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PubMed1975

Cortisol secretion in Nelson syndrome: Persistence after "total" adrenalectomy for Cushing syndrome.

In two patients who were severely pigmented (Nelson syndrome) following bilateral adrenalectomy for Cushing syndrome, symptoms of hyper-cortisolism developed while they were receiving only physiologic steroid replacement. Cortical assays proved that endogenous cortisol production had not been obliterated. Even after total adrenalectomy, steroid measurement should be performed to guard against adrenocortical excess.

17-Hydroxycorticosteroids↗
PubMedDate not supplied

Simultaneous bilateral laparoscopic adrenalectomy is safe for synchronous large adrenal tumors.

Laparoscopy is now considered the gold standard for treating benign monolateral adrenal lesions. We present the case of a patient affected by Cushing's syndrome due to large bilateral adrenal adenomas (7.5 cm) who underwent simultaneous laparoscopic bilateral adrenalectomy. An anterior, lateral transperitoneal approach was used. Operative time was 200 minutes, and blood loss was 200 mL. No intraoperative complications were encountered. The postoperative course was uneventful, and the patient was discharged after 3 days. Laparoscopic bilateral adrenalectomy is a safe, effective procedure when performed by experienced hands and may be an alternative treatment for large adrenal lesions.

Adenoma↗
PubMedDate not supplied

Comparative study of laparoscopic and open adrenalectomy.

BACKGROUND: Laparoscopic adrenalectomy (LA) had become the preferred operation for management of adrenal neoplasm. We conducted this cohort study to evaluate the outcome of laparoscopic and open adrenalectomy (OA). METHODS: A total of 67 patients with complete medical records were included in this study. Thirty patients underwent OA and the other 37 patients received LA. The intraoperative and perioperative data analyses focused on surgery time, blood loss, pain scale rating, resumption of oral feeding, hospital stay, complications and convalescence. RESULTS: LA was completed in all 37 patients without conversion to OA or mortality. The surgery times (203.4 vs. 192.9, p = 0.776) were similar for both OA and LA groups. There was less blood loss in the LA group (355.0 vs. 104.0, p = 0.021). The postoperative pain scale rating was lower in the LA group (5.6 vs. 4.5 p = 0.035) as was analgesia demand (57.4 vs. 3.7, p < 0.001). Oral feeding resumed earlier in the LA group (91.7 vs. 16.4, p < 0.001) and these patients had a shorter postoperative hospital stay (8.4 vs. 3.9, p < 0.001). The complication rate in both groups was similar. In the LA group, patients with primary aldosteronism had shorter surgery times and less blood loss than patients with other tumor types (p < 0.05). CONCLUSIONS: LA results in good surgical outcome without increased risks. We suggest that LA should be the preferred choice for management of adrenal neoplasms. We also suggest that surgeons inexperienced in LA consider beginning with a case of primary hyperaldosteronism.

Adrenalectomy↗
PubMed1991

Adrenalectomy in the Zucker fatty rat: effect on m-RNA for malic enzyme and glyceraldehyde 3-phosphate dehydrogenase.

The effects of adrenalectomy with or without replacement doses of corticosterone were examined on the levels of messenger RNA for malic enzyme (ME) and glyceraldehyde 3-phosphate dehydrogenase (GAPDH) in adipose tissue and liver from Zucker fatty (fa/fa) and littermate lean rats. The levels of both GAPDH and ME mRNAs were increased in the obese rats. Adrenalectomy markedly reduced the m-RNA for GAPDH and ME in Zucker fatty rats to the low levels observed in adrenalectomized lean rats. Corticosterone treatment induced a greater and earlier increase in mRNA levels in adrenalectomized obese rats than in adrenalectomized lean rats. Since the fatty rat represents an autosomal recessive trait, these results are consistent with the hypothesis that the genetic defect is a loss of a modulator of steroid action which normally restricts the response of genes to glucorticoid hormones.

Adipose Tissue↗
PubMedDate not supplied

[Neuroendocrine surgery in Parkinson's disease: comparative analytical evaluation of approaches to microsurgical adrenalectomy. Experimental studies].

