectomy. Brown adipose tissue (BAT) mass was larger in sham-operated obese rats, but tissue protein concentration, mitochondrial yield and mitochondrial GDP binding were all markedly reduced in obese rats. BAT mass, composition and GDP binding were almost identical in adrenalectomized obese and all lean rats. These findings demonstrate that the reduced fat deposition in Zucker rats after adrenalectomy is mainly due to the large decrease in the efficiency of energy utilization associated with a restoration of brown fat activity.

Adipose Tissue, Brown↗
PubMed1987

Effects of adrenalectomy on energy balance in obese (ob/ob) mice fed high carbohydrate or high fat diets.

We reported previously that adrenalectomy reduced the energy density of body weight gain (an indicator of proportional gain in lean and fat tissue) and the efficiency of energy retention in obese (ob/ob) mice to values approximating those in lean mice, but that adrenalectomy had much less influence on these parameters in ob/ob mice fed a purified high fat diet. To determine if fat was the exclusive factor in the purified high fat diet that negated effects of adrenalectomy, ob/ob mice were fed a purified high carbohydrate (glucose) diet identical in composition to the high fat diet, except for the fat/carbohydrate ratio. Responses of adrenalectomized ob/ob mice fed the purified high glucose diet from 4 to 7 wk of age mimicked those of mice fed the purified high fat diet, not those of mice fed the high carbohydrate nonpurified diet. Plasma glucose responses to a glucose load in adrenalectomized ob/ob mice paralleled the diet-dependent changes in energy balance. These results demonstrate that diet composition interacts with adrenal secretions to influence energy and glucose metabolism in ob/ob mice; consumption of either a purified high glucose or high fat diet negates the beneficial effects of adrenalectomy on energy and glucose metabolism observed when adrenalectomized ob/ob mice consume a nonpurified diet.

Adrenalectomy↗
PubMed1998

Adrenalectomy-induced apoptosis and glial responsiveness during ageing.

Cell death by apoptosis occurs in mature neurones of adult rat dentate gyrus following adrenalectomy. In these studies, apoptosis in the dentate gyrus was induced 3 days after adrenalectomy in male Fischer 344 rats ranging in age from 2-3 to 24-26 months. Glial fibrillary acidic protein and transforming growth factor-beta 1 mRNAs were increased in dentate gyrus of all age groups after adrenalectomy, but there was no effect of age on these responses. Furthermore, corticosterone treatment in the drinking water of adrenalectomized rats prevented both cell death and increases in glial mRNAs in all age groups that were tested (up to 16-18 months). Therefore, adrenalectomy-induced apoptosis can be used to study mechanisms of cell death and survival in aged brain.

Adrenal Glands↗
PubMed1985

Redevelopment of elevated blood pressure following adrenalectomy in rats with isolation-induced hypertension.

We have previously shown that rats housed in individual metabolism cages develop arterial hypertension and that this can be prevented by adrenalectomy. In the present work the influence of adrenalectomy on blood pressure, heart rate and on fluid and electrolyte balance was investigated in rats with established isolation-induced hypertension. Seven days after adrenalectomy, systolic blood pressure was reduced to levels similar to those seen before the induction of hypertension; the fall in blood pressure was accompanied by tachycardia. It is likely that the reduction in blood pressure was partly due to volume depletion, since adrenalectomized rats showed reductions in fluid, sodium and potassium balance during the first week after operation. Over the following 3 weeks, blood pressure and heart rate returned to pre-operative hypertensive levels, associated with increasingly positive balances for fluid and sodium. Maintenance of elevated blood pressure in isolated rats following adrenalectomy is likely to have been aided by activation of the renin-angiotensin system, since infusion of saralasin caused profound hypotension in these circumstances, whereas it had a slight pressor effect in intact rats with isolation-induced hypertension.

Adrenalectomy↗
PubMed1995

Efficacy of an ultrasonic surgical system for laparoscopic adrenalectomy.

PURPOSE: We determine the value of an ultrasonic surgical system for laparoscopic adrenalectomy. MATERIALS AND METHODS: We analyzed 16 patients who underwent laparoscopic adrenalectomy using the ultrasonic surgical system and compared the results with those of patients undergoing laparoscopic adrenalectomy without the system. RESULTS: The system simplified exposure of the renal pedicles and inferior vena cava, and facilitated adrenal separation from the perinephric fat as well as dissection and identification of the adrenal vessels. Operating time was shorter and blood loss was also less with use of the ultrasonic surgical system. CONCLUSIONS: The ultrasonic surgical system simplified laparoscopic adrenalectomy and made the operation much safer.

Adrenalectomy↗
PubMed2001

Experience with retroperitoneal laparoscopic adrenalectomy for pheochromocytoma.

