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PubMed1976

Effects of adrenalectomy and hypophysectomy on water and electrolyte metabolism in male and female rats with inherited hypothalamic diabetes insipidus (Brattleboro strain).

Observations on water and electrolyte metabolism after hypophysectomy or adrenalectomy, in male and female rats with hereditary hypothalamic diabetes insipidus (Brattleboro strain) are confirmed and extended. The diabetic (homozygous, DI) state relative to the non-diabetic (heterozygous, non-DI) state was characterized by (1) water intake of 55-120% body weight; (2) copious urine hypo-osmotic to plasma; (3) greater excretory rates of total solute, Na, Ca and Mg; (4) similar plasma composition except that in male DI rats, K concentration was less, and in female DI rats osmolarity was higher; (5) glomerular filtration rates (GFR) were similar with close correlations between: food and water intakes, water intake and output, urinary Na and K, Na and Cl, K and Cl, and Ca and Mg; (6) both female DI and non-DI rats had lower urinary Na:K ratios and lower plasma Na concentrations than males; (7) female DI rats excreted relatively larger amounts of K and Cl, and had higher plasma Ca concentrations than other groups. Hypophysectomized DI rats had decreased water intake and urine output, decreased solute excretion, decreased loss of osmotically free water, lower excretory rates of Na, K and Cl, and increased urinary osmolarity and K concentrations. Hypophysectomized non-DI rats had increased urinary excretory rates, decreased solute excretion (by 60-70%), decreased osmotically free water absorption, decreased urinary osmolarity, Na and K concentrations, and increased excretory rates of Ca and Mg. Hypophysectomized DI and non-DI rats had increased plasma osmolarity and Na concentration. Plasma renin activities (PRA) were higher in DI than in non-DI rats with female values lower than those of males; values for both sexes of DI and non-DI rats were reduced after hypophysectomy. Adrenalectomized DI rats had about a 50% reduction in water intake, urine output and free water clearance, increased urinary concentration of electrolytes and total solute by day 4 after operation; their Na balance (dietary:urine) did not change significantly in contrast to adrenalectomized non-DI rats in which a greater percentage of dietary Na appeared in the urine. GFR was similarly reduced in adrenalectomized DI and non-DI rats. Plasma osmolarity increased in adrenalectomized male DI, decreased in female DI and non-DI, and did not change in male non-DI rats. Plasma K concentrations increased after adrenalectomy in all groups, only non-DI rats had a significantly decreased plasma Na concentration. There was no sex difference in pituitary oxytocic activity but it was consistently reduced in DI rats; there was little change after adrenalectomy in male DI and non-DI rats; but there was an increase in DI and non-DI females. Pituitaries of DI rats had no measurable ADH activity (except the inherent activity of oxytocin). Pituitary ADH values for male and female non-DI rats were similar and were unaffected by adrenalectomy.

Adrenal Glands↗
PubMed1978

Effects of adrenalectomy and prednisolone on the absorption and phosphorylation of thiamine in rats.

After adrenalectomy, the absorption of [35S]thiamine in the small intestine of rats was significantly reduced. Injection of delta1,4-pregnadiene-11beta,17alpha,21-triol-3,20-dione (prednisolone) restored this absorption to some extent, but not to the value found in control (unoperated) rats. Treatment with 1% saline had no effect. Adrenalectomy also reduced the amount of [35S]thiamine that accumulated in the intestinal mucosa and liver compared with that found in controls, but treatment with prednisolone increased the retention of thiamine in these tissues. One per cent NaCl raised the retention of thiamine in the liver but not in the mucosa of the jejunum. The loss in body weight that occurred after adrenalectomy was not, however, corrected after treatment with either saline or steroid. In adrenalectomized rats, the concentrations of thiamine mono- and diphosphates in the intestinal mucosa and the liver were lower than in the control animals. The concentration of thiamine triphosphate was, however, higher in the intestinal mucosa after adrenalectomy, but remained unchanged in the liver. Treatment with prednisolone increased the concentrations of thiamine mono-, di- and triphosphates in both of these tissues in adrenalectomized rats, compared with unoperated control animals.

Adrenalectomy↗
PubMed1981

Brain adrenocorticotrophin after adrenalectomy and sham-operation of rats.