In this experimental contribution to the study of neurobiological interactions between adrenal medullary graft and CNS, is presented a model to estimate the approaches to rat adrenalectomy using statistical inference techniques. Eighteen rats were divided into three samples. The members of every sample were left adrenalectomized using lombotomic, anterior transperitoneal and posterior approaches respectively. A score was attributed to every experimentally meaningful parameter, according a previously well established plan. Scores were tested by analysis of variance and by previously planned orthogonal comparisons. Mean, standard deviation of every sample score and confidence interval for mean difference were computed. Statistical analysis results show that, objectively, there is a meaningful difference between anterior approach and posterior or lateral approach, anterior approach being more difficult then posterior or lateral approach, while there is not meaningful difference between posterior and lateral approach. Subjectively, on the contrary, there are not meaningful differences between three approaches to left adrenalectomy statistically.

Adrenalectomy↗
PubMed1990

Effects of bilateral adrenalectomy on the induction of learned helplessness behavior.

In the learned helplessness model of depression, naive Sprague-Dawley rats are exposed to a 40-minute uncontrollable shock training and are subsequently tested in a shock escape paradigm. "Helpless rats" exhibit 11 to 15 failures in a 15-trial test while "nonhelpless" rats and naive controls score 0 to 5 failures in the same test. We report on the effect of bilateral adrenalectomy on the induction of learned helplessness. Most of the adrenalectomized rats (70%) became helpless whereas sham controls responded to the training and testing similarly to naive nonoperated rats (20% to 30% helpless). This increase in behavioral deficits after adrenalectomy was reversed by administration of corticosterone, the naturally occurring glucocorticoid in rat. We conclude that secretion from the adrenal cortex is necessary for the incorporation of a learned response after stress and that a dysregulation of the hypothalamic-pituitary-adrenal axis seems to be involved in helpless behavior.

Adrenalectomy↗
PubMed1989

Quality of life after bilateral adrenalectomy in MEN 2.

Pheochromocytoma is a major cause of morbidity and mortality in the multiple endocrine neoplasia type 2 (MEN 2) syndrome. For the physician, surgical treatment seems well justified even though bilateral adrenalectomy will induce iatrogenically complete loss of adrenocortical function. For the patient this treatment may be a cause of medical problems as well as worry. We have evaluated quality of life after bilateral adrenalectomy in 27 MEN 2 patients through a combined oral and written approach. Mortality was low (one of 27), as was serious morbidity. Most patients had adapted well to the postadrenalectomy state. However, fatigue, worry, and noncompliance with daily medication often caused problems.

Adaptation, Psychological↗
PubMed1989

Effects of adrenalectomy and corticosterone on hippocampal lesions induced by trimethyltin.

The effects of adrenalectomy and corticosterone supplementation on the neurotoxicity of trimethyltin (TMT) were tested. CD-1 mice with or without adrenalectomy were injected with TMT at a dose of 3.0 mg/kg body wt. At 48 h post-TMT administration, the animals were killed for pathological examination. It was found that the adrenalectomized animals developed even more severe lesions in the hippocampal formation (fascia dentata granule cells) than the intact animals. When animals were given a supplement of corticosterone pellets at doses of 0.15, 1.5, and 7.5 mg, there was a reduction of lesion development. Total alleviation of pathology was seen at the two higher doses of supplementation. Our present investigation strongly indicates that there may be a close and important interrelationship between TMT-induced neurotoxicity and adrenal function.

Adrenalectomy↗
PubMed1989

The effect of bilateral adrenalectomy on the nucleus arcuatus-hypophysis and the circumventricular organs of Balb mice.

