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PubMedDate not supplied

Laparoscopic adrenalectomy for adrenal tumours causing hypertension and for 'incidentalomas' of the adrenal on computerized tomography scanning.

1. In a 19 month period from June 1993 to December 1994, 60 patients (mean age 54.8 +/- 1.5 years s.e.m.; 32 males, 28 females) underwent unilateral laparoscopic adrenalectomy by one of us (JCR) for the treatment of hypertension due to primary aldosteronism (n = 48), phaeochromocytoma (n = 3) and cortisol-producing adenoma (n = 1) or to remove adrenal massess incidentally discovered on abdominal computerized tomography scanning ('incidentaloma') performed for other reasons (seven adenomas without biochemical evidence of excessive steroid hormone or catecholamine secretion and one carcinoma autonomously producing cortisol). 2. Compared with conventional open procedures, laparoscopic adrenalectomy was associated with reduced recovery time and a low complication rate (one pulmonary embolus and one port site incisional hernia). 3. Operation time with experience approximates that of open procedures (60 min), but is significantly longer in obese than in non-obese patients, and in males than in females. 4. Patients with adrenal causes of hypertension were cured or significantly improved by laparoscopic unilateral adrenalectomy. 5. Because of our concern regarding malignant potential of incidentalomas and high patient acceptance of laparoscopic techniques, we have reduced our size criteria for removal of incidentalomas.

Adenoma↗
PubMed1997

Aldosterone-producing adrenocortical carcinoma metastases found seven years after adrenalectomy.

We report a case of metastatic adrenocortical carcinoma detected 7 years after adrenalectomy. A 52-year-old woman, who had undergone adrenalectomy for an aldosterone-producing adrenocortical carcinoma at age 45, was found on examination by computerized tomography to have enlarged paraaortic lymph nodes. These nodes were surgically resected, and the histological diagnosis from the resected tissue was metastatic adrenocortical carcinoma. The patient has now survived for more than 9 years following the original adrenalectomy. Evidence suggests that this was a slow-growing tumor, because the primary tumor was sharply demarcated and the metastases were found 7 years after the original operation. We believe that aggressive surgical resection of metastatic lesions could lead to prolonged survival in patients with adrenocortical carcinomas of this type.

Adrenal Cortex Neoplasms↗
PubMed1997

Laparoscopic adrenalectomy for bilateral pheochromocytoma: a case report.

We report a case of bilateral (2.4-cm left and 6.5-cm right) adrenal pheochromocytoma in a 27-year-old man that was treated by laparoscopic adrenalectomy. The patient had no evidence of multiple endocrine neoplasia, type II. The left adrenalectomy was performed first, with the patient in a semilateral position, and then the patient was turned before the procedure was begun on the right side. His postoperative convalescence was uneventful, and he continues corticosteroid replacement therapy. Transperitoneal laparoscopic adrenalectomy can be a safe procedure for bilateral pheochromocytoma, if the patients are carefully selected and the procedures are performed by experienced laparoscopists.

Adrenalectomy↗
PubMed2004

Anatomical reconsideration to renal area: lessons learned from radical nephrectomy or adrenalectomy through a minimal incision over the 12th rib.

BACKGROUND: To perform radical nephrectomy or adrenalectomy through a minimal incision over the 12th rib and to compare this with the traditional supracostal or transcostal approach. We review and clarify the related surgical anatomy through close observation. METHODS: We performed radical nephrectomy in six patients with upper urinary tract carcinoma through a minimal incision over the 12th rib and in five patients with renal cell carcinoma through a medium-sized incision, and adrenalectomy in five patients (bilaterally in one) again through a minimal incision over the 12th rib. During surgery, special points were noted to find out the differences between the new minimal-incision approach and the conventional approach. RESULTS: The procedures were accomplished smoothly with no complications through either a minimal or medium-sized incision. From our observation, it is clear that most of the procedures involved in the minimal-incision approach were and should be carried out within the space created in the retroperitoneum beneath the lateroconal fascia. CONCLUSION: Entering the correct anatomical planes posteriorly and anteriorly in the renal fasciae is a prerequisite for full mobilization of the kidney, together with the perinephric fat. To perform this, recognition of the lateroconal fascia and incising it along the correct lines are of the utmost importance for minimal-incision radical nephrectomy and adrenalectomy. Furthermore, this anatomical approach is also important for the conventional open approach and laparoscopic approach.

