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PubMed1990

Effect of adrenalectomy on Ca2+ signaling in rat hepatocytes.

To pursue our studies of the effects of adrenalectomy on the adrenergic regulation of phosphorylase a, cAMP, cell calcium, and Ca2+ signaling in rat hepatocytes (Studer, R.K., and Borle, A.B. (1984) Biochim. Biophys. Acta 804, 377-385; Freudenrich, C.C., and Borle, A.B. (1988) J. Biol. Chem. 263, 8604-8610), we have further examined the alpha 1-adrenergic pathway in adrenalectomized and sham-operated male rats. We measured the number and affinity of alpha 1-adrenergic receptors, the cytosolic free Ca2+ concentration [(Ca2+]i) of hepatocytes with aequorin, inositol triphosphate (IP3) accumulation, and Ca2+ influx and efflux across the plasma membrane. We also compared the effects of vasopressin with those obtained with epinephrine. We found that the number of alpha 1-adrenergic receptors was slightly depressed (-23%), but that their affinity was unchanged. However, IP3 accumulation evoked by epinephrine was decreased 50%. This is probably the main cause for the depressed peak rise in [Ca2+]i we previously observed and reported. We also found that the basal resting Ca2+ influx was increased after adrenalectomy. Experiments with the beta-blocker propranolol, which abolished the epinephrine-evoked increase in Ca2+ influx, suggest that this effect may be mediated by cAMP, at least in adrenalectomized animals. The effects of vasopressin on IP3 [Ca2+]i and Ca2+ influx and efflux were also significantly decreased after adrenalectomy, indicating that alpha 1-adrenergic-mediated and other IP3-dependent Ca2+ signaling pathways are depressed after adrenalectomy.

Adrenalectomy↗
PubMedDate not supplied

Adrenalectomy for disseminated breast cancer.

Forty-three patients (two males and 41 females) were submitted to bilateral adrenalectomy for disseminated mammary carcinoma. Several factors were considered for their prognostic value in predicting the response to endocrine ablation. The age of the patients, the treatment of the primary lesion, the free interval, the location of metastases and the involvement of regional lymph nodes did not affect the response to adrenalectomy. Response to therapeutic castration was directly correlated to the response to adrenalectomy (P less than 0.01); this is a valuable predicting factor that should be taken into consideration before proceeding to bilateral adrenalectomy. A statistically significant variation in survival between the responders and nonresponders was found (P less than 0.05). Finally, the high response rate to the operation (53.4%) can be attributed to the complete removal of the adrenal tissue during the operation.

Adrenalectomy↗
PubMed1987

Energetic efficiency and brown adipose tissue uncoupling protein of obese Zucker rats fed high-carbohydrate and high-fat diets: the effects of adrenalectomy.

The influence of diet on the response of lean and obese fa/fa rats to adrenalectomy has been studied. Adrenalectomized and sham-operated rats were fed either a semi-synthetic high-carbohydrate (HC) or high-fat (HF) diet for 13 days. Energetic efficiency, calculated for measurements of energy storage and energy intake, was increased in obese rats fed both HC and HF diets and reduced close to values of lean rats after adrenalectomy. Brown adipose tissue mitochondrial GDP binding and uncoupling protein concentration were reduced in control obese rats fed both HC and HF diets. After adrenalectomy the level of GDP binding and uncoupling protein concentration were increased to levels of lean rats. Molar ratios of GDP binding to uncoupling protein were similar in lean and obese rats, were unaffected by adrenalectomy, but were elevated in rats fed the HC diet (0.40 +/- 0.02 vs 0.28 +/- 0.03). The data suggests that diet, but not obese genotype, may influence the masking of mitochondrial uncoupling protein.

Adipose Tissue, Brown↗
PubMed1983

[Chemical adrenalectomy induced by aminoglutethimide in the treatment of breast cancer. A review].

