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At least 1,135 records · Page 63Linked to original sources
PubMed1997

Laparoscopic adrenalectomy in asymptomatic pheochromocytoma.

A patient with asymptomatic pheochromocytoma associated with catecholamine hypersecretion but no hypertension was treated by right laparoscopic adrenalectomy. The 63-year-old male patient was referred to us for treatment of an incidentaloma. The diameter of the adrenal tumor was 50 mm, and the peripheral blood nonrepinephrine level was 1.12 ng/ml (normal level, 0.4 ng/ml). Blood pressure was normal. A flexible electron laparoscope was used for open laparoscopy, and four trocars were inserted. The retroperitoneum was incised to the right of the inferior vena cava, and the tumor was excised. During the operation, blood pressure rose transiently, and a blocker and nitroglycerin were administered. The tumor bled extremely easily. The duration of surgery was 3 hours and 20 minutes, and blood loss was 210 ml. The excised tumor was 55 mm in diameter. The patients's postoperative course was uneventful. If the size of asymptomatic pheochromocytoma is not large, and blood pressure and cardiac function are stable, laparoscopic adrenalectomy is indicated for this type of tumor as long as it is performed by experienced surgeons.

Adrenal Gland Neoplasms↗
PubMedDate not supplied

Impact of minimally invasive surgery on adrenalectomy for incidental tumors: comparison with laparotomic technique.

BACKGROUND: To compare laparoscopic and laparotomic techniques for the excision of incidental adrenal tumors. MATERIALS AND METHODS: Twenty patients with silent adrenal tumor underwent adrenalectomy or tumor excision through the laparotomic (LPT Group: 12 cases) or laparoscopic (LPS Group: 8 cases) approach. LPT Group and LPS Group were comparatively analyzed in terms of age, gender, Body Mass Index (BMI), concomitant diseases, previous upper abdominal surgery, tumor side and size, type of operation (excision vs adrenalectomy), associated procedures, and pathology. The two groups were then compared for intra/postoperative complications, length of operation, and postoperative ileus, pain, hospitalization. Comparisons were performed also adjusting for variables (BMI, depression, tumor size) unhomogeneously distributed between the two groups. RESULTS: LPT Group and LPS Group were comparable when evaluated for age, gender, BMI, concomitant diseases (except for depression), previous upper abdominal surgery, tumor side, type of operation, associated procedures, and pathology. Tumor size (LPKT > LPS, p = 0.03) and depression (LPT < LPS, p = 0.04) turned out to be differently distribution between the two groups, and were then considered, as well as the BMI (p = 0.08), in the covariance analysis. Postoperative ileus (LPT vs LPS: 3.5 +/- 0.2 days vs 2.3 +/- 0.2 days, p = 0.006), pain (LPT vs LPS: 3.0 +/- 0.3 days vs 1.7 +/- 0.2 days, p = 0.012), and hospitalization (LPT vs LPS: 7.9 +/- 1.0 days vs 3.5 +/- 0.4 days, p = 0.0002) were statistically shorter in the LPS Group; the length of operation, even if shorter in the LPS Group (LPT vs LPS: 2.9 +/- 0.3 hours vs 2.5 +/- 0.3 hours), did not reach statistical significance (p = 0.12). Results were confirmed by covariance analysis. CONCLUSIONS: Laparoscopy seems a safe and effective approach which permits adrenal surgery with lower surgical stress than laparotomic technique.

Adrenal Cortex Neoplasms↗
PubMed1998

[Control of hypertensive crisis with urapidil in two cases of adrenalectomy].

We review the use of urapidil to manage hypertension in two patients undergoing adrenalectomy for pheochromocytoma and aldosterone producing adenoma. Bolus administration (25 mg/i.v.) of urapidil provided good control of blood pressure during surgical manipulation of the tumor, although continuous perfusion of the drug was required by one patient before complete excision was achieved. No changes in heart rate or sudden decrease in blood pressure were observed. We believe that urapidil may be useful for treating hypertension during tumor adrenalectomy.

Adenoma↗
PubMed1998

[Laparoscopic adrenalectomy. A general review of a current technic].

The anatomical situation of the adrenal gland explains the diversity of the surgical incisions used for adrenalectomy. Laparoscopic adrenalectomy was first performed in 1992. It allows eradication of small adrenal lesions, which are often incidental findings. There are two routes of laparoscopic access to the adrenal gland: transperitoneal and retroperitoneal. Laparoscopy allows excellent operative exposure, reduction of postoperative pain and hospital stay and rapid convalescence. Retroperitoneoscopy, by allowing direct access to the retroperitoneum, is more rapid than the transperitoneal route.

