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At least 919 records · Page 51Linked to original sources
PubMed1986

Effect of adrenalectomy on in vivo glucose metabolism in insulin resistant Zucker obese rats.

Lean (Fa/?) and obese (fa/fa) Zucker rats were adrenalectomized (ADX) in order to assess the contribution of adrenal hormones to insulin resistance of the obese Zucker rat. Glucose utilization was measured using an insulin suppression test. Sham-operated obese rats gained almost twice as much weight as sham-operated lean littermates. However, body weight gain of ADX animals was comparable in both genotypes. It was significantly less than that of the respective sham-operated controls. Body weight differences can be accounted for almost entirely by a marked loss of adipose tissue. Although insulin resistance may be attributable to obesity in part, steroid hormones are thought to be directly antagonistic to insulin for glucose metabolism. Adrenalectomy resulted in a decrease in serum glucose concentrations for both lean and obese Zucker rats compared with their respective sham-operated groups. Serum insulin concentration of lean ADX rats was 23% of sham-operated controls; in obese ADX rats, it was 9% of controls. Elevated levels of steady state serum glucose (SSSG) levels in sham-operated obese rats demonstrate a marked resistance to insulin induced glucose uptake compared with sham-operated lean animals. Adrenalectomy caused a marked improvement in insulin sensitivity of obese rats. The hyperglycemic SSSG levels of the obese rats were reduced 2.5 times by ADX. These results indicate that insulin resistance of Zucker obese rats can be ameliorated by ADX, suggesting adrenal hormones contribute to insulin resistance in these animals.

Adrenal Cortex Hormones↗
PubMed1984

Effects of diabetes on glucose oxidation in rat aorta after hypophysectomy and adrenalectomy.

The influence of diabetes, hypophysectomy and adrenalectomy on glucose oxidation in rat aorta was studied. Diabetes was induced in normal, adrenalectomized and hypophysectomized-cortisone substituted rats by streptozotocin (65 mg/kg body weight). The oxidation of glucose to CO2 was determined during incubation of rat aorta in vitro for 2-3 hours. The aortic glucose oxidation was reduced after hypophysectomy but was unaffected by adrenalectomy. After streptozotocin treatment the rise in blood glucose concentration was similar in normal, adrenalectomized and hypophysectomized-cortisone substituted rats. In shamoperated diabetic rats the aortic glucose oxidation was reduced after a diabetes duration of 4 days. In adrenalectomized diabetic rats the aortic glucose oxidation was not significantly affected after 4 days but was reduced after a diabetes duration of 14 days. When adrenalectomized diabetic rats were treated with hydrocortisone the aortic glucose oxidation was reduced after diabetes for 4 days. After incubation of normal rat aorta in vitro for 6 hours with cortisol (1 microgram/ml) in the incubation medium a decrease in the aortic glucose oxidation was found. Incubation of aorta with only growth hormone had no effect. These results suggest that cortisol is of importance for the lowered glucose oxidation in diabetic rat aorta.

3-Hydroxybutyric Acid↗
PubMed1995

[Endoscopic retroperitoneal adrenalectomy].

AIM OF STUDY: To determine prospectively in consecutive patients the value of endoscopic retroperitoneal adrenalectomy. PATIENTS AND METHODS: Between March 1994 and March 1995, endoscopic adrenalectomy via a retroperitoneal approach was performed in eleven patients (three men, eight women; median age 61 [48-73] years), unilateral in nine, bilateral in two. The procedure was indicated if the adrenal tumour was thought to be benign and no larger than 5 cm in diameter (two adrenal and two central Cushing's syndromes; three incidentally detected adrenal adenomas, two phaeochromocytomas, two Conn adenomas). RESULTS: Twelve of the 13 procedures were successfully performed. In one case the primary incision in the mid-axillary line had been too large and no satisfactory pneumoretroperitoneum was achieved. Median duration of operation was 180 (125-330) min, and the intraoperative blood loss was 200 (125-330) ml. There were no postoperative complications and the median postoperative hospital stay was 6 days (3-12). CONCLUSION: In small (up to 5 cm) adrenal tumours not suspected to be malignant the endoscopic retroperitoneal approach constitutes a sparing alternative to the conventional access to the adrenal gland.

Adenoma↗
PubMed1993

[Laparoscopic adrenalectomy].

