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PubMedDate not supplied

Laparoscopic adrenalectomy in pheochromocytoma and Cushing's syndrome. Reflections about two case reports.

Laparoscopic adrenalectomy is possible as well on the left as on the right side using a percutaneous transabdominal approach. The exposure of the glands seems better than it could be achieved with an open method. In combination with intraoperative infusion of nicardipine, a calcium-channel blocker, the laparoscopic removal of a pheochromocytoma was performed safely and under stable conditions. In case of Cushing's syndrome, the laparoscopic approach reduces the problems related to poor healing. In all cases of laparoscopic adrenalectomy, this approach could offer the clear advantages of smaller incisions, reduced postoperative pain and incisional discomfort as well as complications related to large and invasive procedure and finally allows quicker recovery. Moreover, conversion to open surgery remains always possible, if needed.

Adrenal Gland Neoplasms↗
PubMed1994

[Endoscopic, extraperitoneal adrenalectomy].

Between March and June 1994 three adrenalectomies were performed via an endoscopic extraperitoneal approach. After creating a carbon dioxide retropneumoperitoneum three 10 mm trocars were introduced in the area of conventional lumbar incision. Via these ports adrenalectomy was performed. Time of operation amount to 215, 290 and 330 min. No postoperative complications were observed. Time of postoperative hospitalisation amount to 3, 4 and 7 days. The advantage of the extraperitoneal approach is that it decreases postoperative pain and allows more rapid recovery.

Adenoma↗
PubMed1994

Incidence of Nelson's syndrome and residual adrenocortical function in patients of Cushing's disease after bilateral adrenalectomy.

Eighteen patients of Cushing's Disease, who had undergone bilateral "total" adrenalectomy 2 to 10 years back, were evaluated for residual adrenocortical function and for any evidence of Nelson's Syndrome. Surprisingly, all patients were discovered to have measurable plasma cortisol, albeit in the subnormal range. The standard criteria for accepting "completeness of adrenalectomy" were fulfilled in 16 patients. It was possible to wean one patient off replacement therapy. Thus, the dose of replacement steroids needs to be regulated according to the blood steroid levels in order to avoid unnecessary hypercortisolism. Radiological evidence of pituitary tumor diagnosed Nelson's Syndrome in 2 patients. Nelson's Syndrome was further suspected in 8 others who showed pigmentation. One of these had an enlarged sella and an erosion of the dorsum sellae, but had a normal CT scan. Another patient had evidence of incidental pituitary pathology (incidentaloma) which resolved spontaneously. Contrast enhanced CT scans of the sella are necessary for early detection of Nelson's Syndrome.

Adenoma↗
PubMed1994

Adrenalectomy suppresses insulin secretion from pancreatic islets of ob/ob mice.

The aim of this work was to examine effects of adrenalectomy and intracerebroventricular injection of dexamethasone on insulin secretion from pancreatic islets of ob/ob mice. Female ob/ob and lean mice fed a stock diet were adrenalectomized at 5 wk of age and studied at 8-9 wks of age. Removal of the adrenal glands from ob/ob mice fed a stock diet normalized their plasma insulin concentration, islet size, and essentially normalized insulin secretion from islets incubated in 10 mM glucose. Insulin secretion from islets was, however, not fully normalized when the incubation buffer contained higher concentrations of glucose (20 mM), or acetylcholine, a potentiator of glucose-induced insulin secretion. Within 90 min after intracerebroventricular administration of dexamethasone plasma insulin concentrations were elevated and glucose-induced (10 mM) insulin secretion from isolated islets of adrenalectomized ob/ob mice increased, but dexamethasone was ineffective in lean mice. Regulation of insulin secretion from pancreatic islets of adrenalectomized ob/ob mice remains abnormal even though adrenalectomy normalized plasma insulin concentrations in these mice. Alterations in glucocorticoid-mediated, central nervous system regulation of insulin secretion likely contribute to hyperinsulinemia in ob/ob mice.