Adrenal Gland Diseases↗
PubMed1998

Consequences of prenatal morphine exposure on the hypothalamo-pituitary-adrenal axis in the newborn rat: effect of maternal adrenalectomy.

The hypothalamo-pituitary-adrenal axis is already functional in rat fetuses in late gestation. We have reported previously that prenatal morphine exposure induced a severe atrophy of the adrenals and a decrease of corticosterone release in newborn rats at birth and during the early postnatal period. The first aim of the present study was to determine the effects of prenatal morphine exposure (1) on corticotrophin releasing factor (CRF) content of the hypothalamus, CRF immunofluorescence in the median eminence, CRF mRNA in the paraventricular nucleus (PVN) and pro-opiomelanocortin (POMC) mRNA in the anterior pituitary gland; (2) on CRF-induced ACTH release from the anterior pituitary gland in vitro; and (3) on ACTH-induced corticosterone release by the adrenals in vitro. Moreover, as morphine is a hepatotoxic factor, we determined the effects of prenatal morphine on liver weight and plasma corticosteroid binding globulin (CBG) binding capacity in newborn rats. Since acute administration of morphine stimulates corticosterone secretion in adult rats and since maternal corticosterone can cross the placental barrier, we also measured both adrenal weight and glucocorticoid activity in newborns from adrenalectomized mothers treated with morphine. The present results show that prenatal morphine given to intact mothers induced adrenal atrophy and hypoactivity in newborns but did not affect the responsiveness of the anterior pituitary gland to CRF or that of the adrenal gland to ACTH. Prenatal morphine reduced both CRF content in the newborn hypothalamus and CRF immunofluorescence in the median eminence without a significant effect on CRF mRNA expression in the PVN. Moreover, morphine induced a significant decrease of POMC mRNA in the anterior pituitary gland. However, morphine did not significantly affect the weight of the liver, or the plasma CBG binding capacity for corticosterone, in rat pups. In contrast, morphine treatment of the adrenalectomized mothers did not induce adrenal atrophy in newborns and did not impair adrenal activation during the early postnatal period. Maternal adrenalectomy also prevented the effects of prenatal morphine on hypothalamic content of CRF, CRF immunofluorescence in the median eminence, and POMC mRNA in the anterior pituitary gland. However, adrenal atrophy was observed at term in newborns of adrenalectomized mothers treated with both morphine and corticosterone or only corticosterone. In conclusion, morphine given to pregnant rats induced inhibition of the hypothalamo-pituitary-adrenal axis in pups at term. As maternal adrenalectomy prevented these effects, we speculate that an adrenal factor of maternal origin, probably corticosterone, mediated these drug effects on newborns.

Adrenal Glands↗
PubMed1997

Adrenalectomy does not affect the nocturnal peak of Fos expression within hypothalamic pro-opiomelanocortin neurons.

Circulating glucocorticoid (GC) levels are thought to modulate the basal activity of pro-opiomelanocortin (POMC) neurons within the mediobasal hypothalamus (MBH) of the male rat. In a recent study we demonstrated that Fos-immunoreactivity (Fos-IR) was spontaneously induced throughout the dark phase of the light/dark cycle within a large population of these MBH neurons. Here, we have investigated the effect of adrenalectomy on the nocturnal expression of Fos protein within POMC neurons. To this aim, groups of intact (IN), adrenalectomized (ADX) and sham-operated (sham) rats were killed 7 days after surgery (or no surgery) at times when Fos-IR is known to show either nadir (at light offset) or peak (6 h after light offset) values within MBH POMC neurons. Brains were processed for Fos- and/or POMC-immunohistochemistry. The results showed that, at both times studied, 7-day adrenalectomy did not affect the number of POMC/Fos double-stained neurons within the MBH. The rostro-caudal pattern of distribution of such labeled neurons throughout the MBH of ADX rats was also similar to that of IN or sham rats. The present data demonstrate that the nocturnal induction of Fos within MBH POMC neurons is not controlled via the nychtemeral rhythm of secretion of the adrenal gland. Furthermore, this study shows that basal levels of circulating GC do not alter the nocturnal peak of Fos synthesis within POMC neurons.

Adrenal Glands↗
PubMed1998

[Laparoscopic adrenalectomy].