Adrenalectomy↗
PubMed2005

Laparoscopic adrenalectomy in patients with large adrenal tumors.

OBJECTIVES: The maximum size of adrenal tumors that should be removed by laparoscopic adrenalectomy is controversial. We conducted a retrospective comparison of the results of laparoscopic adrenalectomy between patients with adrenal tumors > or =6 cm ('large tumors') and patients with adrenal tumors <6 cm ('small tumors'). METHODS: The participants in the study were 16 patients with large tumors and 111 patients with small tumors. The patients comprised 59 men and 68 women (mean age, 49.0 years; age range, 23-79) with varying diagnoses. Of the 16 patients with large tumors, five had Cushing's syndrome, four had pheochromocytomas, six had a non-functional tumor and one had malignant lymphoma. Adrenal tumors were confirmed by hormonal assays, biochemical tests and computed tomography. Of the 16 large tumors, five tumors were on the right and 11 were on the left. RESULTS: We found no significant differences in general demographic parameters between patients with large and small tumors. The mean duration of surgery was not significantly different between two groups. (large tumors, 210 min; small tumors,175 min). The mean volume of blood loss was 212 mL for large tumors and 30 mL for small tumors (P < 0.001, significant difference). There was no significant difference in time until walking, duration of hospitalization or number of using analgesics used. The time to first oral intake of group 1 (<6 cm) was significantly shorter than group 2 (> or =6 cm). Tumor size (> or =7.5 cm) was an independent predictor of a longer operation and greater blood loss in large tumors. CONCLUSIONS: Laparoscopic adrenalectomy for large tumors was safe and minimally invasive.

Adrenal Gland Neoplasms↗
PubMed2004

Laparoscopic adrenalectomy for phaeochromocytoma: with caution.

INTRODUCTION: Laparoscopic adrenalectomy is well described and many series include patients with phaeochromocytoma. Our aim was to establish whether laparoscopic adrenalectomy for phaeochromocytoma was a safe and feasible technique at our institution. METHODS: Patients requiring adrenalectomy were entered into a prospective database that included patient details, operative data, hormone excretion, tumour size, hospital stay and complications. All operations were performed under the supervision of a single surgeon. Analysis was performed for those patients with a diagnosis of phaeochromocytoma. RESULTS: Of 60 patients having laparoscopic adrenal surgery, 18 had phaeochromocytoma as the indication. Seventeen (89%) of 19 tumours in these 18 patients were successfully removed laparoscopically. Median operative time was 180 min (range 130-300 min) and this was significantly longer compared with other adrenal pathology. The median tumour size was 6 cm which was significantly larger than other adrenal tumours. Seven (38%) patients developed complications and median postoperative inpatient stay was 5 days (range 3-8 days). CONCLUSIONS: The postoperative stay was equivalent to other laparoscopic series and laparoscopic removal was successful in 89%. The laparoscopic approach to the adrenal gland in phaeochromocytoma is safe and effective treatment.

Adolescent↗
PubMed1997

Plasticity in the stress-regulating circuit: decreased input from the bed nucleus of the stria terminalis to the hypothalamic paraventricular nucleus in Wistar rats following adrenalectomy.

