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PubMed2006

Effects of long-term adrenalectomy on apoptosis and neuroprotection in the rat hippocampus.

Reduction in corticosterone by acute adrenalectomy (5 d) promotes apoptosis in dentate gyrus (DG) granular neurons, an effect concomitant with variations in the expression of the Bcl-2 gene family implicated in apoptotic regulation. However, no studies exist correlating the effect of long-term adrenalectomy (30 d) on the hippocampus in terms of extent of apoptosis and the levels of proteins related to an apoptotic cascade. After 5 d of adrenalectomy, we found an increase in apoptosis of the DG granular region, correlated with an increase in the processing of caspase-9. The magnitude of apoptosis 30 d after adrenalectomy was reduced in the DG granular layer compared with 5 d after adrenalectomy, in close relation to a reduction in the level of processed caspase-9. To understand how the increase in cell survival long after adrenalectomy occurs, we analyzed changes in the expression of genes and proteins related to apoptosis. Long-term adrenalectomy did not change hippocampal pro-apoptotic Bax or antiapoptotic Bcl-2 mRNA levels or protein content with respect to control. However, we found an increase in mRNA levels of the GD's Bcl-x gene, in parallel with the increase in anti-apoptotic BCL-XL protein levels. These results suggest the reduction in apoptosis observed after long-term adrenalectomy occurs through mechanisms that repress proapoptotic genes previously found to be increased at shorter times of adrenalectomy.

Adrenalectomy↗
PubMed1977

Randomized sequential hormonal therapy vs adrenalectomy for metastatic breast carcinoma.

One hundred sixty-one postmenopausal and 65 premenopausal women, a total of 226 patients with metastatic breast carcinoma, were included in this randomized study to evaluate the merits of adrenalectomy as the primary mode of therapy as compared to the customary sequential hormonal manipulation. The 145 evaluable postmenopausal patients were randomized as follows: (1) primary additive hormone therapy first followed by adrenalectomy and (2) primary adrenalectomy followed by chemotherapy and/or additive hormone therapy. When 76 patients in group 1 were compared with 70 patients in group 2 regarding their survival time, there was no essential difference, but the response rate was 20% vs 38.6%, a significant difference. The 55 evaluable premenopausal women were randomized into two groups: (1) oophorectomy followed by adrenalectomy; (2) adrenalectomy-oophorectomy as primary mode of therapy. The response rate in group 1 was 17.4% as compared with 41.9% in group 2, but again there was no difference in the survival time among these two groups. When sequential hormonal manipulation was utilized, only one-third of these patients were subjected to adrenalectomy because of their rapidly deteriorating condition. Adrenalectomy performed as a secondary procedure showed a lower response rate but the total survival time was comparable with primary adrenalectomy patients.

Adrenalectomy↗
PubMed1984

Tamoxifen (Nolvadex) versus adrenalectomy in metastatic breast cancer.

The relative efficacy of adrenalectomy and tamoxifen (Nolvadex) was evaluated in a randomized study of 51 patients with metastatic breast cancer. In 25 patients undergoing adrenalectomy, there were 13 responders. There were 9 responders of 26 patients receiving tamoxifen. There was no statistically significant difference. In the crossover phase, 15 patients received tamoxifen following adrenalectomy and 3 responded, one of the 6 previous adrenalectomy responders and 2 of the 9 adrenalectomy nonresponders. Nine patients underwent adrenalectomy following tamoxifen, and there were five responders, one of two tamoxifen responders and four of seven tamoxifen nonresponders. Both tamoxifen and adrenalectomy were effective modalities, and appear to retain effectiveness in crossover trials. The frequency of remission was similar in both groups treated by both modalities in different sequences. Response rates to adrenalectomy, considered as both primary and secondary therapy, were significantly higher, since 18 of 34 patients (53%) responded to this therapy, whereas 12 of 41 (29%) responded to tamoxifen as either primary or secondary therapy.

Adrenalectomy↗
PubMed1998

Retroperitoneal adrenalectomy: open or endoscopic?