Between June and September 1993, laparoscopic adrenalectomy was indicated in five patients (three women, two men; aged 25-50 years). Three had a phaeochromocytoma, two had an adenoma (Conn's syndrome). Four of the five tumours were localized to the right adrenal gland, one to the left. Tumour diameter ranged from 3 to 5 cm. The laparoscopic procedure was successful in four of the patients (three right, one left). In the fifth case the operations had to be completed by conventional surgery, because of non-controllable haemorrhage. Duration of operation ranged between 165 and 360 min for right adrenalectomy and was 135 min for the left one. Rapid convalescence, lower dose of pain-killing drug required, short hospital stay and good cosmetic results characterized the postoperative course after the laparoscopic procedure. This technique thus opens up new perspectives for adrenal surgery.

Adrenal Gland Neoplasms↗
PubMed1999

Laparoscopic bilateral adrenalectomy in a child.

Laparoscopic adrenalectomy is an established technique--in adults. This report describes a bilateral laparoscopic adrenalectomy in a child. As in adults, it indicates that the technique is superior in anatomic exposure and postoperative recovery, and is well suited for children.

Adolescent↗
PubMed1990

Exacerbation of autoimmune thyroid dysfunction after unilateral adrenalectomy in patients with Cushing's syndrome due to an adrenocortical adenoma.

Little is known about the factors that cause exacerbations of autoimmune thyroid dysfunction. One possibility is an alteration in adrenocortical function, since glucocorticoids are known to alter both pituitary-thyroid and immunologic function. We encountered three patients in whom overt autoimmune thyroid disease developed after unilateral adrenalectomy for Cushing's syndrome due to an adrenocortical adenoma. We compared the postoperative changes in thyroid function in these patients with those in 21 other patients with Cushing's syndrome who underwent the same treatment. After unilateral adrenalectomy, one of the three patients had transient hyperthyroidism and a low thyroid uptake of 131I, indicative of silent thyroiditis. After the same surgical procedure, the second patient had hypothyroidism, where-as the third patient had transient hyperthyroidism at first, and hypothyroidism then gradually developed. All three patients had serum antithyroid antibodies, the titers of which increased after surgery. In the remaining 21 patients (only 2 of whom had antithyroid antibodies initially), the serum concentrations of thyroxine, triiodothyronine, and thyroxine-binding globulin and the secretion of thyroid-stimulating hormone increased after surgery from values that were low or near the lower limit of normal to values still well within the normal range. None of these patients had clinically evident thyroid disease or increased antithyroid-antibody titers. We conclude that reductions in the secretion of glucocorticoid may exacerbate subclinical autoimmune thyroid disease. Patients with Cushing's syndrome due to adrenocortical adenoma who have thyroid antibodies should be followed closely after treatment, because thyroid dysfunction may develop.

Adenoma↗
PubMed2005

Successful pregnancy after unilateral adrenalectomy in a case of primary pigmented adrenocortical disease.

We describe a case of successful pregnancy in a patient with primary pigmented nodular adrenocortical disease. Unilateral adrenalectomy was performed pre-conception as treatment for the patient's bilateral adrenal disease. She later delivered a healthy infant by cesarean section at week 38 of gestation. There was no evidence of either hyper- or hypo-cortisolism during the pregnancy. The unilateral laparoscopic adrenalectomy was successful in controlling her hypercortisolism during the ensuing pregnancy, and might provide a valid (albeit temporary) solution in similar situations.

Adrenal Cortex Diseases↗
PubMed1969

Effects of adrenalectomy on blood pressure in salt-fed, hypertension-prone rats. Failure of hypertension to develop in absence of evidence of adrenal cortical tissue.

In adrenalectomized, genetically hypertension-prone rats, a high degree of correlation was found between evidence of functioning adrenal tissue and the development of salt hypertension. There is considerable evidence that some rats have the capacity to regenerate functioning adrenal cortical tissue from accessory glands and microscopic rests, sometimes in remote locations. Therefore, the criteria for continued absence of adrenal function after surgical adrenalectomy are critical. In this study we used three tests to validate the presence, or absence, of adrenal function: (a) a biochemical test, the quantitative, serial measurement of plasma glucocorticoids in individual rats; (b) a physiological test, the ability to survive a virtually sodium-free diet; and (c) the anatomical search for histological evidence of adrenal cortical tissue. Among those animals that developed hypertension after adrenalectomy, the correlation between plasma steroid concentration and blood pressure was statistically significant. We suspect that this correlation exists only during the period when cortical tissue is regenerating; it does not exist among intact animals with and without hypertension induced by salt. It was concluded that some adrenocortical function is necessary for salt hypertension to develop. The evidence was insufficient to settle the question whether the action of corticosteroids is causative, or whether they play a supporting, although necessary, role for an extraadrenal hypertensinogenic factor to become manifest.