The bed nucleus of the stria terminalis is involved in the stress-regulating circuit by funnelling limbic information to the hypothalamic paraventricular nucleus. Since adrenalectomy influences both limbic structures (by inducing cell death in the hippocampus) and the hypothalamic paraventricular nucleus (by increased corticotrophin-releasing hormone synthesis), we investigated whether the bed nucleus of the stria terminalis is also influenced by adrenalectomy. For this purpose, we analysed and compared the projections from the bed nucleus of the stria terminalis to the hypothalamic paraventricular nucleus in normal and adrenalectomized rats by anterograde tracer injections in the bed nucleus of the stria terminalis. Quantitative analysis of the fibre pattern in the hypothalamic paraventricular nucleus of normal rats revealed a homogeneous distribution of fibres of the bed nucleus of the stria terminalis over the different subdivisions of the hypothalamic paraventricular nucleus. In adrenalectomized rats, the absolute fibre density was significantly lower in the whole hypothalamic paraventricular nucleus (1.17 +/- 0.27 10(-3) microm/microm3 in adrenalectomized rats versus 2.59 +/- 0.24 10(-3) microm/microm3 in normal rats; P < 0.01) and all its subdivisions. The largest decrease of fibre density was found in the corticotrophin-releasing hormone-rich part of the hypothalamic paraventricular nucleus (relative fibre density; adrenalectomized rats: 0.602 +/- 0.106, versus 1.095 +/- 0.019 in normal rats, P < 0.01). These results show a loss of input from the bed nucleus of the stria terminalis to the hypothalamic paraventricular nucleus, and particularly to the corticotrophin-releasing hormone neurons, following adrenalectomy. The data suggest that this pathway within the stress-regulating circuit is functionally affected by corticosteroids in adult rats and may imply that human disorders associated with corticosteroid imbalance are allied to a changed circuitry in the brain.

Adrenalectomy↗
PubMed2004

Robot-assisted laparoscopic adrenalectomy: preliminary UK results.

OBJECTIVE: To describe the results of our first two cases of laparoscopic adrenalectomy using the da Vinci surgical system (Intuitive Surgical, Inc., Mountain View, CA, USA). PATIENTS AND METHODS: Amongst 75 robot-assisted procedures performed at our institution, two patients underwent robot-assisted laparoscopic adrenalectomy. The set-up time, procedure time, hospital stay, complications and outcomes were recorded. RESULTS: Both operations were completed successfully using the robot; the mean (range) set-up time was 31 (25-37) min and mean procedure time 118.5 (107-130) min. One patient had a postoperative pulmonary embolus and was discharged 5 days after surgery; the second patient was discharged after 3 days. There were no intraoperative complications; both patients were well at the 1-year follow-up. CONCLUSIONS: Robot-assisted laparoscopic adrenalectomy is technically feasible and can be conducted efficiently and safely with the da Vinci surgical system.

Adenoma↗
PubMed1988

Stress-related changes in cerebral catecholamine and indoleamine metabolism: lack of effect of adrenalectomy and corticosterone.

The concentrations of catecholamine and indoleamine metabolites were measured in intact and adrenalectomized mice to determine whether adrenal hormones mediate or modulate the stress-induced responses. Thirty minutes of footshock resulted in significant increases of the ratios of the dopamine (DA) catabolite, dihydroxyphenylacetic acid (DOPAC), to DA in prefrontal cortex, nucleus accumbens, striatum, hypothalamus, and brainstem, and of homovanillic (HVA)/DA ratios in nucleus accumbens, striatum, amygdala, and hypothalamus. Ratios of 3-methoxy-4-hydroxyphenylethyleneglycol to norepinephrine (NE) were also increased in prefrontal cortex, nucleus accumbens, septum, amygdala, hypothalamus, hippocampus, and brainstem. The concentration of NE was decreased in amygdala. 5-Hydroxyindoleacetic acid (5-HIAA)/5-hydroxytryptamine (5-HT, serotonin) ratios and free tryptophan were also increased in every brain region. Very similar data were obtained from mice restrained for 30 min. Adrenalectomy resulted in increased HVA/DA ratios in prefrontal cortex and striatum, and 5-HIAA/5-HT in septum. The stress-related changes were largely similar in adrenalectomized mice. Significant interactions between adrenalectomy and footshock treatment occurred in prefrontal cortical DOPAC/DA and hypothalamic NE which was depleted only in adrenalectomized mice, suggesting tendencies for these measures to be more responsive in adrenalectomized mice. Corticosterone administration (0.5-2.0 mg/kg s.c.) which resulted in plasma concentrations in the physiological range did not alter the concentrations of the cerebral metabolites measured in any region. We conclude that adrenal hormones do not mediate cerebral catecholamine or indoleamine metabolism in stress, although adrenalectomy may affect HVA and 5-HIAA metabolism, and there was a tendency for catecholamines to be more sensitive to stress in adrenalectomized animals.