The influence of adrenalectomy on the level of immunoreactive 18-24 ACTH extracted from hypothalamus, hippocampus and pituitary gland of rats was investigated. Brain ACTH was further characterized by fractionation by gel-permeation chromatography. Porcine 1-39 ACTH was exposed to synaptic plasma membranes in vitro in order to evaluate the role of metabolic conversion in changes of brain ACTH content. Removal of the adrenals, when compared with sham-adrenalectomy, resulted in a transient depletion of ACTH content in the anterior pituitary gland and the hippocampus, but not in the hypothalamus and the neurointermediate lobe. However, sham-adrenalectomy caused a transient reduction in levels of ACTH when compared with levels before operation in all tissues studied. The effects of adrenalectomy on hippocampal ACTH content persisted in hypophysectomized rats. Treatment of adrenalectomized rats with corticosterone failed to restore the reduced ACTH content when it was administered in doses that completely suppressed the release of pituitary ACTH. Adrenal steroids, however, may exert a direct effect on the metabolism of ACTH in the brain as judged from the in-vitro studies with porcine 1-39 ACTH exposed to a synaptosomal plasma membrane fraction of hippocampal tissue. The present study suggests that control of brain ACTH occurs independently of the control of pituitary ACTH release.

Adrenalectomy↗
PubMed2002

Laparoscopic adrenalectomy: the new standard?

PRINCIPLES: Since 1994 we have been removing most non-malignant classified pathologies of the adrenal gland laparoscopically. Does this minimal invasive procedure involve advantages over the conventional approach? METHODS: Retrospective analysis of 22 all-consecutive laparoscopic adrenalectomies in 21 patients (10 women, 11 men, age 26-70 years, mean 43 years, 11 right, 9 left, one bilateral in MEN IIa syndrome). These procedures were performed between 1994 and 2001 transperitoneally in the lateral decubitus position, recently by use of the Ultracision device and once with a handport. These results are compared with 20 consecutive open transperitoneal unilateral adrenalectomies with similar pathologies (13 women, 7 men, age 28-77 years, median 51.5 years, 8 right, 12 left) carried out between 1988 and 1993. RESULTS: The mean operating times were 150 and 115 minutes with the laparoscopic and the open procedure respectively (p <0.011). On the other hand, mean hospital stay (6 versus 15 days, p <0.00001), intraoperative blood loss (200 versus 300 ml, p <0.04) and postoperative need for analgesics were significantly shorter or lower. Two out of the first five laparoscopic operations had to be converted into open adrenalectomy due to intraabdominal adhesions and a diaphragmatic injury with pneumothorax. In both groups three complications occurred (14% and 15%). CONCLUSION: Laparoscopic adrenalectomy is a safe, effective and useful procedure involving a shorter hospital stay, lower intraoperative blood loss and a lower postoperative analgesics requirement compared with the open approach. The laparoscopic approach is the procedure of choice for all benign adrenal pathologies.

Adenoma↗
PubMed1996

[Extraperitoneal laparoscopic adrenalectomy: the initial 9 cases].

(PURPOSE). To determine the efficacy of extraperitoneal laparoscopic adrenalectomy for patients with adrenal tumor, the clinical results of 9 patients treated with this procedure were analysed. (PATIENT AND METHOD). Between July 1994 and March 1995, we have performed extraperitoneal laparoscopic adrenalectomy using the modified Gaur technique of balloon dilatation of the retroperitoneum in 4 men and 5 women with unilaterla small adrenal tumor who were 30 to 79 years old (mean age 56 years). Preoperative diagnosis was primary aldosteronism in 2, 18-hydroxycorticosterone producing adnoma in 1, pre-Cushing syndrome in 5, and nonfunctioning adrenal tumor in 1 patient. The operations were performed with the patients on lateral position and 4 torocars were positioned. The retroperitoneal space was first dissected bluntly by the index finger and a balloon dissector through a small skin incision, and the retroperitoneal space was insufflated with carbon dioxide at the pressure of 10 to 12 mmHg. After the dissection of the adrenal gland, adrenal vein was clipped and transected. The completely freed adrenal gland was enclosed in an entrapment sack and removed en bloc through the open laparoscopy wound. (RESULTS). All 9 procedures were successfully performed. The mean estimated blood loss and the mean operating time were 53 ml and 168 min respectively. There was no intraoperative complication. A postoperative retroperitoneal hematoma was observed in one patient, however it spontaneously resolved without surgical management. (CONCLUSION). In open adrenalectomy, the benefit of the extraperitoneal approach (excluding patients with pheochromocytoma or bilateral lesions) have already been established elsewhere. Although the working space is smaller than that of peritoneal approach, and the surgical techniques are slightly more difficult, extraperitoneal laparoscopic adrenalectomy promises to be safe and a minimally invasive treatment for patients with unilateral small adrenal tumors except for pheochromocytoma.

