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PubMed2002

[Adrenal insufficiency after unilateral adrenalectomy for primary hyperaldosteronism].

A case of unexpected insufficiency of the remaining adrenal gland after unilateral adrenalectomy for primary hyperaldosteronism is described. The patient recovered from the initial disease, but postoperative tests repeatedly showed insufficient response to injection of ACTH. This case raises the question of interaction between the renin-angiotensin system and the hypothalamic-pituitary-adrenal-axis. Furthermore, it stresses the importance of testing the function of the remaining adrenal gland after unilateral adrenalectomy.

Adrenal Insufficiency↗
PubMed2002

[Bilateral laparoscopic adrenalectomy in ACTH-independent macronodular adrenal hyperplasia: a case report].

We report a case of ACTH-independent macronodular adrenal hyperplasia (AIMAH). A 62-year-old man was admitted to our hospital for further examination of obesity and diabetes mellitus. He was diagnosed with Cushing's syndrome by endocrinological examinations, and computed tomography and magnetic resonance imaging findings revealed nodular hyperplasia in bilateral adrenal glands, suggesting its etiology to be AIMAH. We underwent simultaneous bilateral laparoscopic adrenalectomy. A preoperative diagnosis of AIMAH was confirmed by histological examination of both adrenal glands, weighing 21 g (right) and 16 g (left). The postoperative course was uneventful. We believe that simultaneous bilateral laparoscopic adrenalectomy is feasible, safe, and results in minimal postoperative morbidity for the treatment of AIMAH.

Adrenal Cortex↗
PubMed1975

[The influence of adrenalectomy on DNA-synthesis in the liver after partial hepatectomy and on corticosterone concentration of the serum in rats (author's transl)].

UNLABELLED: Problemacy: In an earlier paper we have reported the influence of adrenalectomy on DNA-synthesis in rat liver and found that during the first 2 days the incorporation of H3 thymidine is elevated). (DESSER-WIEST 1974). Therefore we have examined the DNA-synthesis in regenerating live of rats with and without adrenals. MATERIAL AND METHODS: 300 g male rats were adrenalectomized and 14 days later 2/3 hepatectomized. One group of animals were bled and the concentration of corticosterone in serum was determined by a radioprotein-binding method (SPATH and JOZAN 1972). The other group of animals were injected with H3thymidine at 9 a.m. All animals were killed between 10:00 a.m. and 10:15 a.m. The incorporation of H3thymidine was determined by the method of BURTON (1969). In adrenalectomized animals, the onset of liver regeneration was found to be retarded for 18 hours, the maximum of DNA-synthesis was depressed. RESULTS: The corticosterone concentration of the serum was 17,8 mug/100 ml serum in contro animals and was undetectable in animals during the first and second day after adrenalectomy, thereafter the steroid level increased. A third of the amount found in control animals was found 14 days after operation. Partial hepatectomy, caused an increase of the corticosterone level in serum of animals with and without adrenals. In castrated and adrenalectomized animals no corticosterone in serum was found. The importance of corticosterone for liver regeneration is discussed.

Adrenalectomy↗
PubMed2002

Effect of adrenalectomy on rat epididymidis.

AIM: To investigate the effect of adrenalectomy (ADX) on the epididymidis of Sprague-Dawley rats. METHODS: The histological, biochemical (cholesterol protein, zinc, copper, alkaline and acid phosphatase aryl sulphatase, lactic dehydrogenase and leucine amino peptidase) and hormonal (FSH, LH and testosterone) changes of caput and cauda epididymis in ADX rats were observed. RESULTS: Organ wet weight, histological studies and morphometric measurements indicated a cellular degeneration in caput and cauda epididymis of ADX rats. Serum testosterone level was significantly lower in ADX than in sham-operated rats, while the serum FSH and LH were below the detection limit of 1 mIU/mL. The enzymatic activity was higher in ADX than in sham-operated rats. Epididymal zinc level increased whereas copper level decreased in ADX rats compared to the sham-operated. CONCLUSION: Adrenalectomy leads to degeneration of caput and cauda epididymidis epithelial cells as a result of decreased supply of testosterone.

Acid Phosphatase↗
PubMed2003

Retroperitoneal minimally invasive endoscopic adrenalectomy in children.

Conventional adrenalectomy for tumor excision is one of the challenging tasks in adults as well as children with mounted postoperative complications. Advancing laparoscopic techniques with the new era of diagnostic image developments aids this kind of procedure performed mainly in adults with only few reports in children. Here we present a review of this considerably new approach in children, adrenalectomy achieved through endoscopic retroperitoneal minimally invasive technique, discussing the indications, the advantages and disadvantages, and a comparison between this approach and other endoscopic techniques performed for this type of surgery.