3,4-Dihydroxyphenylacetic Acid↗
PubMed1989

Enhanced brain cell proliferation following early adrenalectomy in rats.

We have previously demonstrated an increase in adult brain DNA content in rats adrenalectomized on postnatal day 11. The present studies examined cell proliferation in cerebral cortex, cerebellum, hippocampus, and midbrain-diencephalon following adrenalectomy at this age. Compared to sham-operated controls, adrenalectomized animals showed increased [3H]thymidine incorporation into DNA (measured at 1 h following a pulse injection) in all brain regions at 7 and 14 days postsurgery. In some areas, the effect was already present as early as 2 days following adrenalectomy. Chronic replacement with corticosterone prevented this increase in DNA labelling in a dose-dependent manner. When cell proliferation in the cerebral cortex and cerebellum was independently assessed by measuring changes in thymidine kinase activity, enzyme activity was significantly elevated in both areas at 7 and 14 days postsurgery. Finally, histological examination of the cerebellar cortex suggested a delayed disappearance of the external granular layer in several cerebellar lobules of adrenalectomized animals. Overall, these findings indicate that day-11 adrenalectomy leads to a prolonged stimulation of mitotic activity in areas where cell formation at this time is exclusively glial (i.e., cerebral cortex and mid-brain-diencephalon) as well as in areas where postnatal neurogenesis is also occurring (cerebellum and hippocampus). It is hypothesized that this stimulation results from the removal of a tonic inhibitory effect exerted by circulating glucocorticoids in the normal intact animal.

Adrenalectomy↗
PubMed2000

The effects of PACAP on insulin secretion and glucose disposal are altered by adrenalectomy in mice.

We previously showed that pituitary adenylate cyclase-activating polypeptide (PACAP) potently stimulates insulin secretion in vivo in mice without altering glucose disposal. Such a combination of results would be explained if epinephrine released by PACAP counteracts the action of insulin and, therefore, that the glucose disposal after PACAP administration is altered by adrenalectomy. In the study reported in this paper, we examined the influence of PACAP27 (1.3 nmol/kg i.v.) on insulin secretion and glucose disposal during an intravenous glucose (1 g/kg) tolerance test in mice subjected to bilateral adrenalectomy 48 h prior to the tolerance test. We found that in control mice, PACAP potentiated glucose-stimulated insulin secretion threefold without affecting glucose disposal. Adrenalectomy potentiated the augmentation by PACAP27 of glucose-stimulated insulin secretion, and in adrenalectomized mice, PACAP27 simultaneously augmented glucose disposal (elimination rate 2.30 +/- 0.07%/min vs. 2.56 +/- 0.05%/min; p = 0.011). Furthermore, PACAP27 augmented glucose elimination stimulated by i.v. insulin administration only in adrenalectomized, but not in control mice. We, therefore, conclude that under in vivo conditions, epinephrine released by PACAP from the adrenals prevents the marked insulinotropic action of the peptide from augmenting glucose disposal.

Adrenal Glands↗
PubMed1975

Renal excretion of monovalent cations during functional adrenalectomy in conscious sheep.

In sheep with both adrenals removed and one re-implanted in the neck, functional adrenalectomy was produced in conscious undisturbed animals by occluding the blood supply to the transplanted gland. Functional adrenalectomy caused a fall in potassium excretion and a very large increase in sodium excretion and was reversed by aldosterone. Hydrocortisone infusions slightly increased potassium excretion and reduced solute-free water reabsorption. Preliminary evidence suggests that potassium secretion into urine was still occurring during the 8 hr period of adrenal occlusion and functional adrenalectomy.

Adrenalectomy↗
PubMed1988

Effects of adrenalectomy and glucocorticoids on the peptides CRF-41, AVP and oxytocin in rat hypophysial portal blood.