Adrenal Glands↗
PubMed1975

Glucidic and lipidic metabolic changes in rats induced by irradiation and the effect of adrenalectomy.

In experiments on X-irradiated rats (1000 R) the hepatic glycogen, total lipids, phospholipids content, and plasma glucose, cholesterol and beta-lipoprotein concentration were determined in intact and adrenalectomized animals. It was confirmed that irradiation produces a hepatic glycogen and blood glucose increased concentration. The glucidic metabolic response on irradiation is diminished by adrenalectomy. The adrenalectomy-induced modifications in the lipid metabolism of irradiated rats are more inconstant, which corresponds with its relative independence from glucocorticoid hormones.

Adrenal Cortex↗
PubMed1993

Polychlorinated biphenyl-induced immune suppression: castration, but not adrenalectomy or RU 38486 treatment, partially restores the suppressed cytotoxic T lymphocyte response to alloantigen.

The cytotoxic T lymphocyte (CTL) response to allogeneic P815 tumor in C57bl/6 mice is dose-dependently suppressed after treatment with 3,3',4,4',5,5'-hexachlorobiphenyl (HxCB). Elevation of plasma corticosterone (CS) is also observed coincident with CTL suppression. Because immune suppression is inducible by glucocorticoid administration, the role of elevated CS was investigated as an indirect mechanism of HxCB-induced immunotoxicity. In multiple experiments, HxCB treatment (10 mg/kg b.w.) consistently reduced CTL activity by 70 to 85% in male mice. Adrenalectomy failed to alter the suppression of CTL activity by HxCB. However, the mortality rate was high (> or = 70%) in these experiments and plasma CS elevation persisted in HxCB-treated adrenalectomy survivors. Therefore, the use of adrenalectomized mice was inadequate to determine whether CS elevation leads to CTL suppression after HxCB treatment. Daily administration of the glucocorticoid receptor antagonist 17-beta-hydroxy-11-beta-(4-dimethylaminophenyl)-17-alpha-(propanyl )-estra- 4,9-dien-3-one (RU 38486) (150 mg/kg b.w., p.o.) also failed to alter the suppression of CTL activity in HxCB-treated mice; however, spleen cellularity was significantly increased, suggesting functional GCR antagonism. Male mice were more sensitive to HxCB-induced CTL suppression than female mice, and HxCB-induced plasma CS elevation was greater in male mice. Castration failed to reduce the elevation of plasma CS in HxCB-treated male mice. However, castration partially alleviated CTL suppression in HxCB-treated male mice.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenalectomy↗
PubMed1993

Unilateral adrenalectomy as a treatment for adrenocortical tumors in ferrets: five cases (1990-1992).

Adrenocortical tumors were diagnosed in 5 adult spayed ferrets. Four ferrets had bilaterally symmetrical alopecia of the caudal femoral region, abdomen, and tail, and 1 had alopecia of the distal limbs and feet. All 5 ferrets had vulvar swelling. During abdominal ultrasonography, irregular masses, believed to involve the adrenal glands, were seen in all 5 ferrets. Unilateral adrenalectomy was performed successfully in each ferret by use of ventral midline celiotomy. On histologic examination of biopsy samples, 4 ferrets were found to have adrenocortical adenomas, and 1 ferret was found to have an adrenocortical adenocarcinoma. All clinical signs resolved after adrenalectomy, suggesting that the adrenocortical tumors had been secreting adrenocortical hormones.

Adrenal Cortex Neoplasms↗
PubMed1993

Effect of adrenalectomy on the latency of radiation myelopathy in rats.