The clinical profile of aminoglutethimide (AG), an amino derivative of the hypnotic agent glutethimide, is described. AG suppresses estrogen formation in postmenopausal women by its inhibitory effect on steroid synthesis in the adrenal glands as well as in the peripheral tissues. The results of treatment of 959 breast cancer patients by AG and glucocorticoids in several studies are reviewed. The treatment of these patients, who were not selected according to the hormonal receptor status in their tumors, resulted in about 30% objective responses. About 50% of the patients with estrogen receptor positive tumors responded with an objective regression. The favorable effect of medical adrenalectomy is comparable to that of hypophysectomy or surgical adrenalectomy; the advantage of medical adrenalectomy compared to ablative endocrine surgery is reversibility of the inhibitory effect on the production of adrenal hormones and estrogens after cessation of treatment. The AG-glucocorticoid regimen appears to exert a greater effect on skeletal metastases than tamoxifen. Patients who fail on tamoxifen and other endocrine regimens can still benefit from AG-glucocorticoid treatment. The value of medical adrenalectomy as adjuvant treatment is not yet known. At present, several agents with a selective effect on androgen-to-estrogen conversion in the peripheral tissues are under study. Their potential as inhibitors of the estrogen production in breast cancer patients is considerable.

Adrenal Glands↗
PubMed1982

Effects of adrenalectomy and dexamethasone on hepatic lipid metabolism.

The influence of adrenalectomy and dexamethasone on hepatic free fatty acid metabolism was studied in isolated perfused livers from male rats. Adrenalectomy 1 week prior to perfusion did not affect uptake of oleate, output of triglyceride, or rate of ketogenesis compared to sham-operated match-fed controls. Livers from dexamethasone-treated rats (0-2 mg/kg per day for 7 days) removed less oleate from the perfusate, esterified more to total and very low density lipoprotein (VLDL) triglyceride, and oxidized less to ketone bodies, compared to match fed controls; additional studies with [1-(14)C]oleate confirmed these findings. The output of glucose by livers from dexamethasone-treated rats was also stimulated. The output of VLDL triglyceride was correlated with output of total perfusate triglyceride (r = 0.77, P < 0.001). Prior to perfusion, dexamethasone livers accumulated more triglyceride than did control livers. Adrenalectomy did not affect the concentration of plasma free fatty acid or blood ketones and glucose; however, the plasma concentration of triglyceride was elevated. Dexamethasone increased the concentration of plasma free fatty acid, total triglyceride, and VLDL protein, triglyceride, phospholipid, and free cholesterol. No changes were observed in the concentration or composition of plasma low density lipoprotein (LDL) lipids. The concentration of plasma high density lipoprotein (HDL) protein and lipid, and plasma apoA-I, tended to increase; the ratio of total HDL cholesterol to LDL cholesterol was elevated with dexamethasone treatment. These observations suggest that augmented synthesis and secretion of VLDL triglyceride contribute to glucocorticoid-induced hyper-triglyceridemia.-Cole, T. G., H. G. Wilcox, and M. Heimberg. Effects of adrenalectomy and dexamethasone on hepatic lipid metabolism.

Adrenalectomy↗
PubMedDate not supplied

Bilateral adrenalectomy or subdiaphragmatic vagotomy on gastric tissue histamine concentration in albino rats.

Gastric tissue histamine concentration was determined 14 days after mock subdiaphragmatic vagotomy, subdiaphragmatic vagotomy, mock bilateral adrenalectomy and bilateral adrenalectomy in four different groups of animals and the results were compared with those of control rats. The results show that neither of the experimental situations of mock subdiaphragmatic vagotomy, subdiaphragmatic vagotomy and mock bilateral adrenalectomy could bring about any significant change in gastric tissue histamine concentration fourteen days after the respective operations, whereas, following bilateral adrenalectomy, the gastric tissue histamine concentration went up to two and half times the basal level during the same period thus indicating that by removal of adrenal influences there was an increase in synthesis and storage of histamine in the stomach wall.

Adrenal Glands↗
PubMedDate not supplied

Surgical treatment of adrenal metastasis following pulmonary resection for lung cancer: comparison of adrenalectomy with palliative therapy.