Adrenal Gland Neoplasms↗
PubMed2001

[Laparoscopic adrenalectomy with transperitoneal approach].

UNLABELLED: The feasibility, safety, and results of 52 laparoscopic transperitoneal adrenalectomies were evaluated. METHODS: A total of 52 patients were included in the study based on thorough endocrinological and imaging assessment. 15 patients with Conn syndrome, 3 with Cushing syndrome, 15 with nonfunctioning adenoma, 14 with pheochromocytoma, 2 with adrenocortical cyst, 2 with adrenocortical lipoma and 1 with metastasis were considered eligible for adrenalectomy. Lesion size ranged from 1 to 12 cm (mean 4.53 cm). Concurrent surgical procedures were performed in 6 patients (11%). RESULTS: There was one conversion (during a left adrenalectomy), because of our learning curve. After we changed the technique, there was no more conversion. There were two (3.8%) postoperative complications: postoperative pancreatitis, one of the patients required re-operation (lavage and drainage). There was one wound infection. We had no postoperative mortality. Mean postoperative hospital stay was 6 days (range, 2-27 days). CONCLUSION: Patients with secreting and non-secreting adrenal lesions can be treated safely and effectively by laparoscopic adrenalectomy.

Adolescent↗
PubMed2000

Laparoscopic versus open adrenalectomy: outcome in 35 consecutive patients.

BACKGROUND: The use of minimally invasive techniques in the surgical treatment of adrenal masses has been used to remove a wide variety of adrenal tumors. AIMS: We have reviewed our experience with laparoscopic adrenalectomy and compared laparoscopic vs. open surgical approach. METHODS: The outcome of 35 consecutive patients who underwent adrenalectomy over a 3-year period has been analyzed retrospectively. Differences in operating time, blood loss, period of hospitalization, use of parenteral analgesia, resumption of oral feeding, complications, and time to return to normal activity after 18 coelioscopic vs. 17 open consecutive adrenalectomies have been considered. RESULTS: The average operative time was longer (mean 160 vs. 148 min, p = 0.48) and postoperative complications lower (4 vs. 5 cases, p =0.73), although not statistically significant, for the laparoscopic compared to the open surgical approach, whereas blood loss (30 vs. 165 ml; p = 0.01), postoperative analgesia (3.4 vs. 5.0 days, p = 0.02), time to restart oral feeding (3.0 vs. 4.7 days, p = 0.001), average time of hospitalization (4.5 vs. 9.6 days, p = 0.001), time to return to normal activity (21 vs. 37 days, p = 0.001) were all statistically significant. CONCLUSIONS: Laparoscopic adrenalectomy can be considered the method of choice for managing almost all adrenal masses, because of its lower morbidity and shorter postoperative recovery.

Adrenalectomy↗
PubMed1979

Bilateral adrenalectomy: effect of tryptophan on protein synthesis and pepsin activity in the stomach of rats.

The effect of bilateral adrenalectomy and subsequent force-feeding of L-tryptophan on the gastric mucosal pepsin activity and [3H]leucine incorporation into total protein of the stomach (fundus) in vivo were investigated. One month after bilateral adrenalectomy the gastric mucosal pepsin activity and overall protein synthesis in the stomach were decreased by 72% and 52%, respectively. Twenty-four hours after a single tube-feeding of tryptophan (30 mg/100 g body weight) both activities returned to sham-operated control levels. In adrenalectomized rats the tryptophan-mediated stimulation of gastric mucosal pepsin activity was found to be sensitive to the RNA synthesis inhibitor, actinomycin-D. The diminution in gastric mucosal pepsin activity after adrenalectomy and its enhancement by tryptophan could not be related to the presence of an inhibitor or activator in the tissue. One month after adrenalectomy serum gastrin concentration was found to be 36% above that of the sham-operated control. In adrenalectomized rats, 24 and 48 h after tryptophan force-feeding, serum gastrin concentrations were decreased by 50% and 20%, respectively, but none of the values differed significantly from those of water-fed adrenalectomized controls.