PURPOSE: Although laparoscopic adrenalectomy has become the preferred surgical treatment of benign adrenal masses, for pheochromocytoma it is limited by concerns over hypertensive events related to early access to the adrenal vein. We report our experience with retroperitoneal laparoscopic adrenalectomy for pheochromocytoma. MATERIALS AND METHODS: From January 1995 to December 1999, 21 retroperitoneal laparoscopic adrenalectomies (left 12 and right 9) were performed for symptomatic pheochromocytoma in 11 men and 9 women 17 to 68 years old (mean age 46). To our knowledge pheochromocytoma was always diagnosed by increased urinary catecholamine, computerized tomography, magnetic resonance imaging and 131iodine iobenguane scintigraphy. RESULTS: There were no conversions to open surgery. The operating time ranged from 100 to 150 minutes (mean 116). Mean blood loss was 140 ml. (minimum 550), and none of the patients required transfusion. Hemorrhage due to adrenal vein injury occurred in 1 patient and was controlled intraoperatively. Average postoperative hospital stay was 3.4 days (range 1 to 12). The mean diameter of the excised masses was 38 mm. (range 15 to 70). Postoperative complications occurred in 4 cases, including hematoma in 1, trocar wound infections in 2 and eventration in 1 after 1 year. With a mean followup of 21.6 months (range 6 to 46), all patients had normal urinary catecholamine levels and 18 had normal blood pressure without treatment. CONCLUSIONS: Retroperitoneal laparoscopic adrenalectomy can be safely performed for small (less than 5 cm. diameter) pheochromocytoma. Retroperitoneal laparoscopy is a direct approach that allows the surgeon to control the adrenal vein first, thereby avoiding hypertensive events.

Adolescent↗
PubMed2006

Laparoscopic adrenalectomy: Comparison of lateral transperitoneal and lateral retroperitoneal approaches.

Laparoscopic adrenalectomy has become the method of choice of removal of most of adrenal lesions. This study investigated and compared the results of 2 different approaches of laparoscopic adrenalectomy, through retrospective review of 40 patients. Within this study period between 1995 and 2004, there were 20 lateral retroperitoneal and 20 lateral transperitoneal laparoscopic adrenalectomies performed. There was no significant difference in demographic variables between the 2 groups. Operative time, days to diet and ambulation, hospital stay, rate of conversion and complication did not differ significantly between the 2 approaches. No recurrence was detected upon mean follow-up period of 15.9 months. Learning curves showed gradual decrease in operation time in both approaches, reflecting maturation of techniques. In conclusion, both lateral transperitoneal and lateral retroperitoneal laparoscopic adrenalectomy are safe and effective. There is no difference in outcome between 2 approaches.

Adrenal Gland Neoplasms↗
PubMed2004

Laparoscopic radical adrenalectomy with adrenal vein tumor thrombectomy: technical considerations.

PURPOSE: We describe the technique of adrenal vein tumor thrombectomy during laparoscopic radical adrenalectomy for cancer. MATERIALS AND METHODS: During laparoscopic adrenalectomy for a heterogeneous 7 cm left adrenal mass an adrenal vein thrombus was detected intraoperatively. Laparoscopic ultrasonography was used to delineate precisely the tumor thrombus and its extension into the left main renal vein. The left renal artery and vein were transiently controlled with atraumatic vascular clamps. The renal vein was incised and the intact tumor thrombus was removed en bloc with the radical adrenalectomy specimen. The renal vein was suture repaired with 4-zero prolene and the kidney was revascularized. RESULTS: Renal warm ischemia time was 21 minutes, blood loss was 300 cc and operative time was 6.2 hours. Pathological evaluation revealed a 7.5 cm 68 gm adrenal cortical cancer with tumor thrombus. Soft tissue and adrenal vein margins were negative for cancer. CONCLUSIONS: Laparoscopic radical adrenalectomy with en bloc adrenal vein tumor thrombectomy can be exclusively performed intracorporeally, while respecting oncological principles. Essential technical steps include wide margin excision of the adrenal gland, intraoperative ultrasonography, renal vascular control, en bloc tumor thrombectomy and renal venous suture repair in a bloodless field.

Adrenalectomy↗
PubMed2005

Laparoscopic radical adrenalectomy for malignancy in 31 patients.

PURPOSE: Laparoscopic adrenalectomy for malignancy is controversial. We analyzed our experience with laparoscopic radical adrenalectomy for cancer with an emphasis on predictors of surgical outcome and oncological followup data. MATERIALS AND METHODS: Since July 1997, 31 patients have undergone a total of 33 laparoscopic adrenalectomies for malignancy. Mean adrenal tumor size was 5 cm (range 1.8 to 9). The laparoscopic approach was transperitoneal in 17 cases, retroperitoneal in 15 and transthoracic in 1. Data were obtained from patient charts, radiographic reports and direct telephone calls to patient families. RESULTS: Associated organ resection (radical nephrectomy) was performed in 3 patients. One case was electively converted to open surgery. There was no operative mortality. The pathological diagnoses were metastatic cancer in 26 cases and primary adrenal malignancy in 7. Current median followup, available on 30 patients, was 26 months (range 1 to 69). Overall 15 patients (48%) died and 16 (52%) were alive, of whom 13 (42%) showed no evidence of disease. Cancer specific survival at a median followup of 42 months was 53% and 5-year actuarial survival was 40%. Local recurrence was noted in 7 patients (23%). There were no port site metastases. Survival was similar in patients with tumors less than 5 cm vs 5 cm or greater. Survival was not associated with patient age, tumor size, operative time or surgical approach. Survival was compromised in patients with local recurrence (p = 0.016). CONCLUSIONS: Laparoscopic radical adrenalectomy can be performed with acceptable outcomes in the carefully selected patient with a small, organ confined, solitary adrenal metastasis or primary adrenal carcinoma. To our knowledge the largest series in the literature to date is presented.

Adrenal Gland Neoplasms↗