Although adrenal metastases from lung cancer are frequently detected during the late clinical stage or at autopsy, they are rarely surgically treated following pulmonary resection for lung cancer. We detected adrenal lesions as initial clinical recurrence in 9 (1%) of 904 patients who underwent pulmonary resection for lung cancer at our institute between 1980 and 1992. Adrenalectomy was performed in five who had developed unilateral adrenal metastasis. One underwent simultaneous operation for primary and metastatic lesions, and 4 underwent adrenal surgery following pulmonary resection. The adrenal tumor was removed via laparotomy in three patients, and via posterolateral non laparotomic approach in two. Co-metastatic lesions which were detected incidentally at operation included intestinal metastasis in two patients and regional lymph node metastasis in two; these were simultaneously resected. Following adrenalectomy, all these patients were treated with adjuvant chemotherapy or radiotherapy. Two patients have remained free of relapse for 40 and 26 months, respectively, after adrenal surgery, while three died of other distant metastases more than 9 months after adrenalectomy. In contrast, the four patients who received chemotherapy or radiation therapy died less than 6 months after palliative therapy. Thus, we consider that surgical treatment for adrenal metastases following pulmonary resection for lung cancer is effective in selected cases. The indications for adrenalectomy are presented in comparison with those for palliative therapy, and several difficulties in the surgical management of adrenal metastases are discussed.

Adenocarcinoma↗
PubMed1995

[Adrenalectomy for nonfunctioning adrenal tumors--comparison between open and laparoscopic surgery, and indication for operation].

Since 1977, we have operated on 18 nonfunctioning adrenal tumors. The pathological diagnosis included seven adrenocortical adenomas, three adrenocortical hypeplasias, three ganglioneuromas two adrenal cysts, two myelolipomas and one metastatic cancer. We successfully performed laparoscopic adrenalectomy in 11 of these patients and open surgery in the other 7 patients. In the patients undergoing laparoscopic adrenalectomy, post-operative recovery (fist oral intake, first ambulation, and total convalescence) was remarkably rapid. The indication of adrenalectomy for nonfunctioning adrenal tumors is controversial, but we can not exclude the possibility of malignancy even in small tumors. Therefore, because of the minimally invasive nature of laparoscopic surgery, the indications for operating on nonfunctioning adrenal tumors will be widened by introducing laparoscopic adrenalectomy.

Adrenal Gland Neoplasms↗
PubMed1995

Laparoscopic adrenalectomy for Cushing's syndrome: comparison with primary aldosteronism.

BACKGROUND: Removal of adrenal adenoma of Cushing's syndrome is believed to be more troublesome than primary aldosteronism because of large amount of retroperitoneal adipose tissue and bleeding from the fat. The objective of the present study was to evaluate the feasibility of laparoscopic adrenalectomy for Cushing's syndrome and comparison of the results of laparoscopic adrenalectomy between primary aldosteronism and Cushing's syndrome. METHODS: From January 17, 1992, to July 31, 1993, laparoscopic adrenalectomies for functioning adrenal lesions were performed in 14 patients (five men, nine women), three of whom had Cushing's syndrome and 11 of whom had primary aldosteronism. RESULTS: Operative times (mean +/- SD) for primary aldosteronism and Cushing's syndrome were 269.0 +/- 100.9 minutes and 253.7 +/- 57.9 minutes, respectively. No difference was noted in operative time, operative bleeding, and postoperative recovery between them. However, the weight of removed tissue from patients with Cushing's syndrome (20.00 +/- 8.17 gm) was greater than that from those with primary aldosteronism (6.64 +/- 2.01 gm). No operative complications occurred in patients with Cushing's syndrome. Ultrasonic aspiration and argon-beam coagulation were useful for laparoscopic adrenalectomy in patients with Cushing's syndrome. CONCLUSIONS: Cushing's syndrome may be a good indication for laparoscopic operation.

Adenoma↗
PubMed1994

Long-term outcome of bilateral adrenalectomy in patients with Cushing's syndrome.