Conventional adrenalectomy requires relatively large incisions. To assess the value of retroperitoneal endoscopic adrenalectomy, a case-control study was performed comparing the endoscopic technique to conventional posterior adrenalectomy. All patients had adrenal tumors less than 7 cm in diameter. Endoscopic retroperitoneal adrenalectomy required more operative time (90 vs. 60 minutes, p < 0.0001) than the open approach but was associated with less blood loss (20 vs. 125 ml, p < 0.0001). Endoscopic adrenalectomy caused less pain postoperatively (p = 0.0005) and was associated with fewer complications (p = 0.035). The hospital stay was shorter after endoscopic adrenalectomy than after open adrenalectomy (p < 0.0001). In conclusion, we advocate endoscopic retroperitoneal adrenalectomy in patients with small adrenal tumors.

Adenoma↗
PubMed1999

Lateral transperitoneal laparoscopic adrenalectomy.

Several laparoscopic approaches to the adrenal gland have been described. The lateral transperitoneal approach has several distinct advantages when contrasted with other techniques for laparoscopic adrenalectomy (LA). We present our technique and results obtained in 50 consecutive transperitoneal LAs. We review 50 consecutive laparoscopic adrenalectomies (28 female, 19 male) performed from 1993 to 1998 S.J. Shichman or R.E. Sosa was either the primary surgeon or the first assistant for all cases. The lateral transperitoneal approach described below was used in all cases. Indications for adrenalectomy included Cushing's syndrome (13), aldosteronoma (15), pheochromocytoma (7), nonfunctioning adenoma (11), hyperplasia (2), and 1 case each of Carney's syndrome and metastasis to the adrenal gland. We performed 5 bilateral, 22 left, and 18 right laparoscopic adrenalectomies. The average time needed for bilateral adrenalectomy was 503 min (range 298-690 min); for left adrenalectomy, 227 min (range 121-337 min); and for right LA, 210 min (range 135-355 min). We demonstrated a yearly trend in lower operative times. The largest adrenal gland removed measured 13.8 x 6.7 x 3.5 cm. Intraoperative blood loss was low. Only one patient received a blood transfusion. Conversion to open adrenalectomy was not required. Postoperative analgesic requirements were low. The average length of stay was 3.8 days for bilateral LA and 3 days for unilateral LA. Complications occurred in 5 patients (2 wound infections, 2 hematomas, and 1 pleural effusion). There was no mortality. Lateral transperitoneal adrenalectomy is a safe and efficient technique for the removal of functional and nonfunctional adrenal masses. This technique is associated with low morbidity, a minimal postoperative analgesic requirement, and a short hospital stay and, in our opinion, is more versatile than the retroperitoneal approach.

Adrenal Gland Neoplasms↗
PubMed2003

Applicability and outcome of laparoscopic adrenalectomy.

Laparoscopic adrenalectomy has been shown to be as safe and effective as conventional open surgery for small and benign adrenal lesions. With increasing experience with laparoscopic adrenalectomy, this approach has become the procedure of choice for the majority of patients requiring adrenalectomy, although careful selection of patients accounts for the favourable clinical outcome observed. Laparoscopic adrenalectomy was adopted as the procedure of choice for patients requiring adrenalectomy in our institution in 1995. From 1995 to 2001, 82 consecutive patients underwent adrenalectomies for various adrenal pathologies. The laparoscopic approach was used for 60 of these patients, whose selection was based on the preoperative size and/or benign nature of the adrenal lesion. The procedures were successfully performed in 57 patients (54 unilateral, 3 bilateral), while three (5%) patients required conversion to open surgery. There was no hospital mortality and complications occurred in two (3%) patients. The median hospital stay was 3 days (range, 2-8 days) and analgesic requirement was minimal. Laparoscopic adrenalectomy can be done for all patients with small and benign adrenal pathologies, and has become the gold standard for patients undergoing adrenalectomies. When successfully performed, the laparoscopic approach offers the advantages of a minimally invasive procedure with improved patient comfort and faster postoperative recovery.

Adolescent↗
PubMed2002

Long-term follow-up and cost benefit of adrenalectomy in patients with primary hyperaldosteronism.