Adrenal Gland Neoplasms↗
PubMedDate not supplied

[Laparoscopic adrenalectomy in the treatment of malignant adrenal lesions].

The role of laparoscopic approach for the treatment of malignant adrenal diseases is still controversial. The aim of this study was to verify the results of laparoscopic adrenalectomy in the management of adrenal malignancies. The medical records of all the patients who underwent laparoscopic procedures for adrenal diseases and in whom malignancy was demonstrated at final histology were reviewed. Nine patients were included (3 malignant pheochromocytomas, 4 adrenocortical carcinomas and 2 adrenal metastases). At a mean follow-up of 17.0 +/- 12.8 months (range, 2-36), all but two patients were alive and disease free. One patient died for unrelated causes. No patient developed local or port site recurrence. The results of this study demonstrate that laparoscopic adrenalectomy can be safe and effective also in case of adrenal malignancies. Conversion to open surgery in mandatory in case of local invasion and when the dissection cannot be as accurate as in conventional operations. A preliminary laparoscopic exploration can be planned in case of suspected malignant lesions to confirm the diagnosis and to evaluate their operability.

Adrenal Gland Neoplasms↗
PubMed1956

Hypophysectomy or adrenalectomy; their use in management of advanced malignant disease as observed in clinics in Europe.

The dependence of cancer of the breast and prostate gland upon sex hormones has led to an attack on this problem by way of adrenalectomy with castration or by hypophysectomy when hormone treatment has failed. The survival period of patients who have had adrenalectomy or hypophysectomy has been prolonged by use of cortisone. The risk of either operation is reasonable and maintenance of life on cortisone is simple. The results are encouraging, with a tendency in favor of hypophysectomy. It seems justifiable to advise operation at an early stage of the disease.

Adrenal Glands↗
PubMed2003

[Lateral extraperitoneal mini-approach for adrenalectomy].

The techniques of adrenalectomy from lateral extraperitoneal mini-approach are described. This approach creates necessary space and ensures adrenalectomy in organic diseases of the adrenal glands. Fourteen operations with good short- and long-term results were performed. Limiting factors of this approach are the following: depth of the surgical wound 15 cm and more due to stage IV obesity and acute costal angle, sclerosis of retroperitoneal fat, significant splenomegaly, size of adrenal tumor more 6 cm. The "assisting hand" and endovideoscopy expand possibilities of the method.

Adolescent↗
PubMed2002

[Severe perioperative hypotension after nephrectomy with adrenalectomy].

A 70-year-old obese, hypertensive woman taking angiotensin converting enzyme (ACE) inhibitors and chlorthalidone but with no history of corticosteroid treatment or hypothalamus-hypophyseal-adrenal disease, underwent nephrectomy and adrenalectomy under combined general and epidural anesthesia. Severe hypotension with oliguria developed during surgery and persisted during postoperative recovery, with anuria, metabolic acidosis, hyponatremia and hyperpotassemia. Although the symptoms were initially attributed to prior treatment with ACE inhibitors and diuretics together with combined anesthesia, the patient's lack of response to crystalloid, colloid and inotropic catecholamine therapy in the context of anuria, metabolic acidosis, hyponatremia and hyperpotassemia led us to consider a diagnosis of Addisonian crisis. Blood samples were taken to determine adrenocorticotropic hormone levels, and hydrocortisone treatment was started. The patient responded to treatment and cortisol levels fell, confirming the diagnosis of adrenal insufficiency. Compensatory endrocrine secretion of cortisol by the contralateral adrenal gland has been observed in patients undergoing nephrectomy and adrenalectomy for excision of a hypernephroma, and replacement therapy is therefore not recommended. Perioperative Addisonian crises have also been described in patients suffering great surgical stress, and severe hypotension has been observed in patients on long-term treatment with ACE inhibitors after induction of general anesthesia and after epidural anesthesia with local anesthetics. The combination of these factors made rapid diagnosis and start of appropriate therapy difficult.

Addison Disease↗
PubMed1992

[Bilateral pheochromocytoma. Is there stimulation of an extra-adrenal adrenaline liberation after bilateral adrenalectomy?].