The effect of adrenalectomy on the development of radiation myelopathy was studied. A 1-cm section of cervical cord of adrenalectomized and intact animals was exposed to graded doses (18 to 30 Gy) of gamma rays. The radiation tolerance, the latent period from exposure to paralysis, plasma corticosterone levels at the time of paralysis, and histopathology of the cord were evaluated. Adrenalectomy essentially eliminated endogenous production of corticosterone and significantly shortened the mean latent period between irradiation (24 to 30 Gy) and paralysis by more than 10 weeks. This reduced latent period was not reversed by the administration of the exogenous glucocorticoid, dexamethasone, and corticosterone, although prolonged administration of dexamethasone resulted in the development of Cushingoid features, indicating hypercorticoidism. Histopathological examinations indicated that adrenalectomized paretic animals had multiple hemorrhages in both the gray and the white matter, but less white matter necrosis than normally observed in intact paretic animals irradiated similarly. Possible mechanisms for the shortened latent period in adrenalectomized animals are discussed.

Adrenalectomy↗
PubMed1993

Selective loss of hippocampal granule cells following adrenalectomy: implications for spatial memory.

We examined the effects of long-term adrenalectomy (ADX) on hippocampal anatomy and behavioral learning in two spatial memory tasks. We assessed damage throughout the hippocampus by stereological analysis of the dentate gyrus and Ammon's horn. Rats were ADX or sham operated, and then tested in the Morris water maze 12 weeks after surgery, followed by testing on an eight-arm, alternating-baited radial maze at 22 weeks postsurgery. Animals were killed 7 1/2 months after surgery. ADX rats had selective volume reduction in the dentate gyrus with no changes in pyramidal regions CA1, CA2, CA3, or CA4. Dentate gyrus damage in some cases occurred throughout the entire rostrocaudal extent of the hippocampus. Analysis of corticosterone serum levels, serum Na+/K+ ratios, and body weight gain suggested that individual differences in dentate gyrus damage appear to be due to incomplete adrenalectomies or remaining ectopic tissue. ADX rats were able to learn in both the Morris water maze and eight-arm radial maze, even when the dentate gyrus was severely damaged (80% volume reduction). However, in the Morris water maze, the ADX rats' learning rate was significantly slower compared to controls. There was no difference between ADX and controls during reversal in either task. These data indicate that damage to the dentate gyrus following long-term ADX is severe enough to cause learning impairment in selected learning tasks. Such damage is restricted to the dentate gyrus and can occur throughout the rostrocaudal regions of the hippocampus.

Adrenalectomy↗
PubMed1994

[Activity of some indicator enzymes in myocardium of rats after adrenalectomy, stimulation and inhibition of adrenal function].

An activity of some selected indicator enzymes in rats after adrenalectomy, stimulation and inhibition of adrenal glands has been investigated in the heart muscle. An increase in the activity of CPK, isoenzyme CK-MB, LDH and AspAT after the adrenal stimulation (Synacthen) have been observed. As well as significant decrease in the activity of these enzymes after adrenalectomy and inhibition (by use Orimeten-aminoglutethimide) functioning of adrenal glands have been observed.

Adrenal Glands↗
PubMed1995

Ultrastructural variations of the rat fetal adrenal cortex after maternal bilateral adrenalectomy and exogen glucocorticoid administration.

Rat fetal adrenal cortex ultrastructure was studied in fetuses of 20 days of gestation coming from control (C) pregnant rats and from mothers undergoing two experimental conditions: maternal bilateral adrenalectomy on day 1 of gestation (ADX) and maternal bilateral adrenalectomy plus posterior dexamethasone administration the days 15, 16 and 17 of gestation (A+D). Our results show ultrastructural changes in the ADX rat fetal adrenal cortex, consisting of hyperactive steroidogenical features as response to the absence of maternal glucocorticoids, and the restoration of the control structural characteristics after dexamethasone administration to adrenalectomized animals.

Adrenal Cortex↗
PubMedDate not supplied

[Monoamine oxidase activity and amount of catecholamines in rat tissues with adrenalectomy and demedullation].

The activity of monoaminoxidase (MAO) and the amount of catecholamines (CA) were studied in the heart, brain and liver of adrenalectomized and demedullated rats. Adrenalectomy increased the MAO activity of the brain and heart homogenates but had no effect on that of the liver mitochondria. The level of liver mitochondria MAO does not change when rats were demedullated, in this case there is some reduction in the content of the so-called PO (substances with the affinities of CA chinoid oxidation product). Neither adrenalectomy nor demedullation affect the amount of CA of all the studied tissues.