The authors performed three left and one right sided laparoscopic adrenalectomies between 3rd April and 8th August 1997. The indication of surgery was hormonally active cortical adenoma of about 2 cm size in three cases, a 6 cm large hormonally inactive tumour in one case respectively. For the operation on the left side three, on the right side four trocars with 11 mm diameter was used. The duration of the operations was between 115 and 220 min. The patients left one the second or third postoperative day, no complication was observed. The authors' opinion based on both literature data and their own experience is that laparoscopic approach to adrenalectomies is the method of choice today.

Adrenalectomy↗
PubMed1997

[Retroperitoneal laparoscopic adrenalectomy. The 3-trocar surgical technic].

Laparoscopic adrenalectomy (LA), introduced in surgical practice quite recently, proves to be an effective method for treating diseases of the adrenal gland on account of the good visualization provided, in conjunction with all additional advantages of laparoscopic surgery, such as reduced traumatism, postoperative pain alleviation, shortened hospital stay and the like. Two patients presenting Cushing's syndrome are subjected to retroperitoneal laparoscopic adrenalectomy (RLA). With the patient in lumbotomy position on the operating table, a retroperitoneal space is created using a balloon dissector (Ethicon). The optics is introduced after placing a 10 mm balloon trocar (Origin). Under visual control two additional 10 mm trocars are placed along the course of lumbotomy line, accordingly along the anterior and posterior axillary lines. Next blunt dissection of the adrenal gland is done, and a clip applied to v. centralis. The adrenal gland is removed through one of the trocars, and the operation terminates after hemostasis and insertion of a drainage tube. The patients are discharged on the 4th postoperative day in a good general condition, mobilized, well fed with restored passage. In conclusion, the assumption is warranted that the early experience with RLA is encouraging as a safe and considerably less traumatic surgical procedure for operative management of diseases of the adrenal glands.

Adrenalectomy↗
PubMed1998

[Comparative study between laparoscopic and conventional adrenalectomy for pheochromocytomas].

This prospective study compares the outcome of 2 groups of patients with pheochromocytoma undergoing adrenalectomy via a transabdominal approach or a laparoscopie approach. Mean operating time was exactly the same in both groups (122 and 125 minutes). Postoperative stay in the intensive care unit and in hospital was significantly shorter in the laparoscopic group as previously demonstrated fo other adrenal tumors. More important, no differences in haemodynamic changes were observed during surgery. In both groups, the increase of cathecholamine levels was identical, with a peak occuring during manipulation of tumors. Pneumoperitoneum was not responsible for any cardiovascular instability. Laparosopic adrenalectomy should therefore be preferred to open procedures in pheochromocytomas unless tumors are too large or potentially malignant.

Adrenal Gland Neoplasms↗
PubMed1976

[Behavior of various metabolites of carbohydrate metabolism in the liver of young pigs following inhibition of C-11 hydroxylase and adrenalectomy].

The effects of glucocorticoid depression by C-11 hydroxylase inhibition and total adrenalectomy upon certain metabolites of the plasma, liver, and muscles that are related to gluconeogenesis were studied on ten store pigs. Metopiron caused decline of glucose and pyruvate concentrations in plasma and drop of liver glycogen. Total adrenalectomy caused changes of the same kind but much stronger in the agonal phase, yet without rendering the animals hypoglycaemic. Muscular glycogen dropped to one third of the normal. The results are discussed with reference to earlier studies into store pig.

Adrenalectomy↗
PubMed1981

Influence of damage of hypothalamo-hypophysial neurosecretory system and adrenalectomy on the blood-brain barrier alteration during intracranial hypertension.

Short-term intermittent cerebral compression following the lesion of NSO, NPV or ME alone or with adrenalectomy, caused disturbances in cerebrovascular system. It was characterized by congestion of blood vessels or vasoparalysis with the damage of BBB. These symptoms were much more pronounced in animals in which ME lesion was combined with adrenalectomy. It seems that the decreased level of vasopressor peptides (VSP, Ox) and catecholamines(A, NA) in the blood could be related to the increased activity of cholinergic system and other substances which are responsible for the dilatation of vessels. It is quite possible that the mutual relation of the above mentioned neuro-humoral factors determine the threshold for cardiovascular and cerebrovascular response to cerebral shock. The breakdown of this threshold could occur at the last stage of intracranial hypertension, being expressed by insufficient control of cardiovascular system with the fall of blood pressure and paralysis of cerebral blood vessels, BBB damage, that eventually might lead to brain death.

Adrenal Glands↗
PubMed1981

Cytological evidence for activation of neuroendocrine cells in the parvocellular preoptic nucleus of the goldfish hypothalamus following pharmacological adrenalectomy.