BACKGROUND: The purpose of this study was to evaluate the long-term efficacy of adrenalectomy on blood pressure control in patients with primary hyperaldosteronism (HA), and to analyse the cost of adrenalectomy compared with non-surgical management of HA over the patient's lifetime. METHODS: All patients who underwent an adrenalectomy for HA were recalled to the endocrine surgical clinic. Data gathered included blood pressure, aldosterone : renin ratios and medication. Total costs for adrenalectomy and ongoing medications were compared with the estimated costs of lifelong medical therapy alone. RESULTS: Twenty-four adrenalectomies were performed for HA, with one death. The mean follow-up was 42 (range 13-97) months. Long term, there was a significant decrease in both the mean diastolic and systolic blood pressure. The aldosterone : renin ratio decreased in 21 patients. Of these patients, 20 were either off all antihypertensives (eight) or had a reduction in medication (12). An increased aldosterone : renin ratio occurred in two patients, both of whom required an increase in antihypertensive medication. Using the predicted life expectancy, the mean estimated cost savings over the lifetime of each patient undergoing adrenalectomy compared with medication alone was Canadian $31 132. CONCLUSION: Adrenalectomy for HA resulted in significant long-term reduction in blood pressure. Adrenalectomy for HA is a significantly less expensive than long-term medical therapy alone.

Adrenalectomy↗
PubMed2002

Quality of life after laparoscopic bilateral adrenalectomy for Cushing's disease.

BACKGROUND: Bilateral adrenalectomy to control symptoms of Cushing's disease after failed transsphenoidal operation is effective. We examined surgical outcomes and quality of life after laparoscopic bilateral adrenalectomy for the treatment of Cushing's disease. METHODS: Eighteen patients underwent laparoscopic bilateral adrenalectomy from November 1994 through December 2000. Patient data were obtained from chart reviews. Patients completed a follow-up survey including the SF-36 health survey (QualityMetric Inc, Lincoln, Neb). RESULTS: Laparoscopic bilateral adrenalectomy was accomplished in all 18 patients. There was 1 intraoperative complication of a colotomy, and 2 postoperative complications including 1 pancreatic pseudocyst and 1 hemorrhage. Three patients died at 12, 19, and 50 months after operation. At a median follow-up of 29 months, patients reported improvement in all Cushing's-related symptoms. Nine of 11 patients who responded to the survey stated their heath was improved after adrenalectomy. Results of the SF-36 health survey showed significantly lower scores in all 8 measured parameters when compared with the general population. CONCLUSIONS: Results of laparoscopic bilateral adrenalectomy show this procedure is comparable with open adrenalectomy in controlling symptoms of Cushing's disease. Despite patient reported improvement in health after adrenalectomy, this patient population continues to experience poor health as measured by the SF-36 when compared with the general population.

Adolescent↗
PubMed2005

Laparoscopic transperitoneal adrenalectomy using the LigaSure vessel sealing system.

BACKGROUND: Laparoscopic adrenalectomy is being performed with increasing frequency in the surgical treatment of adrenal tumors. Among laparoscopic approaches to the adrenal glands, the transperitoneal access is preferred. Along with advances in technology, different energy systems have been utilized. Laparoscopic adrenalectomy has become easier with the use of the LigaSure vessel sealing system (Valleylab, Boulder, Colorado). MATERIALS AND METHODS: Between January 2002 and August 2004, 23 laparoscopic transperitoneal adrenalectomies were performed in 22 patients using the LigaSure vessel sealing system: 16 of the patients were female, 6 were male and the mean age was 44 years (range, 17-70 years). Indications for surgery were non-functioning adenoma (n = 10), pheochromocytoma (n = 4), Cushing's syndrome (n = 5), Conn's syndrome (n = 2), and lymphoma (n = 1). The mean diameter of lesions was 4 cm (range, 1-7 cm). The distribution was 12 left, 9 right, and 1 bilateral adrenalectomies. RESULTS: The mean operative time for unilateral adrenalectomies was 57 minutes (range, 30-75 minutes). The operative time for the patient with Cushing's disease in whom a bilateral adrenalectomy was performed was 180 minutes. All operations were completed laparoscopically. A nonsteroidal anti-inflammatory drug (Lornoxicam) was sufficient for postoperative analgesia. Oral feeding was started 6 hours postoperatively. When used, drains were removed on postoperative day 1. The mean postoperative hospital stay was 1.5 days (range, 1-3 days). Wound infections developed in two patients with Cushing's syndrome. There was no mortality. Histopathologic examination of specimens revealed a cortex adenoma in 16 cases (10 of which was nonfunctional), a pheochromocytoma in 4 cases, a bilateral cortical hyperplasia in 1 case, and a lymphoma in 1 case. CONCLUSION: Laparoscopic adrenalectomy is an established method in the treatment of adrenal masses. Laparoscopic adrenalectomy as well as other laparoscopic procedures has become easier with the introduction of new energy systems. Vascular control and dissection of the gland by Liga- Sure is feasible. It makes the procedure easier and eventually shortens the operation time.

