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Laparoscopic adrenalectomy. New experiences.

Authors have performed 23 laparoscopic adrenalectomies between 03.04.1997 and 02.04.1999. They have removed 16 cortical adenomas, 2 nodular hyperplasias, 2 cysts, 1 carcinoma, 1 pheochromocytoma and 1 myolipoma. The operation time was 90-260 minutes that gradually has been decreased by using "Ultracision" ultrasonic shear. They have made simultaneously two cholecystectomies and one liver wedge biopsy. During removing pheochromocytoma they have not detected extremely high blood pressure data. They had one intraoperative complication, the perforation of the diaphragm which required a temporary thoracic suction drainage. All operations were completed laparoscopically. Patients have been released on the 2nd-3rd postoperative day. Their experiences confirm the literary data that the laparoscopic approach to adrenalectomy is the method of choice today.

Adrenal Cortex Neoplasms↗

Diagnosis and management of adrenal incidentalomas.

PURPOSE: The incidental discovery of adrenal masses has become a common clinical problem. We address current trends in clinical, endocrine, radiological and scintigraphic evaluation, and strategies for management of adrenal masses. A diagnostic and therapeutic algorithm is suggested. MATERIALS AND METHODS: A comprehensive review of the literature was performed using MEDLINE, bibliographies of select articles, current issues of peer reviewed general medicine, endocrinology, diagnostic imaging and surgical journals, and meeting abstracts of recent international congresses. RESULTS: Most adrenal incidentalomas are benign and nonhypersecreting but all should be evaluated to exclude from diagnosis hypersecretory syndromes or malignancy. In all cases hormonal screening for pheochromocytoma, hyperaldosteronism and subclinical hypercortisolism should be performed. Attenuation values on computerized tomography, chemical shift magnetic resonance imaging and scintigraphy reveal the nature of the mass in most cases. Fine needle aspiration biopsy should be reserved for cases suspected of extra-adrenal malignancy. CONCLUSIONS: A multidisciplinary approach, including hormonal screening, radiological evaluation and scintigraphy, is required to identify and remove adrenal masses with endocrine and oncological morbidity. Long-term morphofunctional followup is suggested for nonoperated cases.

Adrenal Gland Diseases↗

The incidentally discovered asymptomatic adrenal tuberculous mass mimicking malignancy.

Tuberculous adrenal mass without any tuberculous changes in other sites is a rare entity. In this study we describe such a case. A male patient of 47 years with 6 months history of anorexia and weakness was presented. Ultrasonography and computed tomography revealed a mass in the right adrenal gland. It was mistaken as a malignant neoplasm and the diagnosis was confirmed by surgical exploration.

Adrenal Gland Diseases↗

Traumatic adrenal injury in children.

BACKGROUND: Multiple organ injury in children is an increasingly frequent phenomenon in the modern emergency room. Adrenal hemorrhage associated with this type of trauma has received little attention in the past. OBJECTIVES: Using computed tomography, we sought to determine the rate and nature of adrenal gland injury in children following blunt abdominal trauma due to motor vehicular accident. METHODS: A total of 121 children with blunt abdominal trauma were examined and total body CT was performed in cases of multi-organ trauma or severe neurological injury. RESULTS: Of all the children who presented with blunt abdominal trauma over a 51 month period, 6 (4.95%) had adrenal hemorrhage. In all cases only the right adrenal gland was affected. Coincidental injury to the chest and other abdominal organs was noted in 66.7% and 50% of patients, respectively. CONCLUSIONS: Traumatic adrenal injury in the pediatric population may be more common than previously suspected. Widespread application of the more sophisticated imaging modalities available today will improve the detection of damage to the smaller organs in major collision injuries and will help in directing attention to the mechanism of trauma.

Abdominal Injuries↗

[Cystic adrenal lesion. Incidental finding].

We report a case of a non functioning cystic adrenal mass. It was incidentally found in an abdominal ultrasound carried out for unrelated symptoms. According to the classification of adrenal cysts it is a multilocular pseudocyst with wall fibrosis and calcification. The pseudocyst lining expresses Factor VIII suggesting a vascular origin.

Adrenal Gland Diseases↗

MR imaging of the adrenal neoplasms.

The most commonly encountered adrenal mass is the non-hyperfunctioning adrenal adenoma. Chemical-shift MR imaging can detect and characterize these adrenal masses as benign but cannot distinguish between hypersecreting and nonhypersecreting adrenal adenomas. Because of its direct multiplanar capability and superb soft tissue contrast, MR imaging can detect and potentially characterize other adrenal neoplasms.

Adrenal Cortex Neoplasms↗

[Hormonal and morphologic characteristics of adrenal incidentalomas].

The authors analyse hormonal and morphological characteristics of adrenal incidentalomas, i.e. pathological adrenal masses accidentally found on CT scan performed due to extraadrenal causes of other causes of adrenal pathology. The group of patients was consisted by 42 patients at the age 24-79 years (27 females and 15 males). The most frequent clinical symptoms included arterial hypertension, diabetes mellitus and obesity. CT examinations revealed 36 cases of unilateral lesions (in 21 cases the lesions were localised on the right and in 15 cases on the left) and 6 bilateral lesions. The size of adrenal masses ranged from 7 mm to 12 cm. The CT examination helped in characterising myelolipomas in 3 cases, cysts in two cases, and pre-assuming malignity in 6 cases. Hormonal analyses have revealed primary aldosteronism in 2 cases, subclinical hypercortisolism in 1, steroid enzymopathy in 2 and secondary hyperaldosteronism in 2 patients. No patient had catecholamine overproduction. 19 patients were indicated for adrenalectomy with the following histological findings.: adenoma (n = 5), cyst (n = 2), myelolipoma (n = 3), carcinoma (n = 3), feochromocytoma, ganglioneuroma, metastases, lymphoma, sarcoidosis and pseudodrenal structure--Gravitz tumor (n = 1, respectively). The size of all neoplasms exceeded 3 cm, therefore the authors recommend adrenalectomy in incidentalomas with hormonal activity exceeding 3 cm in size. (Tab. 2, Fig. 1, Ref. 17.)

Adrenal Gland Diseases↗

General anaesthesia for laparascopic adrenalectomy.

Surgical treatment of adrenal disorders is increasingly performed under laparascopic approach. Both pneumoperitoneum and adrenal tumour manipulation may induce haemodynamic variations. The aim of this study was to compare the inhalational and intravenous anaesthetic management for laparascopic adrenalectomy. Between 1977 and 1999 there were performed 28 laparascopic adrenalectomies. At patients with functioning adenoma and hypertension the anaesthesia was maintained with isoflurane in 8 cases and sevoflurane in 6 cases, et 14 patients with non-functioning adrenal masses with propofol and fentanyl (TIVA). In addition to the circulatory and respiratory monitoring there were made serial laboratory determinations (acid-base state, serum potassium, blood glucose) during the operation. On the basis of measured parameters isoflurane and sevoflurane anaesthesia proved to be favourable in case of functioning adrenal adenoma and TIVA with propofol and fentanyl in case of non-functioning adenoma.

Adenoma↗

New adrenal-scanning agent.

A new adrenal-specific compound, 6beta-iodomethyl-19-norcholest-5(10)-en-3beta-ol(NCL-3-I), which is derived from 19-iodocholesterol (CL-19-I), has been found. Tissue distribution studies have revealed that the rat adrenal gland accumulates ten times more NCL-6-131-I than CL-19-131-I. The advantage of NCL-6-131-I as a possible adrenal-scanning agent is discussed.

Adrenal Gland Diseases↗