1. The effects of adrenalectomy (3 weeks) and dexamethasone (3 h) treatment on the release of corticotrophin-releasing factor-41 (CRF-41), arginine vasopressin (AVP), oxytocin (OT), adrenocorticotrophin (ACTH) and corticosterone were studied in adult female Wistar rats. 2. The animals were anaesthetized with sodium pentobarbitone which, as assessed by the effects on the circadian rhythm of plasma ACTH and corticosterone, appeared to be a better anaesthetic than either urethane or alphaxalone for studies on the hypothalamic-pituitary-adrenal system. 3. Adrenalectomy increased the concentrations of ACTH in peripheral plasma and the output of CRF-41 and AVP into hypophysial portal plasma. 4. Dexamethasone administered to adrenalectomized rats significantly reduced the concentration of ACTH in peripheral plasma and the amount of AVP released into portal plasma. However, dexamethasone did not affect the output of CRF-41 into portal blood. 5. The output of OT into portal plasma was unaffected by either adrenalectomy or dexamethasone treatment. 6. Dexamethasone administered to adrenalectomized rats reduced significantly the ACTH response to CRF-41. 7. These results show that the feed-back action of glucocorticoids is mediated by two mechanisms. The increased release of ACTH which follows adrenolectomy [corrected] is produced predominantly by an increased release of both CRF-41 and AVP into hypophysial portal blood. The intermediate negative feed-back of glucocorticoids is produced by a reduction in the output of AVP but not CRF-41 into portal blood and, as well, by a significant reduction in the responsiveness of the anterior pituitary gland to CRF-41.

Adrenalectomy↗
PubMed2003

Three-dimensional volume-rendered helical CT before laparoscopic adrenalectomy.

Use of three-dimensional (3D) volume-rendered helical computed tomography (CT) in surgical planning before laparoscopic adrenalectomy was evaluated in a retrospective study. In 35 consecutive patients before laparoscopic adrenalectomy, 3D volume-rendered CT scans were created from helical CT scans. Videotapes that showed anterior, lateral, posterior, and posterocephalic approaches were assessed retrospectively. The relationship (not contacting, abutting, displacing, or invading) of adrenal masses to adjacent organs (diaphragm, liver, spleen, kidneys, stomach, pancreas, and vessels) was recorded and compared with findings in surgery reports. When such findings were available, they corresponded to those in the videotape. Three-dimensional volume-rendered CT successfully displayed the relationship of adrenal masses to adjacent anatomic structures and organs before laparoscopic adrenalectomy.

Adrenal Glands↗
PubMed1986

Thermogenesis and sympathetic activity in BAT of overfed rats after adrenalectomy.

Resting oxygen consumption was elevated by 30% in young rats fed a cafeteria diet compared with their chow-fed controls and by 22% in cafeteria-fed, adrenalectomized (ADX) rats compared with the ADX chow-fed group, but injection of propranolol reduced oxygen consumption in the cafeteria-fed animals and abolished these differences. Brown adipose tissue (BAT) mass was increased by cafeteria feeding, and the activity of the mitochondrial proton conductance pathway (assessed from purine nucleotide binding) was enhanced by adrenalectomy and by cafeteria feeding. Norepinephrine turnover in BAT (determined from the time-dependent loss of tissue [3H]norepinephrine specific activity) was increased by 105% in sham-operated, cafeteria-fed rats, by 142% in chow-fed ADX rats, and by 400% in cafeteria-fed ADX rats, compared with chow-fed controls. Cardiac norepinephrine turnover was elevated by 80% in sham-operated, cafeteria-fed rats, but unaffected by adrenalectomy. These data indicate that the enhanced thermogenesis and BAT activity induced by adrenalectomy in chow- or cafeteria-fed rats is due to increased sympathetic activity in the tissue.

Adipose Tissue, Brown↗
PubMed1989

Adrenalectomy prevents obesity in glutamate-treated mice.