Three days following bilateral adrenalectomy the following findings were revealed in the hypothalamus-hypophysis and circum-ventricular organs of Balb mice: considerable enlargement of neuronal perikarya and nuclei in the nucleus arcuatus of the hypothalamus. Amitotic divisions were frequent in neurons and glial cells. Mitoses were also sporadically encountered. The pars distalis of the hypophysis showed typical post-adrenalectomy changes. In addition, enlargement of the so-called pars rostralis was observed. This part and the pars intermedia showed signs of enhanced secretion. The subfornical organ of the adrenalectomized animals was much smaller than in the controls. The subcommissural organ and pineal gland, on the contrary, were large and apparently actively secreting.

Adrenalectomy↗
PubMedDate not supplied

Sex differences in adrenocortical structure and function. XXVI. Further studies on the differences in the compensatory growth of the adrenal cortex of the male and female hamster after unilateral adrenalectomy.

The relative adrenal weight of the remaining right adrenal gland was significantly increased 5 days after unilateral adrenalectomy in hamsters of both sexes. This effect was associated with an enlargement of the zonae glomerulosa and fasciculata in males and of the zona fasciculata in females. Unilateral adrenalectomy raised the average volume of zona fasciculata cells in male hamsters and that of zona reticularis cells in females. The number of parenchymal cells in all adrenocortical zones remained unchanged by the removal of the contralateral gland; however, when calculating per mg of adrenal or per cell, the nucleotide uptake by adrenal quarters was notably lowered. A marked drop in plasma cortisol concentration was found in unilaterally adrenalectomized male but not in female hamsters. These findings indicate that the main component of the adrenal compensatory growth in hamsters is the hypertrophy and not the hyperplasia of parenchymal cells.

Adrenal Cortex↗
PubMed1987

Aldosterone-reversible decrease in the density of renal peripheral benzodiazepine receptors in the rat after adrenalectomy.

A statistically significant decrease in the density of peripheral benzodiazepine receptors was observed in renal membranes of rats beginning 2 weeks after adrenalectomy when compared with sham-operated controls. This decrease in peripheral benzodiazepine receptor density was manifest as a decrease in the maximum binding of two ligands, [3H]Ro 5-4864 and [3H]PK 11195, without accompanying changes in their Kd for this site. Similar changes were not seen in another aldosterone-sensitive organ, the submandibular salivary gland. The decrease in peripheral benzodiazepine receptor density observed in adrenalectomized rat renal membranes was restored to control levels after 1 week of aldosterone administration using a dose (12.5 micrograms/kg/day) that had no effect on peripheral benzodiazepine receptor density in sham-operated animals. In contrast, dexamethasone administration (50 micrograms/kg/day, 1 week) had no effect on renal peripheral benzodiazepine receptor density when administered to either adrenalectomized or sham-operated rats. Further, adrenal demedullation had no effect on renal peripheral benzodiazepine receptor density or affinity. The decrease in peripheral benzodiazepine receptor density was localized to the renal cortex and the outer stripe of the medulla by gross dissection of renal slices and renal tissue section autoradiography. The specific effect of adrenalectomy on renal peripheral benzodiazepine receptor density, the lack of direct effect of aldosterone on [3H] Ro 5-4864 binding and the localization of the change in peripheral benzodiazepine receptor density to the renal cortex and outer stripe suggest that these changes may reflect an adaptation of the renal nephron (possibly the distal convoluted tubule, intermediate tubule and/or the collecting duct) to the loss of mineralocorticoid hormones.

Adrenal Cortex↗
PubMed1988

Impairment of stress-induced secretion of prolactin during development: effects of adrenalectomy, TRH and sulpiride.