Adolescent↗
PubMed2005

Laparoscopic partial versus total adrenalectomy for aldosterone producing adenoma.

PURPOSE: Laparoscopic surgery has become a standard method for adrenal treatment. Primary hyperaldosteronism is known to be frequently characterized by multiple adrenal lesions. The indication of laparoscopic partial or total adrenalectomy in patients with aldosterone producing adenoma (APA) remains controversial. We performed the 2 procedures and compared the outcomes of these 2 operations retrospectively. MATERIALS AND METHODS: A total of 92 patients with primary hyperaldosteronism were laparoscopically treated at our institution from 1995 to 2004. A total of 29 patients underwent partial adrenalectomy or enucleation, while unilateral total adrenalectomy was performed in 63. A single pathologist examined the number and histopathological characteristics of APAs. Postoperative median followup was 60.3 and 29.3 months, respectively. RESULTS: Laparoscopic adrenalectomies were successfully performed in each group, although the partial type had fewer ports and shorter operative time. All 63 patients with total adrenalectomy showed recovery from hypertension, suppressed plasma renin activity and high plasma aldosterone. Two of 29 patients with partial adrenalectomy or enucleation still experienced hypertension with high plasma aldosterone. Of the 63 extirpated specimens 17 adrenals (27.0%) demonstrated multiple space occupying lesions along with the main APA. CONCLUSIONS: Primary hyperaldosteronism is highly associated with multiple adrenal space occupying lesions. The risk-to-benefit ratio must be carefully weighed against the potential advantage of partial adrenalectomy. We chose total laparoscopic adrenalectomy in patients with unilateral APA and primary hyperaldosteronism.

Adenoma↗
PubMed1993

Longitudinal evaluation of adrenocorticotrophin and beta-lipotrophin plasma levels following bilateral adrenalectomy in patients with Cushing's disease.

OBJECTIVES: Bilateral adrenalectomy may be indicated in patients with Cushing's disease in whom hypercortisolism is not resolved after pituitary microsurgery. However, Nelson's syndrome is a major long-term complication of such therapy. We have carried out a longitudinal study on patients with Cushing's disease who underwent bilateral adrenalectomy comparing plasma beta-lipotrophin (beta-LPH) with ACTH levels. PATIENTS AND METHODS: Seven patients unsuccessfully treated by pituitary surgery for Cushing's disease underwent bilateral adrenalectomy. Blood samples were collected on days 8 and 15 and at 1, 2, 3, 6, 9, 12, 18 and 24 months after adrenalectomy in all patients. Five patients were followed up for the longer periods of 30, 33, 39, 72 and 84 months respectively. Plasma ACTH and beta-LPH were determined by RIA after extraction. Pituitary CT scan was done at 6-8 month intervals. RESULTS: A pituitary tumour was detected in three patients at 14, 24 and 26 months after adrenalectomy respectively. The basal ACTH (range 8-21 pmol/l) began to rise between 15 and 30 days and exhibited a sharp increase with a range of 36-114 pmol/l at 3 months and a range of 53-187 pmol/l at 6-9 months after adrenalectomy. The ACTH levels in the three patients who later presented with a pituitary tumour were indistinguishable from those observed in the other patients up to 12 months after adrenalectomy. Only at 12 months or thereafter were their ACTH levels higher than in the other patients (958 +/- 252 vs 205 +/- 22 pmol/l). beta-LPH concentrations changed in parallel with ACTH levels. The ACTH levels correlated positively with beta-LPH levels (r = 0.76). CONCLUSIONS: In patients with Cushing's disease undergoing bilateral adrenalectomy, plasma ACTH and beta-LPH concentrations cannot predict the development of pituitary tumours until 12 months after surgery.