Mice treated with monosodium glutamate (MSG) in the neonatal period grow into obese, stunted adults without overeating. We have previously demonstrated normal control of brown adipose tissue (BAT) thermogenic function in the MSG-treated mouse and have concluded that thermoregulation at a lower than normal body temperature for most of the time is a major cause of its obesity. The objective of the present experiments was to find out whether adrenalectomy would prevent obesity in the MSG-treated mouse, as it does in hyperphagic obese rodents, and whether the thermoregulatory anomaly would be prevented by this procedure. MSG-treated mice that were adrenalectomized at 5 wk of age and studied at 10 wk of age did not become obese. Adrenalectomy increased body temperature of MSG-treated mice to normal (male mice) or almost normal (female mice). Adrenalectomy increased BAT mitochondrial guanosine 5'-diphosphate binding in MSG-treated mice, indicative of an increased thermogenic state, but had the same effect in control mice. We conclude that obesity in the MSG-treated mouse is secondary to the high level of corticosterone in its blood, which raises its metabolic efficiency, an effect of corticosterone also seen in normal lean mice, and causes it to thermoregulate at a low energy-conserving level. This latter effect is peculiar to the MSG-treated mouse and is not seen in corticosterone-treated normal mice.

Adipose Tissue, Brown↗
PubMed1985

Hypothalamic obesity after hypophysectomy or adrenalectomy: dependence on corticosterone.

Recent studies have found that the hyperphagia and obesity resulting from lesions of the ventromedial hypothalamus (VMH) are both reversed and prevented by complete adrenalectomy. Several previous experiments, however, reported little or no suppression of VMH weight gain in hypophysectomized (HYPOX) rats. This study directly compared the effects of hypophysectomy and adrenalectomy on hypothalamic obesity in adult female rats. Complete adrenalectomy (i.e, stress-induced plasma corticosterone less than 1.0 micrograms/dl) totally suppressed abnormal weight gain in the first 20 days after VMH lesions but did not affect intracranial self-stimulation. Hypophysectomy also resulted in suppression of weight gain, but the HYPOX-VMH rats nevertheless gained significantly more weight than HYPOX rats with sham lesions. However, the HYPOX-VMH animals had very low levels of plasma corticosterone and adrenocorticotropin (ACTH) (from residual pituitary tissue or of diencephalic origin), and incompletely adrenalectomized rats with similar low levels of plasma corticosterone gained an equal amount of weight after VMH lesions. It was concluded that adrenal glucocorticoid hormones play a largely permissive role in the VMH syndrome, with only very small levels required for the manifestation of obesity.

Adrenalectomy↗
PubMed1989

Adrenalectomy and response to corticosterone and MSH in the genetically obese yellow mouse.

Animals with the viable yellow (Avy/a) gene and their corresponding lean control black mice (a/a) were adrenalectomized or sham adrenalectomized, and changes in body weight, body composition, corticosterone, and GDP-binding to mitochondria isolated from interscapular brown adipose tissue (IBAT) were measured. Adrenalectomy slowed the weight gain of both the yellow obese mice and the black lean mice, but the reduction was greater in the yellow mice. Food intake was significantly reduced in the yellow mice. Adrenalectomy in the yellow mouse was associated with an increase in lean mass and a significant decrease in weights of fat depots. Blood glucose concentrations of the adrenalectomized yellow mice were reduced to levels similar to those of lean mice, but insulin levels, although lower than sham-adrenalectomized yellow mice, remained significantly higher than in lean animals. GDP binding to IBAT mitochondria increased after adrenalectomy in both phenotypes to values that were similar. Corticosterone replacement in adrenalectomized yellow mice produced a dose-dependent increase in body weight that was associated with a decrease in muscle weight and an increase in adipose tissue weight. Both desacetyl-melanocyte-stimulating hormone (MSH) and alpha-MSH interacted with corticosterone to increase body weight gain of adrenalectomized yellow mice. Desacetyl-MSH was more effective than alpha-MSH on increasing adipose tissue and liver weights. The effects of desacetyl-MSH on food intake, weight gain, and tissue weights were independent of the adrenal gland or of corticosterone.

Adipose Tissue, Brown↗