BACKGROUND: In order to determine plasma and urine epinephrine levels after bilateral adrenalectomy, we examined a 16 year old young man with bilateral pheochromocytoma. Bilateral removal of the adrenals was performed because of a left sided pheochromocytoma relapse. An extra-adrenal pheochromocytoma could be excluded by scintigraphy. Macroscopically all adrenal tissue was removed during surgery. METHODS: A modified radioenzymatic determination of the free catecholamines epinephrine, norepinephrine and dopamine was used according to Peuler and Johnson. Sulfoconjugated catecholamines were measured after addition of 60 microU arylsulfatase type VI. Urine catecholamine levels were determined fluorometrically. RESULTS: The elevated plasma andurine norepinephrine levels before surgery returned to normal after surgery. In contrast, plasma epinephrine levels returned to subnormal values thereafter but increases 5-fold at the end of anesthesia suggesting an extra-adrenal source of epinephrine. Urine epinephrine levels remained in the lower normal range. An insulin induced hypoglycemia was performed resulting in adrenergic symptoms of hypoglycemia and a subnormal increase of epinephrine. CONCLUSIONS: We conclude, that epinephrine mediated physiological regulations occur inspite of bilateral adrenalectomy probably by a regulated extra-adrenal source of epinephrine. The kidney could be the site of extra-adrenal epinephrine production.

Adolescent↗
PubMed1992

[The anesthetic management for adrenalectomy of a patient with Cushing's syndrome in pregnancy].

The anesthetic management for left adrenalectomy of a pregnant patient with Cushing's syndrome caused by adrenal adenoma during pregnancy was reported. At 21 week gestation, anesthesia was induced with modified NLA and maintained with nitrous oxide-enflurane-oxygen combined with continuous lumbar epidural anesthesia. Postoperatively, she was delivered a normal, 1990 g infant at 37 week gestation. The present case is believed to be the first reported case of general anesthesia in detail for adrenalectomy in a patient with Cushing's syndrome during pregnancy. The anesthetic management including choice of anesthetics, anesthetic method, intraoperative monitoring, influence of catecholamine, and fetal as well as maternal complication was reviewed from literatures.

Adenoma↗
PubMedDate not supplied

Exceptional bilateral adrenalectomy after secondaries from colorectal cancer.

We report a very uncommon case of bilateral adrenal metastasis treated at our institution. The patient was 65 years old, with a history of low anterior resection for colorectal cancer in 2001. One year later, he was diagnosed with bilateral adrenal metastasis, based on the results of abdominal computed tomography-scan. A bilateral adrenalectomy extended to distal pancreatectomy and splenectomy was performed. Postoperative course was uneventful. He is alive and free of disease 12 months after adrenalectomy. We conclude adrenal metastasis from colorectal cancer should be managed surgically, even if they are bilateral.

Adenocarcinoma↗
PubMed2003

[The influence of adrenalectomy on the treatment of arterial hypertension in patients with benign adrenal medullary and cortical tumors].

One of the reasons of secondary arterial hypertension (HA) are pathological lesions of adrenal glands. The aim of the study was to estimate the influence of performed adrenalectomy on the values of arterial blood pressure (RR) in patients with adrenal tumours and HA observed at least one year after surgical treatment. Data of 54 patients were analysed. Hormonal activity of adrenal tumours was diagnosed in 57.4% of patients. 83.3% of patients underwent unilateral and 16.7% bilateral adrenalectomy. Pathological examination revealed the presence of pheochromocytoma in 14.8% of patients, adenoma in 59.3% and hyperplasia in 25.9%. The observation time was 43.0 +/- 21.3 months from the operation. The mean maximal value of SBP measured during the time of observation was significantly lower than observed before surgery and amounted to 152.4 +/- 27.0 mm Hg and DBP 96.6 +/- 17.7 mm Hg. The decrease of maximal value of SBP amounted to 52.7 +/- 40.9 mm Hg and DBP 26.8 +/- 24.8 mm Hg. In 87.0% of patients performed surgery caused that symptoms of the disease accompanying HA regressed or decreased, and in 72.2% allowed to reduce the number and doses of antihypertensive drugs. Surgical excision of adrenal tumours in patients with pheochromocytoma as well as with Conn and Cushing syndrome leads to significant reduction of maximal RR values. In patients without confirmation of hormone activity of the tumour qualification to the surgical treatment should be based on clinical symptoms accompanying HA as well as on the size of the tumour.

Adrenal Gland Neoplasms↗
PubMedDate not supplied

[Laparoscopic adrenalectomy: our preliminary experience].

INTRODUCTION: In 1992, Gagner described the first laparoscopic adrenalectomy. Since then this technique has been more and more widely employed and several studies confirmed its advantages, comparing to the traditional approach, in terms of reduction of mean hospital stay and therefore of the health expense. PATIENTS AND METHODS: The Authors' preliminary experience spreads from March to November 2003 when 4 patients were studied and thus underwent a transperitoneal laparoscopic adrenalectomy: 2 of them were affected by Cushing syndrome, 1 by pheochromocytoma in MEN and 1 by an incidentaloma. The transabdominal access in lateral decubitus with 4 trocars was performed. RESULTS: No complication was reported with a minimal need of analgesic drugs. The mean hospital stay was 4 days and all patients were discharged 48 hours after surgery. The mean diameter of nodules was 40 +/- 30 mm. The definitive histological examination showed 2 cortical adenomas, 1 diffuse cortical hyperplasia and 1 pheochromocytoma. CONCLUSIONS: This preliminary report confirms the optimal results of other experienced authors. Further interventions will be necessary for improvements and technical requirements.