Adrenalectomy↗
PubMed2003

Laparoscopic adrenalectomy: indications, technique, complications and follow-up.

BACKGROUND: Developments in laparoscopic surgery have rendered it an efficient tool for many complex surgical procedures. In the last few years, laparoscopic adrenalectomy has become a more viable option for removal of adrenal pathology, with many surgeons preferring it to the conventional open technique. OBJECTIVES: To describe the indications, technique, complications and follow-up of patients undergoing laparoscopic adrenalectomy in our department. METHODS: The hospital files of 30 patients who underwent the procedure were reviewed. There were 19 females and 11 males with a mean age of 45 years. Indications for surgery differed and included hypersecreting adenoma, pheochromocytoma, suspected malignancy, and incidentaloma. RESULTS: Of the 31 laparoscopic adrenalectomies performed, 11 were right, 18 were left, and 1 was bilateral. The conversion rate to an open procedure was 3%. The mean duration of procedure was 120 minutes. Only one patient required blood transfusion. Complications occurred in 20% of patients, all reversible. There was no mortality. Mean hospitalization duration was 3.4 days and median follow-up 17 months. There were no late complications. All patients operated on for benign diseases are alive. CONCLUSIONS: Laparoscopic adrenalectomy appears to be a useful tool for the treatment of a range of adrenal pathologies.

Adrenal Gland Neoplasms↗
PubMed2003

Laparoscopic adrenalectomy and splenectomy are safe and reduce hospital stay and charges.

The proposed benefits of laparoscopy for certain surgical procedures have been decreased post-operative pain and hospital stay balanced against the proposed deficits of increased costs. We have reviewed our data to evaluate factors associated with patient, procedure, and hospital charges for patients undergoing open versus laparoscopic adrenalectomy and splenectomy during the same time period. Eighty-seven patients underwent adrenalectomy (n = 47) or splenectomy (n = 40) from October 30, 1995 to June 6, 2001 and were retrospectively reviewed. Patient and operative factors were analyzed by intent to treat; the major endpoints were operating room (OR) time in minutes, blood loss in cm3, length of hospital stay in days, and charges broken down by anesthesia/operation [OR/recovery room (RR)] and total charges in dollars x 1000. Comparisons of means were analyzed by unpaired t test; data are presented as mean +/- SEM, and significance is defined as P < 0.05. Median age of the group was 47 years (range 20-77). Forty-five patients underwent a laparoscopic approach of which two were converted to open (4%) as compared with 42 undergoing an open operation; one patient from each group was excluded from outcome analyses because of prolonged hospitalization (>3 weeks). Operative mortality of the whole group was one per cent. There were no differences between the groups with respect to age, gender, or comorbidity. The laparoscopic group had significantly longer operative times and OR/RR charges. However, the length of hospital stay and the total charges for the patient undergoing a laparoscopic approach were significantly less (P < 0.05). We conclude that a laparoscopic approach for adrenalectomy or splenectomy can be accomplished in approximately 95 per cent of patients selected for this procedure. Despite prolonged OR time and increased OR/RR charges the laparoscopic procedures resulted in significantly decreased length of hospital stay and overall patient charges. Laparoscopy is a safe and cost-effective approach and should be strongly considered in patients requiring adrenalectomy or splenectomy.

Adrenalectomy↗
PubMedDate not supplied

Laparoscopic bilateral adrenalectomy with the use of a single midline hand-assist port.

Indications for bilateral adrenalectomy are rarely present in patients with Cushing's syndrome. The laparoscopic approach to adrenalectomy provides a postoperative course that compares favorably with that of open adrenalectomy, and the hand-assisted technique may provide an additional alternative to the open approach in performing bilateral adrenalectomy.

Adrenalectomy↗
PubMed2004

[Laparoscopic adrenalectomy].

