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PubMed1982

Endosalpingosis ("endosalpingoblastosis") following laparoscopic tubal coagulation as an etiologic factor of ectopic pregnancy.

Recent literature has suggested that the majority of pregnancies following a laparoscopic tubal coagulation failure are ectopic. This is in direct contrast to the failure of other types of tubal ligation procedures which usually result in intrauterine pregnancies. The purpose of this paper is to explain this disparity in hopes of reducing the chance of ectopic pregnancies. A study of pathology is presented and how different portions of the oviduct respond to coagulation injury is reported. It was found that the endosalpinx of the proximal oviduct, which is so frequently injured during laparoscopic coagulation, becomes activated (endosalpingosis or "endosalpingoblastosis") with potential fistula formation. If the coagulation is more distal only fibrosis occurs. This is clinically significant in that if the laparoscopist avoids injury to the proximal isthmic portion of the oviduct, the chance of "endosalpingoblastosis," fistula, and ectopic pregnancy should be reduced, thus improving the outcome of this technique.

Adult↗
PubMed1989

Ectopic pregnancies due to contralateral fistulas after sterilization by electrocoagulation; case reports.

Three cases of post-sterilization tubal pregnancy are discussed. The sterilizations were performed by bipolar electrocoagulation. The location of the pregnancy was distal to the site of sterilization. There was no continuity between the segment containing the ectopic pregnancy and the uterus. Spermatozoa reached the site of fertilization via a tuboperitoneal fistula. The existence of the fistulas was confirmed by a methylene blue test. In two cases fistulas existed on the contralateral side to the ectopic pregnancy. In the third case, bilateral fistulas were found. So, on performing a salpingectomy for ectopic pregnancy after sterilization failure, we have to be aware of contralateral fistulas. Also good understanding of the mechanism of extra-uterine pregnancy secondary to transperitoneal migration of spermatozoa is important when doing conservative tubal surgery.

Adult↗
PubMed1963

The value of leucocyte alkaline phosphatase determinations in the diagnosis of ectopic pregnancy.

Leucocyte alkaline phosphatase activity has been determined in a normal group, a group of pregnant patients, and a group of patients with ectopic pregnancy.A great rise in alkaline phosphatase occurred in pregnant patients in their third trimester, but the results were only slightly raised in the ectopic group. Five of six consecutive cases gave results which fell within the normal range. The method is not considered to be of value in the diagnosis of ectopic pregnancy.

Alkaline Phosphatase↗
PubMed1991

Ectopic pregnancy after tubal sterilization.

We report 13 cases of ectopic pregnancy following tubal ligation out of 287 ectopic pregnancies seen during a six year period (1984-1989). These findings suggest that tubal sterilization does not invariably confer infertility. Ectopic pregnancy must not be disregarded in women who have undergone tubal ligation, especially if two or more years have elapsed since the sterilization.

Adult↗
PubMed1980

Ectopic pregnancy. A study of 300 consecutive surgically treated cases.

Three hundred consecutive women with the surgical and histological diagnosis of ectopic pregnancy were studied to evaluate the etiological factors associated with this problem. Seventy-seven women had a history of surgical evidence of pelvic inflammatory disease (PID); 46 had a history of abdominal pelvic surgery; 32 had a history of both PID and surgery. Forty-three women had used an intrauterine device (IUD), and 32 had a device in utero at the time of the ectopic pregnancy. However, no definite relationship between use of the IUD and ectopic pregnancy could be established. A pregnancy test was positive in 207 of the 251 women on whom it was performed. Culdocentesis, performed on all patients, yielded nonclotting blood in 285 patients. Hematocrit value, measured on the culdocentesis specimen, was greater than 15% in 278 of the 285 women.

Adolescent↗
PubMed1975

Studies on ectopic ACTH-producing tumors. II. Clinical and biochemical features of 30 cases.

This report describes the clinical and biochemical features of 30 cases of ectopic ACTH-producing tumors diagnosed by the detection of ACTH in the tumor tissues. Several uncommon tumors, such as tumors of the esophagus, stomach, and larynx, were included in this series. None of the patients with bronchogenic carcinoma showed signs of classical Cushing's syndrome, whereas 7 of the remaining 13 patients with other tumors were Cushingoid in appearance. Adrenocortical hyperfunction was present in 61 percent at the first examination and developed during the course of the disease in 18 percent more. In the remaining patients (21 percent), adrenocortical function remained within normal limits. These results indicate that there exist ectopic ACTH-producing tumors without clinical and biochemical sequelae of excess hormone. In some of the tumor extracts studied, MSH and CRF-like activities and serotonin were detected. This suggests that multiple hormone production is not uncommon in ectopic ACTH-producing tumors.