BACKGROUND: Bilateral adrenalectomy provides an effective surgical option for patients with Cushing's syndrome. Knowledge of the long-term outcome of the patient who has undergone adrenalectomy is an important factor in determining management strategy in this situation. METHODS: Fifty consecutive patients undergoing bilateral adrenalectomy (1980 to 1991) were studied. Twenty-five had Cushing's disease, 18 ectopic adrenocorticotrophic hormone production, and seven primary adrenal hyperplasia. Median age was 43 years (range, 14 to 82 years); male-to-female ratio was 13:37. At follow-up 17 patients had died; the remaining 33 were interviewed at a median of 62 months after operation. RESULTS: Operative mortality was 4%. Late mortality included two patients with Cushing's disease who died of progressive pituitary disease and eight patients with ectopic adrenocorticotrophic hormone production who died of metastatic disease. Five-year survival was: 100% for patient with adrenal hyperplasia, 86% for patients with Cushing's disease, and 39% for patients with ectopic adrenocorticotrophic hormone production. Of 33 survivors followed for a median of 62 months, three (9%) were hospitalized with acute steroid deficiency. The principal complaint among survivors was chronic fatigue (60%). Only 10 (30%) patients had no symptoms. No steroid-related complications resulted after 16 surgical procedures subsequently performed. Of 20 survivors of Cushing's disease, three had Nelson's syndrome. CONCLUSIONS: Bilateral adrenalectomy for Cushing's syndrome is associated with occasional morbidity and mortality consequent to adrenal insufficiency. These patients suffered a high incidence of chronic physical complaints that may reflect the residual sequelae of chronic Cushing's syndrome. An active program of long-term rehabilitation is essential.

Adolescent↗
PubMed1976

Stimulation of carcinogen-induced mammary tumor growth in rats by adrenalectomy.

The effect of adrenalectomy on 7,12-dimethylbenz(a)anthracene-induced mammary tumor growth was studied in Sprague-Dawley female rats. Weekly measurements revealed that adrenalectomy significantly increased both mammary tumor size and number and elevated serum prolactin levels as compared to the intact controls. Daily injection of 1 mg hydrocortisone acetate into the intact 7,12-dimethylbenz(a)anthracene-tumor bearing rats did not significantly alter tumor size, number, or serum prolactin levels but, when injected into adrenalectomized rats, it prevented increased tumor growth and prolactin release. Daily injection of ovine prolactin and hydrocortisone suppressed endogenous prolactin release but significantly increased tumore size and number. Ergocornine, a prolactin-inhibiting drug, blocked adrenalectomy-induced tumor growth and partially blocked prolactin release. These results indicate that adrenalectomy in rats stimulates tumor growth by increasing prolactin release.

9,10-Dimethyl-1,2-benzanthracene↗
PubMed1993

Effective reversibility of the signs and symptoms of hypercortisolism by bilateral adrenalectomy.

BACKGROUND: The long-term outcome of bilateral adrenalectomy in the management of patients with Cushing's syndrome has not been previously well studied. METHODS: We reviewed our long-term results in 34 patients treated with bilateral adrenalectomy between 1983 and the present. Fourteen presented with occult or metastatic ectopic adrenocorticotropic hormone (ACTH) syndrome, 10 with failed treatment of Cushing's disease, five with primary micronodular and four with massive macronodular adrenocortical disease and one with indeterminate cause of Cushing's syndrome. RESULTS: All patients underwent bilateral adrenalectomy. Of 19 patients who required antihypertensive medications before operation, 15 (79%) had significant improvement and were either off all antihypertensive medication or required less medication after operation. Of 7 patients who required medications for diabetes mellitus, after operation 6 (86%) required no medication or changed from injections to oral hypoglycemic agents. Of 9 patients with mood changes or depression, the symptoms of 8 (88%) resolved. Of 29 patients with documented weight gain, 23 (79%) showed marked weight loss. Of 13 hirsute patients, 10 (77%) had resolutions of symptoms. Of 21 patients with complaints of fatigue, the symptoms of 16 (76%) resolved. Of 8 women with amenorrhea, 6 (75%) had resolution of symptoms. Each patient in the primary adrenocortical disease group, except one with residual fatigue, had complete resolution of his or her symptoms. There was no difference in resolution of symptoms between the ectopic ACTH and Cushing's disease groups. Six patients died: in the ectopic ACTH group one died of suicide at 1 month, and four of metastatic tumor at 9, 24, 25, and 48 months, and the patient with macronodular adrenocortical hyperplasia died of a myocardial infarction at 30 months. The remainder of the patients have been followed for a mean of 32 months (3 to 67 months). None of the patients had any evidence of recurrent hypercortisolism. CONCLUSIONS: We conclude that bilateral adrenalectomy is a safe, effective, and long-lasting method to ameliorate the devastating signs and symptoms of hypercortisolism in patients with Cushing's syndrome.