The nucleus preopticus (NPO) of the goldfish hypothalamus is composed of parvocellular (NPOpc) and magnocellular (NPOmc) neurosecretory neutrons. The cytology of NPOpc and NPOmc neurons was examined with light and electron microscopy following pharmacological adrenalectomy with the adrenocortical inhibitor, metopirone. After five days of metopirone administration, light microscopy revealed a significant increase in nuclear area of NPOpc, but not of NPOmc, neurons. Ultrastructural examination of NPOpc neurons revealed two cell types, PC1 and PC2 neurons, which could be distinguished by the relative abundance and the size of the neurosecretory granules in the cytoplasm. The ultrastructural appearance of the NPOmc neurons revealed a single cell type containing abundant neurosecretory granules. Following five days of metopirone administration, the ultrastructural appearance of the PC1 neurons indicated a state of enhanced secretory activity. Metopirone had no observable effect on the appearance of the PC2 or NPOmc neurons. These observations demonstrate that PC1 neurons are activated under the conditions of pharmacological adrenalectomy and suggest that the secretory activity of these neurons is inhibited by adrenocorticosteroids.

Adrenocorticotropic Hormone↗
PubMed1981

Effect of adrenalectomy on cadmium- and turpentine-induced hepatic synthesis of metallothionein and alpha 2-macrofetoprotein in the rat.

Recent reports have strongly implicated glucocorticoids in the induction of hepatic metallothionein synthesis and hypozincemia which occurs in certain pathophysiologic conditions. Studies were performed in rats to determine the effect of adrenalectomy and glucocorticoid treatment on the hepatic accumulation of metallothionein subsequent to the administration of cadmium and turpentine, two diverse substances known to induce hypozincemia and hepatic synthesis of metallothionein as well as alpha 2-macrofetoprotein in intact rats. By 24 h, both substances induced significant hypozincemia, hepatic metallothionein accumulation, and a severe tissue inflammatory response in adrenalectomized rats. Adrenalectomy only prevented the increase in plasma alpha 2-macrofetoprotein concentration. Results indicate that hepatic synthesis of alpha 2-macrofetoprotein, but not metallothionein, is mediated by adrenal hormones. Thus, glucocorticoids do not play a "vital" role in hepatic metallothionein accumulation or hypozincemia induced by inflammatory stress, as previously postulated.

Abscess↗
PubMed1976

Effect of adrenalectomy on weight gain and body composition of yellow obese mice (Ay/a).

It has been reported that the adrenal gland is essential to the development of obesity if Ay/a Yellow obese mice (Hausberger and Hausberger 1960). Since the actual body composition data to support this report has not been published, we attempted to duplicate this observation by adrenalectomy of the Yellow mice before the onset of obesity. Two groups of Yellow mice (Ay/a) and normal mice (a/a) were either sham operated or adrenalectomized at two months of age and at four months of age. Body weight was monitored until body gain had stopped. At that time the animals were sacrified and checked for completeness of adrenal removal. Body composition of dry matter, fat, protein, and ash was determined. Adrenalectomy caused a reduction of body fat of 33% and 30% in both the a/a Control and the Ay/a Yellow mice, respectively. The adrenalectomized Yellow mice were still fatter than adrenalectomized Controls (25.3% fat vs. 10.6% fat). Yellow and control adrenalectomized mice showed similar depression in growth rate. These data suggest that while the adrenal gland is essential for complete expression of the genetic potential for fat deposition, it may not be necessary for partial expression indicating a secondary role in the development of obesity in the Ay/a Yellow mouse.

Adrenal Glands↗
PubMed2004

Fos expression after mating in noradrenergic cells of the A1 and A2 areas of the medulla is altered by adrenalectomy.