BACKGROUND/PURPOSE: Laparoscopic adrenalectomy is a standard procedure in adult patients. In the pediatric patient the same advantages with regard to traditional surgery have been demonstrated in the treatment of localized adrenal tumours. The aim of this work is to analyze our initial experience in this technique. MATERIAL AND METHODS: We have reviewed our last three adrenalectomy cases. They were two girl and a boy aged 4, 15 and 17 year-old. The etiology was pheochromocytoma in two cases and one ganglioneuroblastoma. In two cases the tumour was right-sided and the other one was in the left adrenal gland. All cases were studied with ultrasound, TC and MRI. Patients with pheochromocytoma were also studied with MIBG-scintigraphy and genetics, hormone and endocrine MEN screening. One patient with pheochromocytoma had von Hippel-Lindau disease. Main size tumour was 40 mm. Preoperative alpha-blockade in pheochromocytoma was done with prazosín and intraoperative with nitroprusside. In lateral decubitus position, through four 10 and 5 mm ports, in two cases adrenalectomy was performed and tumorectomy in one. RESULTS: Main operating time was 120 minutes. There was no operative-related complication. Blood pressure in pheochromocytoma patients was controlled without drugs 36h after surgery. They were discharged between the 2nd and 4th postoperative day. No incidences on follow-up. CONCLUSIONS: Adrenalectomy joins other pediatric procedures affordable with the laparoscopic approach. It minimizes surgical trauma, gland exposure is better, allows a safe and quick resection in adrenal tumours, with a short and suitable postoperative course.

Adolescent↗
PubMed2005

Ten years of laparoscopic adrenalectomy: lesson learned from 104 procedures.

The purpose of this study was to evaluate the short- and long-term results of 104 consecutive laparoscopic adrenalectomies performed during a period of 10 years in two specialist centers. One hundred four patients underwent laparoscopic adrenalectomy in two specialist centers in Italy between 1994 and 2003. Indications to laparoscopic adrenalectomy were aldosterone-secreting adenoma (20%), pheochromocytoma (24%), cortisol-secreting adenoma (11.5%), incidentaloma (26.9%), multiple endocrine neoplasia (MEN) type 2A (2.8%), adrenal metastases from lung cancer (3.8%), adrenal cyst (6.7%), and angiomyolipoma (3.8%). Transperitoneal anterior and lateral approaches were adopted in 17 and 84 patients, respectively. Retroperitoneal approach was adopted in three patients. Mean operative time was 108 +/- 39.1 minutes (range, 40-300 minutes). There was no correlation between adrenal tumor diameter and operative time. Mean intraoperative blood loss was 106 mL (range, 40-600 mL). Intraoperative complication rate and conversion rate were 4.8 per cent (5 cases). Laparoscopic adrenalectomy is a safe procedure. After a relatively short learning curve, it can be performed successfully by any surgeon with low operative morbidity and mortality. The size of the adrenal tumor should not be considered a contraindication to this procedure.

Adolescent↗
PubMed2005

Anesthetic implications of laparoscopic adrenalectomy in nephrotic syndrome.

UNLABELLED: During the last two decades laparoscopic surgery has become a widely practiced procedure. Laparoscopic adrenalectomy for adrenal tumor excision is one of these new applications. The anesthesia implication are special in the presence of long standing essential hypertension and nephrotic syndrome with poly-pharmacy. OBJECTIVES: To report on the first anesthesia for laparoscopic adrenalectomy Security Forces Hospital (SFH) in Riyadh. SETTING: Tertiary care SFH in Riyadh. PATIENT: A 58 year old Saudi woman diagnosed to have essential hypertension, nephrotic syndrome, NIDDM, and right adrenal tumor, with the provisional diagnosis of pheochromocytoma. INTERVENTIONS: General anesthesia, Thoracic epidural, control of hypertension with both alpha and beta blockers, and selective SICU admission for monitoring and pain relief. MEASUREMENT AND THE MAIN RESULTS: Preoperative ultrasound and MRI, MIBG scan of the adrenals, catecholamines serum level, intraoperative direct cardiovascular pressure measurements using Swan-Ganz catheter and arterial line. Pain control using epidural narcotics, measurement of blood glucose, blood gases, urea, creatinine and electrolytes. Adequacy of ventilation monitored by capnography and pulse oximetry. The surgical procedure included right adrenalectomy and cholecystectomy. CONCLUSION: Anesthesia for laparoscopic adrenalectomy has special problems to solve related to the pneumoperitonium effect, poly-pharmacy and the current disease state. The use of modern anesthetic agents, cardiovascular monitoring, ventilation and proper analgesia make the hospital stay short, morbidity and mortality minimal.