Ontogeny of serum and anterior pituitary gland PRL contents was investigated. Pituitary PRL concentrations were found to be low in fetus by 19th day of gestation and to rise slowly after birth with no sex differences being apparent until day 30. Adult levels were reached in males on day 15, while in females they were reached beyond this stage. Serum PRL levels exhibited a similar developmental pattern. In adult rats ether stress stimulated basal serum PRL significantly, with maximum effect one minute after onset of stress. The same pattern was seen with immature animals of 15-20 and 30 days of age. In contrast, in 2 or 6 day-old neonates, serum PRL concentrations remained unaffected by stress. This lack of responsiveness suggests the existence of a transient impairment of lactotrophs to respond to stressful stimuli during postnatal life. Adrenalectomy increased PRL release in adult and newborn rats from day 15 onward and potentiated the response of lactotrophs. Moreover, after adrenalectomy, 6 day-old rats became sensitive to ether stress, while acute treatment with dexamethasone abolished completely this response. In adult or 15 day-old neonates administration of TRH or sulpiride resulted in a marked increase in serum PRL levels. However, at 6 days TRH did not affect resting serum PRL concentrations significantly, whereas sulpiride remained efficient. Moreover, at this age, dopamine inhibited stress-induced PRL release and reduced the stimulatory effect of sulpiride.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenalectomy↗
PubMed1988

[Changes of the chief cells of the proper glands of the stomach after bilateral adrenalectomy and the role of the adrenal hormones in the development of these cells].

In the experiment, performed in 150 white male rats, it has been stated, that after bilateral adrenalectomy differentiation of the chief cells is suppressed, their amount in the proper gland decreases and certain dystrophic processes develop, they involve mitochondria, lysosomes and, mainly, protein-synthesizing apparatus. Decrease in the area of the granular endoplasmic reticulum membranes, in the number of fixed forms of ribosomes, in activity of key oxidoreductases--all they essentially inhibit not only the synthesis phase of pepsinogen, but also its secretion. This results in a sharp drop of proteolytic activity of the gastric juice. Using controls (hydrocortisone--6 mg/kg; DOCA--10 mg/kg), it has been stated that these changes after adrenalectomy are chiefly ensured by deficiency of glucocorticoid hormones.

Adrenal Cortex Hormones↗
PubMedDate not supplied

[Lipid and protein composition of membranes and carbohydrate metabolism in rats subjected to bilateral adrenalectomy; correction of disorders by vitamins K and E].

Experiments in rats have confirmed that fractional composition of membrane (mitochondria, erythrocytes) phospholipids changes under adrenalectomy conditions. These changes are accompanied by disturbances in quantitative composition and correlation of basic phospholipid fractions (phosphatidyl ethanolamine, phosphatidyl choline, cholesterol and its ether). While investigating the content of integral proteins and lipoproteins under adrenalectomy conditions changes in absolute composition and correlation of fractions are observed. Additional injection of vitamins K and E to adrenalectomized animals prevented these disturbances. Changes of main biomembrane structural components (mitochondria, erythrocytes) were accompanied by changes in the direction of metabolism.

Adrenalectomy↗
PubMed1988

Binding parameters of rat liver nuclear receptors for T3 after partial hepatectomy or bilateral adrenalectomy and serum T4 and T3 levels.

Nuclear receptor affinity (Ka) and maximal binding capacity (MBC) for 3,5,3'-triiodothyronine (T3) in rat liver was estimated at 1, 12, 24, 48 and 120 hours after partial hepatectomy and 1, 24, 30, 40 and 120 hours after bilateral adrenalectomy and related to serum T4, T3 levels. Soluble T3 receptor fraction was prepared from purified rat liver nuclei and the values of Ka and MBC were calculated by Scatchard plot analysis from the saturation curves. As compared to sham operated rats a significant diminution in MBC for T3 (P less than 0.05) in the remaining about one third of liver tissue at 12, 24 and 48 hours after partial hepatectomy was observed. The thyroxine (T4) level in serum was diminished (with P ranging from less than 0.001 to less than 0.01) at 12, 24 and 48 hours after partial hepatectomy, while no changes in T3 serum level were found at all indicated time intervals. In contrast, no changes in Ka or MBC for T3 in rat liver nuclear receptor as well as in serum T4 and T3 levels were demonstrated 1, 24, 30, 40 and 120 hours after adrenalectomy. The data reflect an appreciable relation between nuclear receptor occupancy for T3 and serum T4 level after partial hepatectomy, serum T3 level and Ka for T3 of nuclear receptor remaining unchanged.

Adrenalectomy↗
PubMed1987

Effect of adrenalectomy on glucose homeostasis in rats fed a high-protein, carbohydrate-free diet.