In the female rat, the integrity of the ventral noradrenergic bundle (VNAB) is necessary to carry stimuli from the uterine cervix and vagina to brain areas involved in mating-induced pseudopregnancy. Because adrenal hormones are known to alter noradrenergic function, we examined whether adrenalectomy altered mating-induced Fos expression in the A1 and A2 noradrenergic cell groups that project through the VNAB. Ovariectomized females were adrenalectomized (ADX) or sham-operated (Sham) and, 2 weeks after surgery, were given oestrogen and progesterone and mated. They received 15 intromissions, five intromissions or 15 mounts-without-intromission (mounts-only) from a male. Two hours after mating, rats were perfused and brains were collected; controls were perfused after being taken directly from their home cage. After immunocytochemical staining, Fos-immunoreactive (Fos-IR) and dopamine-beta-hydroxylase-immunoreactive (DBH-IR) cells and the percentage of DBH cells that were labelled with Fos (% DBH/Fos) were counted. In the A1 area, Fos-IR and percentage DBH/Fos were not affected by adrenalectomy. Although an overall effect of mating treatment was found for both measures, no specific mating treatment increased labelled cells above home cage levels. In the caudal, middle and rostral A2, 15 intromissions induced a significant increase in Fos-IR in Sham females above all other groups and a higher percentage of DBH/Fos in the middle and rostral A2 areas. ADX females showed no rise in either Fos-IR or percentage DBH/Fos after 15 intromissions. However, in the middle and rostral A2, ADX females showed significantly increased Fos-IR and percentage DBH/Fos after mounts-only treatment above Sham mounts-only females and all other ADX groups. These results demonstrate that adrenal hormones suppress activation of A2 cells to mounts-only stimuli but contribute to A2 activation in response to intromissions from males. The latter effect may result from stress associated with receipt of vaginocervical stimulation during mating.

Adrenal Glands↗
PubMed1980

Effect of adrenalectomy and tryptophan force-feeding on the activity of intestinal disaccharidases in adult rats.

The effects of bilateral adrenalectomy and subsequent force-feeding of L-tryptophan (30 mg/100 g body weight) on the activity of disaccharidases (lactase, sucrase, and maltase) in the jejunum and ileum were investigated. One month after adrenalectomy the activity of lactase, sucrase, and maltase in the ileum and of lactase and maltase in the jejunum was significantly decreased when compared with that of the sham-operated controls. In adrenalectomized rats, administration of tryptophan (24 h later) produced significant increments in lactase and maltase activities in both jejunum and ileum, compared with the corresponding water-fed adrenalectomized control.

Adrenal Medulla↗
PubMed2001

[Change in the surgical treatment of benign adrenal gland tumors. Laparoscopic adrenalectomy].

UNLABELLED: Since 1995 fifty-two patient was operated on the Ist Department of the Surgery (DEOEC) due to uni- and bilateral tumor of the adrenal gland. Between May 1999, and December 2000 the authors performed 11 transperitoneal laparoscopic adrenalectomies (LA). Conversion due to bleeding in 3 cases and due to suspected malignancy in 1 case was necessary. This malignant lesion could have been resected during the open surgery after only the temporary dissection of the right renal vein. Complete resection was carried out in 9 cases. In 2 cases where a well circumscribed adenoma or teratoma was visualized, only enucleation was performed. The complication rate was low (1 ptx). Blood replacement was not necessary. The operation mean time was not any longer in LA compared to the open surgical approach. Preoperatively adrenaline (A), noradrenaline (NA), metadrenaline (metA), normetadrenaline (normetA) and vanillylmandelic acid (VMA) were measured in 24-h urine samples. Adrenal imagery consisted in all patients of abdominal computed tomography and in 4 patients adrenal magnetic resonance imaging but [131I] metaiodobenzylguanidine (MIBG) and octreotide scintigraphy were not performed. CONCLUSION: In the authors experience laparoscopic adrenalectomy is absolutely superior to the open surgery for the benign diseases of the adrenal gland not bigger than 6 cm. A short, uncomplicated and painless postoperative period can be achieved for the patients, with the same efficacy and safety compared to the conventional surgery. Enucleation without the whole adrenal gland excision is also possible.

Adrenal Gland Neoplasms↗
PubMed1984

Effect of adrenalectomy on prostaglandin protection of the rat gastric mucosa.

Prostaglandins can prevent damage to gastric mucosa by agents such as Aspirin and ethanol, but their mechanism of action is not known. The authors examined the role of the adrenal gland in prostaglandin protection. Fifty, male Wistar rats were subjected to bilateral total adrenalectomy or sham operation. Adrenalectomized rats with circulating cortisol were discarded. After allowing 2 weeks for recovery, the authors measured the susceptibility of the gastric mucosa to injury by ethanol in an ex-vivo chamber of the entire stomach. This model permits the mucosa to be bathed by a series of solutions and the damage to be measured by planimetry. Mucosal damage was induced by applying 40% ethanol for 10 minutes. The prostaglandin used was 16,16-dimethyl prostaglandin E2 (10 micrograms) given for 10 minutes before the ethanol was introduced. The results show that mucosal damage from ethanol is consistently higher in the adrenalectomized rat but that adrenalectomy does not prevent protection by prostaglandin. The authors conclude that the mechanism of prostaglandin protection against ethanol injury is not corticosteroid-dependent.

16,16-Dimethylprostaglandin E2↗