Adenoma↗
PubMed1992

[The morphological bases of the pathogenesis of the "stress ulcer": experimental vagotomy and adrenalectomy].

To study the pathogenic mechanisms of stress ulcers, we have studied the morphological changes (micro and macroscopic) occurring in the stomach and duodenum in Wistar rats submitted to a technique producing stress (space restriction and water immersion), as well as the changes produced by vagotomy and adrenalectomy done before stress. Severe vasoconstriction in the submucosa and other histologic signs (minimal stress signs) as well as the presence of intramucosal foci of necrosis and ulcerations (Maximal stress signs) allow us to attribute the origin of stress ulcers directly or indirectly, to ischemia. Previous truncal vagotomy prevents maximal lesions of stress but not the so-called minimal lesions, thus suggesting that the vagus nerve potentiates the lesions produced by ischemia. Adrenalectomy increases the presence and development of stress ulcers therefore suggesting that neither steroids nor catecholamines are involved in their pathogenic mechanism.

Adrenal Glands↗
PubMed2005

Robotic-assisted laparoscopic adrenalectomy.

Robotic surgical systems have recently been used to perform laparoscopic procedures in several diseases. We report the initial 2 cases of robotic-assisted laparoscopic adrenalectomy from Taiwan. Both cases were performed transperitoneally using the ZEUS surgical system (Intuitive Surgical Inc., Mountain View, CA, USA). This system consists of 3 interactive robotic arms and a remote control unit, allowing the surgeon to control the 2 instrument arms and 1 camera arm via a surgical console. The key component of the ZEUS surgical system is the MicroWrist (Computer Motion Inc., CA, USA) technology, which allows the surgeon to roll, pitch and grip laparoscopic tools freely and provides the surgeon with a 3-dimensional view of the operative field. Postoperative courses were uneventful and the patients were discharged on the third and fourth postoperative days, respectively. No intraoperative or postoperative complications were encountered. These cases suggest that robotic-assisted laparoscopic adrenalectomy is technically feasible, and that the role of robotic surgery in urologic laparoscopy is likely to expand in Taiwan.

Adrenalectomy↗
PubMed2005

[Clinical experience of laparoscopic adrenalectomy: the National Defense Medical College experience].

Twenty-seven laparoscopic adrenalectomies (LapAdx) were performed at the National Defense Medical College between 1999 and 2004. We evaluated the results of LapAdx (group L) compared to the results of open adrenalectomy (group O). Twenty-six of the 27 LapAdx were successfully performed, but one patient with a large pheochromocytoma required open surgey because of arterial bleeding in the renal hilus. The mean operating time in group L (185 +/- 19 min) was not significantly different from that in group O (206 +/- 13 min). The mean estimated blood loss in group L (111 +/- 61 g) was significantly lower than that in group O (308 +/- 67 g). The starting time for oral feeding and for ambulation was significantly earlier in group L than in group O. There was a major complication (intraoperative bleeding) in which a group L patient required a blood transfusion. We also compared the surgical results of 26 patients in LapAdx divided chronologically into the first half and the last half to determine the surgical skill acquired. The operating time was significantly shorter and blood loss significantly less for patients in the last half. In addition, the operating time and blood loss for the first-time LapAdx operators were comparable with those of experienced surgeons. Our results support the efficacy and the minimal invasiveness of LapAdx. The accumulated experience and knowledge regarding laparoscopic surgery in our institute were important in improving surgical procedures and results.

Adrenal Gland Neoplasms↗
PubMed2006

Remifentanil preventing hemodynamic changes during laparoscopic adrenalectomy for pheochromocytoma.

In this prospective case-series study, a balanced anesthetic scheme of sevoflurane in nitrous oxide supplemented with remifentanil and sustained neuromuscular block was applied in nine patients scheduled for laparoscopic adrenalectomy for pheochromocytoma. Laparoscopic adrenalectomy to treat pheochromocytoma results in marked catecholamine release during pneumoperitoneum and tumor manipulation. Remifentanil infusion was adjusted to maintain systolic arterial pressure between 120-170 mmHg. Increased infusion rate of remifentanil was used (up to 3 microg/kg/min) to prevent and treat marked hemodynamic changes from catecholamine release during tumor manipulation. Hpotension after tumor removal was treated with additional colloids fluids and decreasing the remifentanil infusion rate by 25-50%.

Adrenal Gland Neoplasms↗