Adrenal Glands↗
PubMed2001

Retroperitoneoscopic adrenalectomy: lateral approach.

Laparoscopy has become the essential surgical approach to the adrenal gland at many institutions, including ours. At the Cleveland Clinic, laparoscopic adrenalectomy for benign and malignant adrenal neoplasms can be performed by either the transperitoneal or the retroperitoneal approach. Herein, we present our technique of lateral retroperitoneal laparoscopic adrenalectomy.

Adrenal Gland Neoplasms↗
PubMed2001

Does tumor size influence the outcome of laparoscopic adrenalectomy?

BACKGROUND: Laparoscopic adrenalectomy is safe and effective for small adrenal tumors, but its role for large adrenal tumors and the influence of tumor size on the outcome of laparoscopic adrenalectomy have been questioned. PATIENTS AND METHODS: Thirty-one patients with unilateral adrenal tumors operated on between January 1997 and April 2000 were selected for this study. The indications for surgery were Conn's adenoma in 16 patients, pheochromocytoma in 7 patients, Cushing's adenoma in 4 patients, and incidental lesions in 4 patients. The patients were divided in two groups: 19 patients with tumors <3.5 cm (Group I) and 12 patients with tumors > or = 3.5 cm (Group II). The outcomes of the two groups were compared. RESULTS: None of the laparoscopic procedures was converted to open surgery. The tumor size correlated with operative time (r = 0.434; P = 0.015) and blood loss (r = 0.513; P = 0.003), with both being significantly greater for larger tumors. No patient required a blood transfusion during or after surgery. One preoperative complication occurred in Group I. There was no peroperative complication in Group II. The median postoperative hospital stay and opioid requirement did not differ significantly between the groups. One patient in Group I developed pneumonia, while no postoperative complications were recorded in Group II. CONCLUSION: Surgery for large adrenal tumors can safely be performed laparoscopically with outcomes comparable to those of surgery for small tumors.

Adrenalectomy↗
PubMedDate not supplied

Laparoscopic adrenalectomy for primary and secondary malignant adrenal tumors.

Laparoscopic adrenalectomy is unanimously recognized as the gold standard for the treatment of adrenal tumors, but it is not indicated for tumors of any size when invasion of the surrounding tissues is clearly detected by preoperative imaging. Although laparoscopic adrenalectomy for metastatic adrenal malignancy is a feasible procedure, in the case of primary adrenal malignancy, it should be done very carefully. When laparoscopic surgery is performed for adrenal tumors >6 cm or for tumors that are considered potentially malignant after preoperative imaging or endocrine studies, the operation should be performed only by a highly skilled laparoscopic surgeon. It is also important to inform the patient and family that the tumors may be malignant and that conversion to open surgery could be necessary. The surgeon must create a sufficiently wide working space, remove the tumor and surrounding fat en bloc, and never grasp the tumor or adrenal tissue. The ultrasonically activated scalpel or ultrasonic endoaspirator should be carefully handled so that it does not touch the tumor surface because this will create a risk of tumor-cell dissemination. It also is essential not to persist unreasonably with laparoscopic procedures but to switch immediately to open surgery when laparoscopic surgery becomes difficult.

Adrenal Gland Neoplasms↗
PubMed2005

Retroperitoneoscopic adrenalectomy for adrenal tumors via a single large port.

BACKGROUND AND PURPOSE: Laparoscopic adrenalectomy is generally performed with carbon dioxide insufflation of the cavity and requires multiple trocars. This study reports the outcomes of retroperitoneoscopic adrenalectomy (RA) for adrenal tumors via a single port using a large cylinder without carbon dioxide insufflation. PATIENTS AND METHODS: Fifty-four patients with adrenal tumors were treated using RA via a single large port. The average tumor size was 2.6 cm. For surgery, patients were placed in the lateral decubitus position with slight flexion, and a 4.5-cm skin incision was performed below the 12th rib in the midaxillary line. The retroperitoneal space was dissected using index fingers and a balloon dilator. A rectoscope tube with a 4-cm diameter was inserted, and the adrenal glands were removed endoscopically via the single large port without carbon dioxide insufflation. RESULTS: This procedure was completed in 53 patients (98.1%). The average duration of surgery was 203 minutes, and the mean estimated blood loss was 252 mL. Four patients (7.4%) required blood transfusion. Postoperative major complications, including fulminant hepatitis and pulmonary thrombosis, were observed in two patients (3.7%), and the patient with hepatic disease died on the 14th postoperative day. The mortality rate after surgery thus was 1.9%. However, no local tumor recurrence or hormonal relapse has occurred at a median follow-up of 34 months. CONCLUSIONS: This procedure appears to be effective and relatively minimally invasive. However, it is limited by the narrow working space and restriction of the manipulation of instruments.