Adrenocortical Hyperfunction↗
PubMed1981

Ectopic hormone production by endocrine tumors: localization of hormones at the cellular level by immunocytochemistry.

Clinical and laboratory data, histologic, electron microscopic and immunocytochemical findings of the tumors of eight patients suffering from Cushing's syndrome and of one patient with hypercalcemia are described. The unlabeled antibody enzyme method was used for the detection of insulin, glucagon, somatostatin, pancreatic polypeptide, corticotropin, beta-lipotropin, calcitonin, parathyroid hormone, and gastrin. Ectopic Cushing's syndrome was caused by pancreatic endocrine tumors, medullary thyroid carcinoma, a bronchial, a gastric and a thymic carcinoid, and a carcinoid of the mediastinum. Hypercalcemia in one patient was related to a pancreatic endocrine tumor. After surgery the clinical symptoms disappeared in two patients, but persisted or relapsed in five patients. ACTH-immunoreactivity could be demonstrated in six of eight tumors; calcitonin-immunoreactivity was found in the tumor of the patient suffering from hypercalcemia. ACTH-immunoreactivity could be localized to secretory granules by immunoelectron microscopy, and the presence of ACTH and beta-LPH in the same tumor cells could be shown in one pancreatic tumor. A combination of production of orthotopic and ectopic hormones was found in one, and secretion of two ectopic hormones was detected in another pancreatic endocrine tumor.

Adrenocorticotropic Hormone↗
PubMed1979

Intrauterine pseudogestational sac in ectopic pregnancy.

Ultrasonic diagnosis of ectopic pregnancy has been thought to depend on exclusion of intrauterine pregnancy on the basis of absence of an intrauterine gestational sac. Two cases illustrating intrauterine echoes suggesting a gestational sac associated with ectopic pregnancy and a plausible explanation for this phenomenon are presented. Because of this and the rare possibility of coexisting intrauterine and extrauterine pregnancies, the ultrasonographer must be wary of dismissing the possibility of an ectopic pregnancy because of an intrauterine gestational sac, whether real or apparent.

Adult↗
PubMedDate not supplied

The timing of a repeat ultrasound examination in the evaluation for ectopic pregnancy.

A method is described for timing a repeat ultrasound examination in patients evaluated for ectopic pregnancy in whom the findings are initially non-diagnostic. This method is based on measuring the serum hCG at the time of the initial ultrasound examination, which allows the time interval required for the serum hCG to exceed 6500 mIU/ml to be calculated. When the serum hCG is above this level, the gestational sac of an intrauterine pregnancy can be reliably identified, and failure to do so signifies ectopic gestation. Seven patients referred for ultrasound to rule out ectopic pregnancy had initially nondiagnostic findings. In each case, a correctly-timed repeat examination, demonstrating a gestational sac, enabled the diagnosis to be excluded.

Chorionic Gonadotropin↗
PubMed2003

Ectopic adrenocorticotropin (ACTH) and corticotropin-releasing hormone (CRH) production in the adrenal gland: basic and clinical aspects.

The hypothalamic-pituitary-adrenal (HPA) axis is integrated in the human stress system and controls the metabolism of many cell systems in the body. Therefore, hypofunction or hyperfunction of the HPA axis potentially threatens the life of the whole organism. Noncontrolled overproduction of its key regulators, CRH and ACTH, causes dysfunction of the stress system. Ectopic secretion of these compounds may be part of extraadrenal paraneoplastic syndromes caused by various benign or malignant tumors. However, ectopic ACTH and CRH may originate from the adrenal itself. A local CRH/ACTH system exists in the normal human adrenal medulla. Overproduction of CRH and ACTH has been documented in pheochromocytomas causing Cushing's syndrome. Finally, ectopic production of ACTH causing Cushing's syndrome has also been demonstrated in adrenocortical cells. This suggests a marked plasticity within the HPA axis and the neuroendocrine cell system.

Adrenal Cortex Neoplasms↗
PubMed2006

A case of bronchopulmonary carcinoid tumor: the role of octreotide scanning in localization of an ectopic source of ACTH.

BACKGROUND: Bronchopulmonary carcinoids are neuroendocrine tumors. They can present with Cushing's syndrome secondary to ectopic adrenocorticotropic hormone (ACTH) secretion. Curative resection is possible only after adequate localization of the ectopic source. OBJECTIVE: To describe a case that illustrates the role of octreotide scanning in the management of a bronchopulmonary carcinoid. RESULTS: The use of preoperative and postoperative octreotide scanning aided in performing a limited resection, thereby preserving the lung parenchyma. CONCLUSIONS: We propose that octreotide scanning can be a very important and informative test in the management of carcinoid tumors. In situations when conventional imaging is not conclusive, octreotide scanning may be of help in determining the source of ectopic ACTH syndrome.

