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PubMed1983

Effects of hyperadrenal states on luteinizing hormone in cattle.

The effect of an induced hyperadrenal state on luteinizing hormone (LH) secretion and subsequent ovarian function was examined in both intact and adrenalectomized (ADRX) heifers. Treatments were begun on Day 2 or Day 16 of an estrous cycle in order to examine their effect on corpus luteum development or ovulation, respectively. In Experiment I, continuous intravenous infusion of ACTH (1.0 mg/24 h) to intact heifers decreased LH concentrations during the early phase of the cycle (Days 3-5). Treatment of ADRX heifers with hydrocortisone succinate (HS) (100 mg/24 h) did not appear to change mean LH concentrations, although da Rosa and Wagner (1981) have reported reduced plasma concentrations of progesterone at mid-cycle in these ACTH-treated intact heifers and HS-treated ADRX heifers. ACTH treatment of ADRX heifers had no effect on LH or progesterone. In the second study, there were similar frequencies of LH surges at the anticipated time of ovulation in all treatment groups. HS (100 mg/24 h) in ADRX heifers and ACTH (0.5 mg/24 h) in intact heifers was given continuously beginning on Day 16 of an estrous cycle. Although some animals in all groups exhibited LH surges, the ACTH-treated intact and HS-treated ADRX heifers failed to show a consistent subsequent increase in progesterone concentrations in plasma, suggesting a failure of luteal development. Although no difference was seen in baseline concentrations of LH, there was a greater difference between basal and overall mean LH concentrations in control groups than was observed in ACTH- or HS-treated animals. These induced hyperadrenal states resulted in depression of ovarian function as shown by decreased plasma progesterone during the luteal phase of the cycle. It is not known if other noncorticoid steroids from the adrenal cortex are necessary for a full expression of this effect.

Adrenal Cortex Hormones↗
PubMed1977

Surgical experience with Cushing's disease.

During the period 1952 to 1976 at Vanderbilt University Hospital 119 patients with pituitary-dependent hypercortisolism or Cushing's disease were studied. The less severe cases, which constitute a majority, were treated by pituitary irradiation with endocrinologic cure or improvement in two-thirds of the treated patients. Bilateral total adrenalectomy was reserved for the most severe cases and for failures of pituitary irradiation. In 29 patients with total bilateral adrenalectomy there was one postoperative death. Two of 28 survivors had incomplete relief of hypercortisolism and required additional therapy for its control. One patient with recent operation is improved and another with early improvement died suddenly at home three months after operation. The 24 other adrenalectomized patients, followed 6 months to 20 years, were considered endocrinologic cures of Cushing's disease. One patient in the group who had not received pituitary irradiation developed signs of expanding pituitary tumor after adrenalectomy (Nelson's syndrome) with satisfactory response to radiation therapy.

Adolescent↗
PubMed1977

The child with ambiguous genitalia: a neonatal surgical emergency.

Although many birth defects pose a real threat to life if left uncorrected, the problem of ambiguous genitalia, if poorly or incorrectly handled, leads to a lifetime of unhappiness for both parent and child. The evaluation of these defects must be attended to with the same dispatch as any life threatening anomaly. A total of 18 children with ambiguous genitalia have been evaluated and treated in the past two years including nine females with virilizing adreno-genital syndrome, three infants with mixed gonadal dysgenesis, two infants with dysgenetic male pseudohermaphroditism, two males with severe perineal hypospadias, bifid scrotum, and undescended testicles, and two females with cloacal deformities. Precise diagnosis and most importantly proper gender assignments were made in 11 neonates by cytogenetic, biochemical, and miniaturized endoscopic techniques. Subsequent surgical reconstruction is governed by existing anatomy, not genetic sex, and has been completed in six children two to two and half years of age. Most are reconstructed as females with recession of the enlarged clitoris and vaginoplasty. Males with hypospadias are handled by standard techniques. Seven previously evaluated patients had been lost to follow-up for up to 13 years and were recently reconstructed. Surgical treatment in five older children with extreme virilization and moderate to severe gender confusion was technically successful but associated with pronounced emotional difficulties. Worse than delay in gender assignment, is making the wrong gender assignment, or failing to follow through with the original plan at an early age. Sample cases from each of these categories are presented in detail to illustrate the innovations in the diagnostic and therapeituc management of these children.

Adolescent↗
PubMed1984

Hyperadrenalism in childhood and adolescence.