Adrenal Gland Neoplasms↗
PubMed1999

Paroxysmal tachycardia and hypertension with or without ventricular fibrillation during laparoscopic adrenalectomy: two case reports in patients with noncatecholamine-secreting adrenocortical adenomas.

We present two cases of sudden unanticipated cardiovascular complications in patients with noncatecholamine-secreting adrenocortical adenomas during laparoscopic adrenalectomy. In the first case, the patient developed paroxysmal tachycardia and hypertension followed by ventricular fibrillation shortly after clipping of the adrenal vein. In the second case, the patient suffered hypertension and bigeminy during manipulation of the adrenal gland just around the adrenal vein. Awareness of such complications during either conventional or laparoscopic adrenalectomy is important even if the operation is performed in a patient with an apparently noncatecholamine-secreting adrenocortical adenoma.

Adenoma↗
PubMed2005

Simultaneous laparoscopic adrenalectomy for pheochromocytoma and dismembered pyeloplasty for uretero-pelvic junction obstruction.

Laparoscopic adrenalectomy for pheochromocytoma and laparoscopic dismembered pyeloplasty are both technically difficult procedures. We describe the case of a 61-year-old female patient who presented with a right adrenal pheochromocytoma and bilateral pelvi-ureteric junction obstruction with renal failure who underwent a successful simultaneous transperitoneal laparoscopic adrenalectomy and pyeloplasty.

Acute Kidney Injury↗
PubMed1993

Laparoscopic adrenalectomy for primary aldosteronism: a new operative method.

From January 17, 1992 to January 16, 1993, laparoscopic adrenalectomy was performed in 7 patients (3 men, 4 women) with primary aldosteronism ranging in age from 35 to 65 years (mean 48.7 years). Five of the adrenal lesions were on the left side and two were on the right. Five to six trocar-sheath units were used, and adrenal tumors were successfully removed with adjacent normal adrenal glands in all patients. The operative time ranged from 165 to 572 min (mean 302 min), operative blood loss was between 50 and 450 ml (mean 217.2 ml), and there was no major complication. In conclusion, laparoscopic adrenalectomy is a safe alternative operative method for primary aldosteronism, although application of this technique to other types of adrenal lesions remains to be examined.

Adrenal Gland Neoplasms↗
PubMedDate not supplied

Effect of adrenalectomy and exposure to corticosterone on alcohol intake in alcohol-preferring and alcohol-avoiding rat lines.

The daily fluid intake of male rats of the alcohol-preferring (AA) and alcohol-avoiding (ANA) lines with simultaneous access to 10% (v/v) ethanol and water was determined during a baseline period (2 weeks), following adrenalectomy (1 week), and for 2 weeks following corticosterone treatment. The results showed that adrenalectomized AA rats decreased their ethanol intake compared to the sham-operated AA controls and that treatment with corticosterone restored the intake of ethanol to that observed during the baseline period. In contrast to the AA rats, there were no alterations in ethanol intake after adrenalectomy and following corticosterone replacement in the ANA rats. These results suggest that corticosterone stimulates ethanol intake in animals with pronounced high preference for ethanol.

Adrenalectomy↗
PubMed1978

Porcine malignant hyperthermia. VI: the effects of bilateral adrenalectomy and pretreatment with bretylium on the halothane-induced response.

The effects of bilateral adrenalectomy, together with the i.v. administration of bretylium tosylate 20 mg kg-1 on halothane-induced malignant hyperthermia (MH), were investigated in six Pietrain pigs. All six animals survived the halothane challenge, and failed to show any signs of increased muscle metabolism. Bilateral adrenalectomy alone prevented halothane-induced MH in three out of four Pietrain pigs, whereas the i.v. administration of bretylium alone protected only one pig out of an additional four animals studied. The results show that complete adrenergic blockade inhibits the susceptibility of Pietrain skeletal muscle to halothane and that the adrenal medulla makes an important contribution to this response.

Adrenalectomy↗