Adrenal Glands↗
PubMed2006

[Anesthetic management of laparoscopic adrenalectomy for pheochromocytoma].

OBJECTIVE: To investigate the anesthetic management features of laparoscopic adrenalectomy for pheochromocytoma. METHODS: Twelve patients scheduled for laparoscopic adrenalectomy for pheochromocytoma under general anesthesia were allocated into group 1, while another 12 patients who received transabdominal adrenalectomy for pheochromocytoma under general anesthesia were selected as group 2. The hemodynamic changes and the postoperative recovery profiles between the two groups were compared. RESULTS: Hemodynamic fluctuation occurred during carbon dioxide insufflation and tumor manipulation in group 1. However, there were no differences between the two groups. Duration of post operative recovery and hospital stay as well as requirement of analgesics in group 1 were significantly lower than those in group 2 (P < 0.05). CONCLUSION: Hemodynamic fluctuation still exists during laparoscopic adrenalectomy for pheochromacytoma. However, patients undergoing such surgical procedure recover faster as compared with open surgery.

Adrenal Gland Neoplasms↗
PubMed2006

[Potentialities of laparoscopic adrenalectomy in treatment of patients with adrenal tumors].

Experiences with laparoscopic adrenalectomies in the clinic were analyzed. The laparoscopic method was used in 47 out of 252 adrenalectomies followed by only 1 mild complication and 3 conversions. A comparison of open and laparoscopic adrenalectomies has revealed advantages of the endoscopic method with respect of tolerance of the procedure, its safety and duration of the rehabilitation period. The technique and indications to adranalectomy were analyzed. The authors emphasize the advantages of the transperitoneal approach and good perspectives of laparoscopic adrenalectomy in almost all cases of benign and non-invasive adrenal tumors.

Adolescent↗
PubMedDate not supplied

[Peptide hydrolase activity in rabbit brain subcellular fractions under conditions of adrenalectomy and administration of hydrocortisone and ACTH].

Adrenalectomy and administration of hydrocortisone and ACTH are shown to induce no changes in the total activity of neutral peptide-hydrolase in both homogenates and brain subcellular fractions. The absence of adrenalectomy and hormone administration effect on the total peptide-hydrolase activity in homogenates is established simultaneously with its essential changes in the brain subcellular fractions. A decrease in the enzymic activity of the mitochondrial-lysosomal fraction (MLF) following adrenalectomy is observed side by side with its increase in a soluble fraction. Hydrocortisone and ACTH administration cause an increase in the acid peptide-hydrolase activity in MLF and its decrease in the brain soluble and microsomal fractions of adrenalectomized rabbits. The degree of solubilization of MLF acid and neutral peptide-hydrolase by detergent triton X-100 after adrenalectomy is increased. Hydrocortisone and ACTH administration, on the contrary, decrease a degree of solubilization of the brain MLF peptide-hydrolase in adrenalectomized animals.

Adrenalectomy↗
PubMed1990

[Is it possible to predict the development of Nelson's syndrome in Cushing's disease after bilateral adrenalectomy?].

A detailed analysis of clinical and laboratory findings in a group of 66 patients with Cushing's disease treated with bilateral adrenalectomy, out of whom 15 developed Nelson's syndrome, gave evidence that Nelson's syndrome mostly affects children and young patients compared to older persons. Bilateral adrenalectomy performed in patients aged over 40 years was never accompanied by Nelson's syndrome. Basal plasma ACTH values prior to adrenalectomy (30.9 +/- 4.53 pmol/l in the absence of Nelson's syndrome and 31.3 +/- 5.41 pmol/l in patients with Nelson's syndrome) as well as the degree of their suppressibility with 8 mg dexamethane (to 18.8 +/- 3.43 pmol/l in Nelson's syndrome and 19.0 +/- 3.44 pmol/l in patients without it) did not provide sufficient evidence for the prediction of later development of Nelson's syndrome. The same is true of the plasma cortisol concentrations. A tendency to a significant plasma ACTH increase after adrenalectomy within a 6-month period, and especially its lesser suppressibility raises a strong suspicion of an incipient development of Nelson's syndrome. These findings will have to be taken into account when deciding on the surgical treatment of Cushing's disease.

Adolescent↗