Hyperadrenalism in childhood and adolescence has unique features that influence diagnosis and management. We reviewed our experience with 18 patients, ranging in age from 18 months to 18 years. Nine had bilateral adrenal hyperplasia, eight had adrenal neoplasms, and one had micronodular hyperplasia. Patients with congenital adrenal hyperplasia and hyperaldosteronism were excluded. Six patients with Cushing's disease diagnosed in earlier years were treated by total adrenalectomy and recently two patients underwent transsphenoidal removal of pituitary tumors. Bilateral adrenalectomy was carried out in one patient with micronodular hyperplasia and in a second because of elevated adrenocorticotrophic hormone (ACTH) levels from an undefined source. Eight patients had adrenal neoplasms, including five adenomas and three carcinomas. We found no reliable criteria to differentiate before surgery between adrenal adenomas and adrenal carcinomas. The most recognizable characteristic of malignancy was tumor size, specifically weight greater than 75 gms. Of the three patients with adrenal carcinoma, one expired 20 months after adrenalectomy and 8 months after receiving palliative partial hepatectomy for liver metastasis. Two patients are well with normal growth and development at 11 and 20 years following adrenalectomy. With the exception of one patient who died 6 years after surgery from a glioblastoma multiforme, all patients with adrenal adenomas are well. Eight patients underwent bilateral adrenalectomy for hypercortisolism. Five of the six who have reached their adult stature are significantly stunted. Four of six patients with Cushing's disease, treated by total adrenalectomy, have developed Nelson's syndrome at 2, 6, 10, and 12 years after surgery. Of the two patients undergoing transsphenoidal surgery, one had recurrent disease at 2 years and was treated by pituitary irradiation with recovery. The patients undergoing adrenalectomy for micronodular hyperplasia and ectopic ACTH are well at 2 and 4 years, respectively. Cushing's disease in children and adolescents is best treated by transsphenoidal removal of the pituitary adenoma. Adrenalectomy, once the most accepted approach, plays a secondary role and is indicated primarily in micronodular adrenal hyperplasia, in patients with ectopic ACTH production of an undefined source, and in recurrent Cushing's disease following prior pituitary irradiation. The high incidence of Nelson's syndrome in children treated by adrenalectomy mandates that patients at risk be monitored lifelong for the progression of a pituitary tumor.(ABSTRACT TRUNCATED AT 400 WORDS)

Adenoma↗
PubMed1995

Hypercorticism induces neurotensin mRNA in rat periventricular hypothalamus.

In vitro studies performed on cell lines or embryonic hypothalamic neuronal cultures suggest that neurotensin gene expression can be stimulated by dexamethasone, a synthetic glucocorticoid agonist. In order to test whether such an action could be observed in vivo, the distribution of neurotensin mRNA in the rat forebrain was analysed by in situ hybridization in rats treated chronically with corticosterone and in control animals. Corticosterone treatment resulted in a selective induction of neurotensin mRNA in both the periventricular and rostral arcuate nuclei of the hypothalamus but not in the paraventricular nucleus of the hypothalamus or the hippocampal CA1-CA2 region. This selective effect of corticosterone could be involved in neuroendocrine changes observed following glucocorticoid administration.

Adrenocortical Hyperfunction↗
PubMed1977

Intersex.

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Adrenocortical Hyperfunction↗
PubMed1984

Chronic anovulation.

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Adrenocortical Hyperfunction↗
PubMed1998

Anesthetic implications for surgical patients with endocrine tumors.

The preoperative evaluation and safe anesthetic treatment of patients with endocrine gland tumors mandate an understanding of the physiologic dysfunctions attributable to these tumors. Some patients will exhibit various signs and symptoms characteristic of the MEN syndromes. In the patient with acromegaly, a fiberoptic-guided intubation of the trachea to secure the airway before induction of general anesthesia must be anticipated. Anesthetic treatment of the patient with hyperadrenocorticism requires knowledge of the physiologic effect of excess cortisol. In the patient with severe hyperparathyroidism, we attempt to correct the markedly elevated plasma calcium levels and maintain adequate hydration and urine output perioperatively. Following thyroidectomy for MCT, 2 potential problems of concern are upper airway obstruction and aspiration resulting from injury (unilateral or bilateral) to the recurrent laryngeal nerve and the superior laryngeal nerve, respectively. The major focus during excision of an insulinoma is prevention of wide swings in blood glucose concentrations. In the gastrinoma patient, the anesthesiologist not only must correct any intravascular fluid volume deficit or electrolyte imbalance but must also consider the patient to have a full stomach at the time of anesthetic induction. Correction of hypokalemia and control of hypertension may be required in the preoperative preparation of the patient with an adrenal cortex tumor. Preoperative alpha-adrenergic blockade must be initiated in the patient with a pheochromocytoma to prevent dangerous elevations in blood pressure during anesthesia and surgery for the tumor's removal. Vasodilators with rapid onset and short duration are used to treat intraoperative hypertension. After ligation of the tumor's blood supply, falls in blood pressure may require treatment with fluids and vasopressors. Carcinoid syndrome patients should be treated with somatostatin to prevent stimuli such as anxiety, abdominal scrubbing, or tumor manipulation from precipitating severe hypotension, hypertension, bronchospasm, or tachycardia. In both pheochromocytoma and carcinoid patients, a smooth anesthetic induction and tracheal intubation plus avoidance of drugs that release histamine or activate the sympathetic nervous system may also prevent intraoperative crises.

Acromegaly↗