1. The effect of adrenalectomy on the adjustments of carbohydrate metabolism to fasting was studied in rats fed a high-protein, carbohydrate-free (HP) diet. 2. Fasting for 24 h induced a 20% decrease of blood glucose levels in intact rats on the balanced, control (C) diet, but did not affect the blood glucose levels of rats adapted to the HP diet. After adrenalectomy, HP rats lost their capacity to maintain constant blood glucose levels during fasting, but the reduction in blood glucose (30% after 24 h) took longer to appear and was 50% smaller than in adrenalectomized C-rats. 3. Intact rats on the control diet responded to fasting with increased in vitro hepatic gluconeogenic capacity as well as increased phosphoenolpyruvate carboxykinase (PEPCK) and glucose-6-phosphatase activities. Adrenalectomized C-rats also responded to fasting with increased gluconeogenesis and PEPCK activity. In contrast, for both intact and adrenalectomized HP-fed rats, liver gluconeogenesis and PEPCK activity, which were already high in the fed state, did not change or even decreased slightly after fasting. 4. After food restriction, the rates of glucose replacement by adrenalectomized rats on the control diet were higher than those of intact animals on the same diet. This effect was not observed in HP-fed rats, in which the rates of glucose replacement were even slightly lower in adrenalectomized than in intact animals. 5. These data suggest that the mechanism of fasting-induced hypoglycemia after adrenal removal is different for HP and control rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Physiological↗
PubMed1985

Pharmacologic excitability of rat motor nerve endings: the effect of adrenalectomy on neostigmine-induced fasciculations.

Neostigmine-induced muscle fasciculations, quantitated as fasciculatory muscle action potentials, served as an indirect in vivo indicator of motor nerve ending (MNE) excitability. By this method, MNE excitability was depressed in adrenalectomized rats compared to matched intact controls. Daily or continuous administration of the mineralocorticoids aldosterone or desoxycorticosterone acetate restored MNE excitability toward normal; corticosterone, the endogenous corticosteroid having both mineralo- and glucocorticoid activity, was variably effective. There was a strong negative correlation (r = -0.95) between log plasma [K+]and the fasciculatory response to neostigmine. Dietary restriction of K in adrenalectomized rats lowered plasma [K+]to near normal and significantly increased MNE excitability. This effect of adrenalectomy on MNE excitability was further demonstrated by recording directly the neostigmine-induced repetitive neural discharges responsible for the muscle fasciculations. In adrenalectomized animals, neostigmine-induced neural discharges were reduced in intensity; restoration of neostigmine responsiveness was attained by lowering plasma [K+]through dietary restriction. Stimulus strength-duration relationships for both ventral and dorsal roots disclosed deficits in axonal excitability after adrenalectomy. These returned toward normal when plasma [K+]was lowered by K withdrawal from the diet. From these studies, it is concluded that 1) in adrenalectomized rats, peripheral nerve excitability, including the unmyelinated endings of motor nerve, is depressed; 2) mineralocorticoids play a significant role in restoring MNE excitability in these animals; 3) mineralocorticoid-induced changes in MNE excitability relate to the lowering of an elevated plasma [K+].

Action Potentials↗
PubMed1978

Proestrous levels of LH and FSH subsequent to adrenalectomy the same morning.

Adrenalectomies and sham-adrenalectomies were performed on the day of proestrus between 0900 and 1000 hours. On the afternoon and evening of the same day, these animals, as well as unoperated control animals, were sacrificed at 2-hour intervals from 1400 through 2400 hours and blood was taken from the abdominal aorta. Plasma concentrations of LH and FSH were determined by radioimmunoassay. Adrenalectomized, sham-adrenalectomized, and normal rats all show a peak in LH levels at 1800 hours on proestrus. Peak concentrations of FSH were found at 2200 hours in control and adrenalectomized rats, while in the sham-adrenalectomized animals an advancement of the FSH surge by 2 hours, to 2000 hours, was seen.

Adrenalectomy↗