Adolescent↗
PubMed1982

Triphasic changes in plasma ACTH concentration and brain serotonin synthesis rate following adrenalectomy in rats.

Following bilateral adrenalectomy in adult male rats, there occurs a pattern of triphasic change in basal plasma concentration of radioimmunoassayable ACTH. Plasma ACTH is markedly elevated at 2 h, has returned down almost to normal at 20 h and is again markedly elevated 96 h after adrenalectomy. We have examined serotonin (5HT) synthesis rats in several brain regions, anterior hypothalamus, posterior hypothalamus, and brain stem, at these times after adrenalectomy using the accumulation of 5-hydroxytryptophan (5HTP) after inhibition of aromatic L-amino acid decarboxylase with m-hydroxybenzylhydrazine. In both anterior hypothalamus and brain stem, decrease 5HT synthesis rates were observed at 2 and 96 h after adrenalectomy, but at 20 h 5HT synthesis rates were normal. This pattern was not observed in the posterior hypothalamus. Thus, we demonstrated inverse correlations between 5HT synthesis rates in anterior hypothalamus and brain stem, but not posterior hypothalamus, and basal plasma ACTH concentration throughout the period of triphasic change following adrenalectomy in adult male rats. Both the adrenalectomy-induced increases in plasma ACTH concentration and the adrenalectomy-induced decreases in brain 5HT synthesis rates were inhibited by treatment with dexamethasone, suggesting that the changes resulted from glucocorticoid withdrawal. The data are consistent with a role of brain 5HT neurons with cell bodies in brain stem and nerve endings in anterior hypothalamus in the regulation of the triphasic changes in plasma ACTH concentration following adrenalectomy in rats.

5-Hydroxytryptophan↗
PubMed1981

Decreased brain serotonin turnover after short term (two-hour) adrenalectomy in rats: a comparison of four turnover methods.

Within the first 2 h after adrenalectomy in rats there is a marked decrease in hypothalamic, brain stem, and hippocampal serotonin (5HT) turnover. This adrenalectomy-induced decrease in brain 5HT turnover was demonstrated in this study using four different methods. These include 1) accumulation of 5HT after monoamine oxidase inhibition with pargyline, 2) decline of 5-hydroxyindoleacetic acid after pargyline, 3) accumulation of 5-hydroxytryptophan after aromatic L-amino acid decarboxylase inhibition with m-hydroxybenzylhydrazine, and 4) accumulation of 5-hydroxyindoleacetic acid after probenecid. The adrenalectomy-induced decreases in 5HT turnover in these areas were prevented by glucocorticoid treatment with either corticosterone or dexamethasone. The similarity of the results obtained with four different methods of assessment of brain 5HT turnover provides strong evidence to suggest that the activity of 5HT neurons, in at least three brain areas, is decreased within the first 2 h after adrenalectomy. Also, it seems likely that glucocorticoid withdrawal is the important factor in this adrenalectomy-induced decrease in brain 5HT turnover. In addition, an increase in hypothalamic 5HT turnover in response to the surgical stress of sham adrenalectomy could be demonstrated. The adrenalectomy-induced decreases in brain 5HT turnover were also prevented by the administration of the serotonin receptor antagonist, pizotifen. In addition, serotonin receptor blockade with pizotifen inhibited the effect of corticosterone to normalize the adrenalectomy-induced changes in both the plasma ACTH concentration and brain 5HT turnover. These data provide further support for an interaction between glucocorticoids and brain 5HT neurons.

Adrenalectomy↗
PubMed1984

Examination of prolactin and pituitary-adrenal axis components as intervening variables in the adrenalectomy-induced inhibition of gonadotropin response to castration.

