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Murine cytomegalovirus adrenalitis in athymic nude mice.

During studies of the pathogenesis of murine cytomegalovirus (MCMV) infection in athymic nude mice, we noted striking virus involvement of the adrenal glands. Because patients with the acquired immunodeficiency syndrome (AIDS) have recently been reported to have adrenal necrosis and evidence of infection of the adrenal gland with human cytomegalovirus (HCMV), we have further evaluated adrenal gland involvement during MCMV infection. Following virus inoculation, MCMV replicated to high titer in the adrenal glands of T-cell deficient, homozygous nude mice, but not heterozygous littermates with intact T-cell function. Concomitant with the high titers of virus, there appeared overt histological evidence of herpes-virus virus infection accompanied by patchy necrosis of adrenal cortical and medullary tissues. Acyclovir, which inhibits growth of MCMV, reduced virus replication in the adrenal gland. Similarly, virus replication was diminished in homozygous nude mice immunologically reconstituted by infusion of normal spleen cells three weeks prior to infection. Thus, in the absence of functioning T lymphocytes, MCMV can infect and replicate in adrenal tissues causing a progressive destructive adrenalitis.

Acyclovir↗

Morphology of human suprarenal glands: a parameter for comparison.

Forty suprarenal glands were studied, 20 being dissected from aborted fetuses of 9 to 36 weeks' gestation and 20 obtained from human cadavers of ages 1 day to 60 years. All the specimens were from a Northern India population. The side and shape of each suprarenal gland was noted and documented. The length, breadth, thickness and volume of each gland were measured and tabulated in terms of age. The mean length, breadth and thickness in fetuses of 9-36 weeks were found to be 1.4 cm, 1 cm and 0.45 cm respectively. In the postnatal age group the measurements were 4.5 cm, 2.08 cm and 0.66 cm respectively. The commonest shape of the suprarenal glands on left side was semilunar but on the right side it was highly variable: triangular, tetrahedral, inverted Y or V shaped. On comparison of the gross measurements with available ultrasound and CT scan data it was found that both the length and thickness in the population studied were greater than reported in the literature. A knowledge of these variations is very important in diagnosis of abnormalities of the suprarenal gland, of which tumoral enlargement is rather common.

Adolescent↗

Acute adrenal insufficiency resulting from adrenal hemorrhage as indicated by post-operative hypotension.

We examined the incidence, diagnosis and therapy of acute adrenal insufficiency, secondary to adrenal hemorrhage. This insufficiency resulted in temperature irregularities. hemodynamic instability, and a large volume resuscitation requirement post-operatively. The case illustrates that a high level of suspicion should be maintained in a clinical scenario that mimics sepsis or myocardial insufficiency in the intensive care unit.

Acute Disease↗

New technique for left adrenal vein catheterization.

A technique for left adrenal vein catheterization utilizing a Mikaelsson catheter is described. This technique allows a stable catheter position within the left adrenal vein and permits bilateral adrenal vein catheterization using a single catheter.

Adrenal Gland Diseases↗

Bilateral adrenal abscess in a neonate.

A 23-day-old male baby with a history of perinatal hypoxia presented with refusal of feeds and abdominal distension. The child had a right-sided cystic upper abdominal mass and features of neonatal septicemia. Abdominal ultrasound (US) and contrast-enhanced CT scan showed bilateral adrenal abscesses. Laparotomy with drainage of the abscesses successfully treated the condition. The literature on the subject is reviewed.

Abdominal Abscess↗

Early adrenal infection by herpes simplex virus type-1 (Miyama + GC strain): special reference to inoculation dose and spread from the adrenal to the central nervous system.

Male C3H/HeN mice, aged 5 weeks, were inoculated intraperitoneally (i.p.) with different doses (1 x 10(3), 1 x 10(5), 5 x 10(5), 1 x 10(6) pfu) of the herpes simplex virus type-1 (HSV-1) (Miyama + GC strain). The LD50 of this virus was 10(2) pfu (i.p.) per mouse. All the mice in each group died 12 days after inoculation. Adrenal necrosis was found to be dose-dependent, the threshold dose being 5 x 10(5) pfu. In addition, encephalitis and inflammatory cell infiltration in abdominal ganglia appeared in 3-4 days after inoculation. By the plaque method, HSV-1 was detected first in the adrenal glands, then in neurons in the spinal cord and the brain. These findings suggest that in mice inoculated with doses of virus sufficient to infect the adrenal gland, HSV-1 spreads to the central nervous system through peripheral nerves after replication in the adrenal.

Adrenal Gland Diseases↗

MRI of the adrenal gland.

Current status of magnetic resonance imaging (MRI) of the adrenal gland is reviewed, and basic techniques and sensitivity of MRI for differentiating histologic lesions are also discussed.

Adrenal Gland Diseases↗

Calcified adrenal masses.

We reviewed 106 cases of adrenal masses of all types in all age groups. Thirty-three contained calcium visible on radiographs, sonography, or computed tomography (CT). Neuroblastoma was the most common calcified adrenal mass (10 cases), and occurred only in children. Adrenal cyst (6 cases) was the most common calcified adrenal mass in adults. Other calcified adrenal masses included 5 cortical adenomas, 4 adrenal carcinomas, 3 cases of adrenal hemorrhage, 2 adrenal metastases, 2 pheochromocytomas, and 1 histoplasmoma. Calcification within an adrenal mass is therefore nonspecific. All the adrenal cysts had a characteristic radiographic pattern, showing only peripheral curvilinear calcification. The presence and pattern of calcium in an adrenal mass must be correlated with other imaging features (e.g., size, homogeneity, enhancement pattern, margination) to allow correct differential diagnosis. This can best be done by CT.

Adenoma↗

Adrenal gland and nonrenal retroperitoneum.

Ultrasound, as the initial cross-sectional imaging technique, confirmed the value of axial records. Although computerized tomography and possibly magnetic resonance offers better resolution, ultrasonography has the advantage of being less expensive, convenient, and highly portable. With these specific indications and reservations, ultrasonography of the adrenal and retroperitoneum has an accepted role in imaging.

Adrenal Gland Diseases↗

Laparoscopic adrenalectomy, an initial experience of fifteen cases.

BACKGROUND: Laparoscopic adrenalectomy is an attractive alternative to open surgery, but making the transition can be difficult. AIM: To evaluate the initial experience of a general surgical team at a single institution at making the transition. METHODS: The details of 15 patients undergoing laparoscopic adrenalectomy were prospectively recorded over a 21-month period. RESULTS: Fifteen glands were removed from fifteen patients. Nine of these were left-sided. The mean gland size was 3.4 cm. Pathology included six non-functioning adenomas, four Conn's syndrome, two Cushing's syndrome and three phaeochromocytomas. Mean operating time was 74 minutes (range 31-172 minutes), with one conversion to open procedure. There were no morbidities and no mortality. CONCLUSION: Our initial experience demonstrates this approach to be the ideal technique for removal of benign adrenal tumours with significant advantages for the patient.

Adrenal Gland Diseases↗

Adrenal insufficiency after adrenal hemorrhage.

Acute adrenal hemorrhage (AAH) is an extremely rare disorder, especially in adults, and may be difficult to diagnose because of its nonspecific presentation. We report a case of AAH following a sepsis, resulting in persistant adrenal insufficiency contrasting with the radiologic normalisation of the adrenals on computed tomography (CT) scan imaging.

Acute Disease↗