ACTH Syndrome, Ectopic↗
PubMed1996

Adrenalectomy reverses pre-existing obesity in adult genetically obese (ob/ob) mice.

OBJECTIVE: To determine if adrenalectomy would reverse the pre-existing gross obesity, characteristic of adult genetically obese (ob/ob) mice. DESIGN: Adult (12 week old) female ob/ob mice were adrenalectomized and fed a stock diet for 6 or 14 weeks. They were housed at 23-25 degrees C or 33 degrees C. Food intake and total body energy were determined. RESULTS: Adrenalectomy abolished the hyperphagia characteristic of ob/ob mice. Adrenalectomized ob/ob mice consumed 8-17% less food than intact lean mice. Adrenalectomized ob/ob mice housed at 23-25 degrees C lost 55% of their pre-existing body energy within 6 weeks after surgery and 75% of their body energy within 14 weeks after surgery. At 14 weeks after surgery, body weights and body energy content of the adrenalectomized ob/ob mice were comparable with values for intact lean mice. Intact ob/ob mice pair-fed to adrenalectomized ob/ob mice lost only half as much body energy as the adrenalectomized ob/ob mice did, indicating that adrenalectomy not only diminished food intake in ob/ob mice but also increased their energy expenditure per unit food consumed. Adrenalectomized ob/ob mice housed at 33 degrees C lost only half as much body energy in 6 weeks as did mice housed at 23-25 degrees C. CONCLUSION: Adrenalectomy reverses the gross obesity characteristic of adult ob/ob mice by abolishing their hyperphagia and increasing their energy expenditure per unit food consumed.

Adrenalectomy↗
PubMed1995

[Ipsilateral adrenalectomy in the surgical treatment of renal carcinoma].

OBJECTIVES: To assess the value of ipsilateral adrenalectomy during radical nephrectomy for the treatment of renal cell carcinoma as a function of preoperative computed tomography findings. METHODS: Between May 1985 and June 1994, 194 patients underwent radical nephrectomy for renal cell carcinoma in our institution. Preoperative radiological reports and postoperative pathological reports were reviewed for 185 patients. RESULTS: 148 patients underwent abdominal computed tomography before surgery. 94 adrenalectomies were performed in this group of patients. None of the 77 patients in whom computed tomography showed a normal adrenal gland had adrenal metastasis on the definitive histological examination. 17 patients had an adrenal mass on computed tomography, 3 of which proved to be neoplastic. Preoperative CT had a sensitivity of 100%, a specificity of 82%, a positive predictive value of 18% and a negative predictive value of 100%. The 185 files reviewed included 114 adrenalectomies, including 4 adrenal glands invaded by renal cell carcinoma (3.5%). In these 4 cases, the smallest diameter of the renal tumour was 4 cm and the minimum pathological stage was T3. CONCLUSIONS: It therefore appears justified not to perform adrenalectomy during nephrectomy, in the presence of a renal tumour and negative adrenal computed tomography.

Adenocarcinoma↗
PubMedDate not supplied

Videoendoscopic adrenalectomy: multicentric study from the Belgian Group for Endoscopic Surgery (BGES).