Adrenalectomy performed at the same time as, or 12 h after, castration delays the postcastration rise in LH and FSH for at least 12 h. We tested three mechanisms previously advanced as possible mediators in this suppression: 1) blocking PRL in castrate-adrenalectomized males with bromoergocryptine did not restore the normal postcastration rise in serum LH and FSH, eliminating high PRL levels as a cause of this gonadotropin suppression; 2) exogenous ACTH given at the time of orchidectomy did not inhibit either gonadotropin, eliminating high peripheral ACTH as an agent of adrenalectomy-induced suppression of LH and FSH; and 3) intestinal traction performed at the same time as orchidectomy suppressed the secretion of LH and FSH to the same degree as adrenalectomy, ruling out the lack of any adrenal factor as a means by which adrenalectomy blocked gonadotropin secretion. Our data suggest that the adrenalectomy-induced suppression of LH is due to a neurally mediated stress response probably resulting in suppression of GnRH secretion. In other treatment groups, we implanted cortisol before surgery to test the effect of ACTH suppression on LH and FSH secretion in castrate-adrenalectomized animals. A striking divergence between LH and FSH was seen in response to cortisol treatment. Cortisol suppressed LH, but not FSH, in castrate animals, and restored postcastration FSH, but not LH, secretion 12 h after combined castration-adrenalectomy. This divergence between LH and FSH secretion suggests that the effect of adrenalectomy on the two gonadotropins might result from different mechanisms. It is also possible that the differential effect of cortisol on LH and FSH secretion is not relevant to the effect of adrenalectomy on the postcastration secretion of these gonadotropins. These data add to the evidence, however, that LH and FSH are regulated by different mechanisms under many experimental conditions, including stress and elevated corticoid levels.

Adrenalectomy↗
PubMed1995

Regulation of hypothalamic and pituitary corticotropin-releasing hormone receptor messenger ribonucleic acid by adrenalectomy and glucocorticoids.

The effects of adrenalectomy and glucocorticoids on the regulation of corticotropin-releasing hormone (CRH) receptor expression in the hypothalamic paraventricular nucleus (PVN) and pituitary were studied by in situ hybridization in the rat using a complementary RNA probe directed toward the coding region of the type 1 CRH receptor. Eighteen hours after adrenalectomy, CRH receptor messenger RNA (mRNA) expression in the PVN was significantly increased, whereas longer term adrenalectomy (4 and 6 days) had no effect. This transient effect of adrenalectomy was prevented by glucocorticoid replacement. In intact rats, 4 h after immobilization for 1 h or a single ip hypertonic saline injection, CRH receptor mRNA in the PVN markedly increased (P < 0.01), an effect that was unchanged by adrenalectomy (4 or 6 days) or dexamethasone injection (100 micrograms at -14 and 50 micrograms at -1 h) before stress. In the pituitary, CRH receptor mRNA levels decreased transiently after adrenalectomy (-62% after 18 h), returning to basal levels 4 or 6 days after adrenalectomy. The early decrease was prevented by glucocorticoid replacement. In intact rats, dexamethasone (100 micrograms, sc) caused a significant decrease in pituitary CRH receptor mRNA levels 2-10 h after injection, returning to basal levels after 15 h. On the other hand, dexamethasone (5-300 micrograms, sc) had no effect on pituitary CRH receptor mRNA levels 18 h after injection. The data show that although stress stimulation of CRH mRNA in the PVN is glucocorticoid independent, basal levels are likely to be under dual, transcriptional and posttranscriptional, control by glucocorticoids. In the pituitary, changes in hypothalamic CRFs probably play a major role in the control of CRH receptor mRNA levels during manipulations of circulating glucocorticoids levels. In addition, the inability of long term adrenalectomy and glucocorticoid administration to modify pituitary CRH receptor mRNA levels suggests that CRH receptor down-regulation observed under these experimental conditions depends mainly on translational and post-translational events rather than receptor mRNA levels.

Adrenalectomy↗
PubMedDate not supplied

Experience with laparoscopic adrenalectomy in children.