ACTH Syndrome, Ectopic↗
PubMed1993

Ectopic ACTH syndrome associated with anorectal carcinoma. Report of a case and review of the literature.

A 25-year-old black homosexual was noted to be hypertensive, hypokalemic, and to have a rectal mass. Histopathology of the biopsied lesion revealed a mixture of poorly differentiated squamous cell and undifferentiated small cell carcinoma. Abdominopelvic CT showed multiple liver metastases, minimal local tumor extension, and normal adrenal glands. Despite aggressive treatment, he remained hypertensive and hypokalemic. Endocrine work-up revealed: normal 24-hr VMA and catecholamines, normal serum aldosterone and renin levels, elevated urinary free cortisol (3360 micrograms/24 hr), elevated serum cortisol (60 micrograms/dl), and elevated serum ACTH (1697 pg/dl). Liver biopsy confirmed metastatic anorectal carcinoma, and immunohistochemical stains of the rectal biopsy were positive for ACTH and neuron-specific enolase. Although many types of neoplasms have been associated with ectopic ACTH production, small cell carcinoma of the lung is the most common. While there are many reports of colorectal and anorectal neuroendocrine small cell carcinomas, few of these tumors have been associated with clinical ectopic hormone production. This case represents the first report of the ectopic ACTH syndrome associated with anorectal carcinoma.

ACTH Syndrome, Ectopic↗
PubMed1990

Circulating levels of placental protein 12 in ectopic pregnancy.

Maternal serum placental protein 12 (PP12) was measured at the time of presentation in 33 women with a histologically confirmed diagnosis of ectopic pregnancy [tubal pregnancy (n = 29), tubal pregnancy with a live fetus (n = 2), cornual pregnancy (n = 1) and ovarian pregnancy (n = 1)]. All but four of the 33 patients had PP12 measurements within the reference range. Two women had circulating PP12 levels above the 90th centile of the normal range, at 7 and 8 weeks gestation, respectively. One of these had a live ectopic gestation and the other patient conceived after in vitro fertilization. Two remaining patients (one each with a cornual and tubal pregnancy) at 11 and 12 weeks, respectively had levels below the 10th centile of the normal range. It is concluded that regardless of the implantation site, ectopic pregnancy is not associated with depressed maternal PP12 levels, suggesting that the decidual synthesis of this protein is independent of the intimate relationship between decidua and trophoblast.

Decidua↗
PubMed1999

Persistent hypokalemia after successful adrenalectomy in a patient with Cushing's syndrome due to ectopic ACTH secretion: possible role of 11beta-hydroxysteroid dehydrogenase inhibition.

Ectopic ACTH secretion is characterized by a high incidence of hypokalemia. The pathophysiology of hypokalemia has not been totally clarified, although it has been postulated that excessive amounts of adrenal steroids may play a role, as well as a possible role of the inhibition of the enzyme 11beta-hydroxysteroid dehydrogenase (11beta-OHSD). This enzyme normally converts cortisol to cortisone avoiding the mineralocorticoid action of cortisol. We present a patient with ectopic ACTH secretion due to a metastatic carcinoid tumor. The clinical picture was characterized by maintained hypokalemia (1.4 mmol/l) resistant to potassium, spironolactone and ketoconazole administration. A bilateral adrenalectomy was performed but the hypokalemia persisted while he was receiving a physiological dose of cortisol. Eight days after adrenalectomy cortisol was replaced by an equivalent dose of dexamethasone. This change was followed by a rapid and persistent normalization of hypokalemia suggesting a mineralocorticoid effect of cortisol. In conclusion, the origin of hypokalemia in our patient with ectopic ACTH secretion was secondary to cortisol. We postulate that this peculiar effect of cortisol could have happened if an inhibition of 11beta-OHSD occurred.

11-beta-Hydroxysteroid Dehydrogenases↗
PubMed2000

Cushing's syndrome caused by ectopic corticotropin secretion by multiple peripheral pulmonary carcinoids and tumorlets of carcinoid type.