Adrenal Medulla↗
PubMedDate not supplied

[Effect of adrenalectomy on alkaline phosphatase isoenzymes in intact and pregnant mice].

The paper shows that alkaline phosphatase activity tends to decrease in the hepatic extracts, in the intestine, significantly in the blood serum and to increase in the kidneys and significantly in the bone in mice 7 days after adrenalectomy, which coincides with the changes in the amount and activity of rapidly migrating alkaline phosphatase isoforms during polyacrylamide gel electrophoresis. Pregnancy in animals enhances alkaline phosphatase activity in the extracts of organs and tissues; adrenalectomy made on day 13-14 of pregnancy does not cause so noticeable differences as in the control group.

Adrenal Glands↗
PubMed1997

Regulation of a putative neurotransmitter effect of corticotropin-releasing factor: effects of adrenalectomy.

This study tested the hypothesis that endogenous glucocorticoids regulate a putative neurotransmitter function of corticotropin-releasing factor (CRF) in the locus coeruleus (LC). LC spontaneous discharge and activation by intracerebroventricularly administered CRF, hypotensive challenge, sciatic nerve stimulation, and carbachol were compared in adrenalectomized and sham-operated halothane-anesthetized rats. LC spontaneous discharge was higher in adrenalectomized versus sham-operated rats. Intracoerulear microinfusion of a CRF antagonist decreased LC discharge rates of adrenalectomized rats to rates comparable with those observed in sham-operated rats but had no effect in sham-operated rats. The CRF dose-response curve was shifted in a complex manner in adrenalectomized rats, suggesting that a proportion of CRF receptors were occupied before CRF administration, and low doses of CRF were additive. Higher doses of CRF produced effects that were greater than predicted by simple additivity. Hypotensive challenge increased LC discharge rates of adrenalectomized rats by a magnitude greater than that predicted on the basis of additivity. In contrast, LC responses to carbachol and sciatic nerve stimulation were similar in both groups. The results suggest that adrenalectomy enhances tonic and stress-induced CRF release within the LC and also alters postsynaptic sensitivity of LC neurons to CRF. Because adrenalectomy also alters release of neurohormone CRF, the present study suggests that CRF actions as a neurohormone and as a neurotransmitter in the LC may be co-regulated. Such parallel regulation may underlie the coexistence of neuroendocrine and noradrenergic dysfunctions in stress-related psychiatric disorders.

Adrenalectomy↗
PubMed1997

The phosphodiesterase type 4 (PDE4) inhibitor CP-80,633 elevates plasma cyclic AMP levels and decreases tumor necrosis factor-alpha (TNFalpha) production in mice: effect of adrenalectomy.

Rolipram was previously reported to elevate plasma cyclic adenosine 3',5'-monophosphate (cAMP) and inhibit serum tumor necrosis factor-alpha (TNF-alpha) production in mice. CP-80,633, a new cyclic nucleotide phosphodiesterase (PDE4) inhibitor, has been shown to augment intracellular cAMP levels and to inhibit TNFalpha release from human monocytes in vitro. This study was undertaken to determine the effect of p.o. CP-80,633 on plasma cAMP levels and lipopolysaccharide-induced TNFalpha production in mice with and without adrenal glands. CP-80,633 dose-dependently (3-32 mg/kg p.o.) elevated plasma cAMP levels and decreased systemic TNFalpha production in response to i.p. injection of lipopolysaccharide. Elevated plasma cAMP levels can be detected for up to 4 hr. CP-80,633 (10 mg/kg p.o.) caused a 6-fold increase in the plasma cAMP level, a 2-fold increase in the plasma epinephrine level and a greater than 95% reduction in TNFalpha production. Unlike CP-80,633, neither vinpocetine, dipyridamole, SKB-94,120 nor zaprinast, at 100 mg/kg p.o., modified the cAMP response, which suggests that this response is mediated by inhibition of PDE4. Adrenalectomy reduced the cAMP response and completely blocked the epinephrine response; however, the levels of plasma cAMP in the CP-80,633-treated mice (10 mg/kg p.o.) remained elevated (vehicle: 47.3 +/- 6.8 vs. CP-80,633: 98.4 +/- 10.3 pmol/ml, n = 7, P < .05). This effect is mimicked by treatment of control mice with propranolol, which demonstrates that beta adrenoreceptors contribute to the cAMP response. Removal of adrenal glands significantly increased the LPS-induced elevation of serum TNFalpha. The ability of CP-80,633 to block the TNFalpha response was only slightly affected by adrenalectomy (ED50 = 1.2 mg/kg in controls vs. 3.9 mg/kg in adrenalectomized mice). Taken together, these results show that CP-80,633, when given p.o. to mice, is capable of elevating plasma cAMP and inhibiting TNFalpha production and that adrenal catecholamines contribute significantly to the effect of CP-80,633 on the cAMP response but only slightly to its effect on the systemic TNFalpha response.