This paper reports the experience of five Belgian surgical teams with 18 videoendoscopic adrenalectomies performed on 16 patients between October 1993 and May 1995. The adrenal gland diseases were pheochromocytoma (4 patients), primary hyperaldosteronism (2 cases), Cushing's adenoma (2 cases), Cushing's disease (1 case), nonfunctional adenoma (3 cases), single metastasis from adenocarcinoma (2 cases), functional adenoma with dehydro-epiandrostenedione (DHEAS) and cortisol hypersecretion (1 case), ACTH secreting metastases from a thymoma (1 case) Two patients underwent bilateral adrenalectomies. Eleven left and three right adrenal glands were removed in 14 other patients. The eight women and eight men range in age from 17 to 72 years (median 47). Six patients demonstrated a body mass index greater than 30. Median tumor size was 3 cm (range 1.3 - 5). Laparoscopic adrenalectomy was successful in 14 patients (87%). The median duration of the procedure was 132 minutes (range 59-360). The median postoperative stay was 6 days (range 2-13). No patient required blood transfusion. We conclude that the videoscopic approach can safely be used for surgical removal of adrenal lesions. However this approach should be performed by surgeons well versed in the techniques of open adrenalectomy for endocrine disorders, but also well trained in videoendoscopic surgery.

Adrenal Gland Diseases↗
PubMed1997

Comparison of laparoscopic and open adrenalectomy.

This review compares the outcomes of patients who have undergone laparoscopic and open adrenalectomy. Records of all patients who underwent adrenalectomy between January 1993 and December 1996 at Cedars-Sinai Medical Center, Los Angeles, were reviewed. Ten patients underwent laparoscopic, and ten patients underwent open adrenalectomy. The average age in the laparoscopic group (LA) was 48 years (range, 23-64) and 47 years (range, 28-79) in the open group (OA). The LA had smaller tumor size (2.9 +/- 2.0 versus 6.1 +/- 2.8 cm; P = 0.01), longer operative times (164 +/- 47 versus 124 +/- 29 minutes; P = 0.03), shorter length of postsurgical stay (4.1 +/- 2.5 versus 5.9 +/- 1.1 days; P = 0.05), and fewer days of parenteral pain medication (1.9 +/- 1.8 versus 3.4 +/- 1.0 days; P = 0.04). Although the differences did not reach statistical significance, LA also had lower estimated blood loss (118 +/- 158 versus 210 +/- 172 cc; P = 0.23), less time to oral intake (1.8 +/- 2.2 versus 2.8 +/- 1.3 days; P = 0.24), and less direct cost ($3645 +/- 1502 versus $5752 +/- 2948; P = 0.07). Complications of LA included one patient who had a prolonged ileus and adrenal insufficiency and another patient who required readmission for adrenal insufficiency. Complications of OA included one patient who had a prolonged ileus and one patient who had a 20 per cent pneumothorax. Laparoscopic adrenalectomy is the preferred technique in nonmalignant adrenal lesions less than 6 cm in size.

Adenoma↗
PubMed1997

[Laparoscopic adrenalectomy].

Minimally-invasive adrenalectomy is a new and attractive procedure, which has advanced to the method of choice in the surgical treatment of benign adrenal diseases. This technique is contraindicated in the treatment of adrenal malignancies. The endoscopic removal of large benign adrenal tumors (> 6-8 cm) may be difficult. The preoperative management of the patients does not differ from the preparation for conventional adrenalectomy. Like in open adrenalectomy several different endoscopic approaches to the adrenals have been described: the transperitoneal approach with the patient in supine position, the transperitoneal approach in lateral position, the retroperitoneal approach in lateral position and the retroperitoneal approach in prone position. Excellent results have been achieved with all four techniques. The approaches with the patient in lateral position have the disadvantage that in case of bilateral adrenalectomy the patient has to be repositioned during the operation. Large tumors are more difficult to be removed with the retroperitoneal techniques, because of the limited space in the retroperitoneum. Operative times and conversion rates have been markedly reduced with increasing experience with these techniques.

Adrenal Gland Diseases↗
PubMed1997

[Indications for laparoscopic adrenalectomy].

Endocrinological indication for surgical adrenalectomy is relatively rare. There is relatively little information on possibilities how to perform adrenalectomy by a minimally invasive procedure. Minimal invasive surgery made it possible to implement some operations sparing the patient. Adrenalectomy is one of these procedures. Laparoscopic adrenalectomy, which is extremely rare in other countries, as practiced in the Czech Republic, is the subject of the submitted paper.

Adrenal Gland Diseases↗