In a review of 109 cases reported in the literature, including our own experience with two successful right laparoscopic adrenalectomies performed in a 3-year old girl for androgen-secreting adenoma and in a 9-year-old male for pheochromocytoma, we analysed the indications, surgical techniques and results of video-assisted (laparoscopic or retroperitoneoscopic) adrenalectomy in children. The indications are no different from those for traditional surgery. It seems that there are no age or tumour size limits for a well-trained surgical team. The best endoscopic approach needs to be more clearly defined. Experience shows that laparoscopy is undoubtly preferred for right adrenalectomy (95.2% of cases), while left adrenalectomy has been performed by retroperitoneoscopy in 30% of cases. Considering the conversion rate of laparoscopy vs retroperitoneoscopy (12.5% vs 28.5%), right laparoscopic vs right retroperitoneoscopic adrenalectomy (4.7% vs 100%) and left laparoscopic vs left retroperitoneoscopic adrenalectomy (5% vs 16.6%) and on the basis of our experience in adults, we recommend laparoscopic adrenalectomy via a transperitoneal route in 45-degree flank decubitus for both right and left adrenal lesions. However, we think that the best surgical result can be achieved if the paediatric and adult surgeon collaborate with their different experience and expertise. As a technical point, we would like to stress that because of the child's small peritoneal cavity, trocar placement must be lower than in adults. Lastly, we suggest the use of new technological devices such as the Ultracision Harmonic Scalpel, which was a critical factor in our two successful right laparoscopic adrenalectomies.

Adenoma↗
PubMed1985

Effects of adrenalectomy and gonadectomy on the antinociceptive effect of morphine and naloxone antagonism in mice.

In the present study the effects of adrenalectomy and gonadectomy on the antinociceptive activity of morphine and its antagonism by naloxone were studied in male and female mice. In the female mice, it was found that adrenalectomy enhanced the antinociceptive activity of morphine by two-fold, while the antinociceptive effects of morphine measured in the presence of naloxone were similar to those of the sham-operated controls. The naloxone potency ratios, expressed as the ratios of morphine ED50s with naloxone to that without naloxone, were increased in adrenalectomised animals. Similar effects were observed in oophorectomised female mice though the influence of oophorectomy on naloxone antagonism was not as effective as adrenalectomy. In animals that were both adrenalectomised and oophorectomised the antinociceptive effect of morphine measured was similar to those animals receiving either operative procedure. However, the naloxone potency ratios determined were between those determined in adrenalectomised mice and oophorectomised animals. In male mice, the effect of adrenalectomy was similar to that observed in the female animals, namely both the antinociceptive activity of morphine and naloxone antagonism were enhanced. Orchidectomy enhanced the antinociceptive effect of morphine but not to the same extent as adrenalectomy. Furthermore, the enhancement of naloxone antagonism was also less than that induced by adrenalectomy. The effects of adrenalectomy and orchidectomy in male mice were similar to those of adrenalectomy alone. These results suggest that steroid hormones are involved in the actions of both morphine and naloxone.

Adrenalectomy↗
PubMed1995

Adrenalectomy for treatment of hyperadrenocorticism in cats: 10 cases (1988-1992).

Outcome of and complications associated with bilateral adrenalectomy in 8 cats with pituitary-dependent hyperadrenocorticism and bilateral adrenocortical hyperplasia and outcome of and complications associated with unilateral adrenalectomy in 2 cats with adrenocortical tumor (adrenocortical adenoma, 1 cat; adrenocortical carcinoma, 1 cat) and unilateral adrenomegaly were determined. Glucocorticoids were administered to all cats at the time of surgery, and mineralocorticoids were administered to the 8 cats that underwent bilateral adrenalectomy. A ventral midline celiotomy was performed in all cats. Intraoperative complications did not develop in any cat. Postoperative complications developed in all cats and included abnormal serum electrolyte concentrations (n = 8), skin lacerations (n = 5), pancreatitis (n = 3), hypoglycemia (n = 2), pneumonia (n = 1), and venous thrombosis (n = 1). Three cats died within 5 weeks after surgery of complications associated with sepsis (n = 2) or thromboembolism (n = 1). Clinical signs and physical abnormalities caused by hyperadrenocorticism resolved in the remaining 7 cats 2 to 4 months after adrenalectomy. Insulin treatment was discontinued in 4 of 6 cats with diabetes mellitus. Median survival time for these 7 cats was 12 months (range, 3 to > 30 months). Two cats died of acute adrenocortical insufficiency 3 and 6 months after bilateral adrenalectomy, 2 cats were euthanatized because of chronic renal failure 3 and 12 months after bilateral (n = 1) or unilateral (n = 1) adrenalectomy, and 2 cats were alive 9 and 14 months after bilateral adrenalectomy. In the remaining cat, clinical signs recurred 10 months after the cat had undergone unilateral adrenalectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenalectomy↗