Multiple peripheral pulmonary carcinoid tumors or their smaller counterparts (tumorlets of carcinoid type) are the most unusual form of carcinoids as a cause of ectopic corticotropin syndrome. Only three case reports were found in the literature. We describe a 35 year-old female patient with ectopic corticotropin secretion due to multiple peripheral pulmonary carcinoid tumors and tumorlets. A high-dose dexamethasone suppression test result led to the diagnosis of Cushing's disease in our case. But no tumor was identified on sella imaging and bilateral inferior petrosal sinus sampling was non-diagnostic. Computed tomography of the lungs revealed multiple acinar-nodular parenchymal infiltrations confined to the left lung. Corticotropin-dependent hypercortisolism persisted after bilateral adrenalectomy. A second operation was necessary to remove the hyperplastic adrenal remnants. Meanwhile, computed tomography findings of the thorax were unchanged. We decided to explore these nodules by open lung biopsy. During the procedure multiple nodules ranging 12 to 3 mm in diameter scattered throughout the left lung were observed and left pneumonectomy was performed. Histopathological diagnosis was multiple peripheral carcinoid tumors and tumorlets of carcinoid type showing positive immunostaining with corticotropin. This observation emphasizes a rare form of carcinoids as a cause of ectopic corticotropin secretion and its unusual response to high dose dexamethasone suppression test.

ACTH Syndrome, Ectopic↗
PubMed2002

Ectopic ACTH syndrome associated with ovarian steroid-cell tumor.

Several cases of ovarian neoplasms resulting in Cushing's syndrome due to ectopic secretion of ACTH or ectopic secretion of F have been reported. Tumors producing ACTH include adenocarcinoma, androblastoma, Sertoli cell carcinoma, carcinoid tumor and teratoma. Cortisol secretion has been reported in ovarian steroid cell tumor (unclassified steroid cell tumor). We present a case of a 19-year-old woman with Cushing's syndrome in course of an ovarian steroid cell tumor with ectopic ACTH production. To our knowledge, it is the first reported case of ACTH secreting ovarian steroid cell tumor causing Cushing's syndrome.

ACTH Syndrome, Ectopic↗
PubMed1999

Endovaginal color Doppler sonographic evaluation of ectopic pregnancy in women after in vitro fertilization and embryo transfer.

The aim of this study was to evaluate the value of endovaginal color Doppler ultrasonography in the early diagnosis of ectopic pregnancy in women after in vitro fertilization and embryo transfer, and to correlate the sonographic findings with ss-hCG serum levels. Thirty-five patients had proven ectopic pregnancies and 4 other patients had heterotopic pregnancies. The diagnosis was disclosed correctly in all cases by endovaginal color Doppler US by identifying an adnexal mass with placental flow and a nongravid uterus called a "cold uterus". An intrauterine sac with "double ring sign" was found in all normal intrauterine pregnancies when the hCG levels exceeded 1000 IU/l but in none of the patients with ectopic pregnancy (EP). These findings suggest the efficacy of the discriminatory hCG serum level of 1000 IU/l in the investigation of EP. In conclusion, this study describes the diagnostic importance of transvaginal color Doppler US in correlation with hCG serum levels in the early detection of EP avoiding life-threatening complications and improving patient outcome.

Adult↗
PubMed2002

Laparotomy or laparoscopic surgery? Factors affecting the surgeons choice for the treatment of ectopic pregnancy.

PURPOSE: In this study, we aim to compare the surgeons' choice on the ectopic pregnancy cases during the last four years. The differences between laparoscopy and laparotomy cases and the factors which directed the surgeon to choose either of the surgical methods were evaluated. METHODS: Our study comprises 135 patients who were diagnosed as ectopic pregnancy and were hospitalized in the Gynecology Department of Istanbul Medical Faculty during 1996-1999. RESULTS: During 1996-1999 a total of 118 cases had been diagnosed as tubal ectopic pregnancy and had been treated surgically. Seventy three patients (62%) had been treated with laparotomy while the rest 45(38%) had been treated laparoscopically. When compared, the amount of intraabdominal free blood volume was significantly higher in laparotomy group [270.45 +/- 466.72 mL laparoscopy group - 889.75 +/- 714 mL laparotomy group, (p = 0.0001)]. When we considered haemoperitoneum amount according to the patients' parity, intraabdominal blood volume was interestingly higher in multiparas [507 +/- 599.32 mL nulliparas vs. 768.68 +/- 749.15 mL mulltiparas, (p = 0.044)]. The percent of cases with ruptured tubes was 64% for the laparotomy and 38% the laparoscopic cases; and the difference between two groups was significant (p = 0.0013). CONCLUSION: Our study implied that haemodynamic stability and less intraabdominal free blood affect the surgeons' decision between laparotomy and laparoscopy. Fewer multiparous patients are suitable for these criteria which leads to less laparoscopic surgery. These findings, which need to be clarified, lead to the idea of human factor affecting the surgeons' choice indirectly.

Adult↗