3',5'-Cyclic-AMP Phosphodiesterases↗
PubMed1997

[Laparoscopic versus laparotomic adrenalectomy: preliminary experiences].

The authors report their experience about laparoscopic surgery in the treatment of adrenal tumours. Three laparoscopic right adrenalectomies were performed. From a comparison with five open adrenalectomies, microinvasive surgery is more advantageous than traditional management: recovery is earlier, incisions are smaller, post-operative discomfort is less, physiologic functions recover in a short time, return to full professional activity in one week.

Adenoma↗
PubMed1997

[Bilateral laparoscopic transperitoneal adrenalectomy in pheochromocytoma].

Laparoscopic transperitoneal and endoscopic extraperitoneal adrenalectomy are two safe options in minimally invasive surgery associated with a very low morbidity. Comparative studies with the conventional access to the adrenal gland demonstrated the advantages of the endoscopic technique. The anterior transperitoneal approach yields a better exposure of the anatomic structures and allows the surgeon to orient himself more easily, while at the same time he may perform additional laparoscopic maneuvers. In two cases of bilateral pheochromocytoma a bilateral laparoscopic adrenalectomy was performed simultaneously by employing the transperitoneal approach. The duration of surgery was approximately 210 and 270 min, respectively, with an intraoperative blood loss of about 350 and 400 ml. There were no complications following this procedure. Already on the 1st postoperative day, the patients could be fully mobilized. Furthermore, immunological data obtained perioperatively support the minimal invasiveness of this technique.

Adrenal Gland Neoplasms↗
PubMed1997

Laparoscopic adrenalectomy: comparison with the conventional approach.

Laparoscopic adrenalectomy (LA) was performed on 14 patients with adrenal tumors. Herein we describe the laparoscopic procedure and the patients' clinical course compared with those of patients who underwent the conventional posterior or transabdominal approach (PA, TA). The 14 patients included four men and 10 women aged 28 to 69 years. Clinical diagnoses in this series were primary aldosteronism in seven patients, Cushing's adenoma in four patients, and nonfunctioning tumor in three patients. Maximum diameters of the adrenal tumors ranged from 10 to 48 mm. In all patients, the adrenal tumors were removed successfully. The mean operating time was longer for LA- than for PA- or TA-treated patients (185 versus 99 and 143 min), whereas the mean blood loss was smaller for LA- or PA-treated (92 and 126 ml) than for TA-treated patients (407 ml). The patients' postoperative condition, as assessed in terms of the number of febrile days, leucocytosis, and elevation of C-reactive protein value, was significantly better with LA. In addition, the frequency of administration of analgesics was lower and the time required until the patient could walk were shorter after LA than after PA and TA. In conclusion, laparoscopic adrenalectomy appears to be a minimally invasive and safe therapeutic option that may become a standard procedure for adrenal surgery.

Adrenal Gland Neoplasms↗