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PubMed1993

Concomitant changes of messenger ribonucleic acid levels of secretogranin II, VGF, vasopressin and oxytocin in the paraventricular nucleus of rats after adrenalectomy and during lactation.

In situ hybridization was used to study the mRNA levels for secretogranin II and VGF in comparison with those of oxytocin and vasopressin in the hypothalamus of rats. VGF is a widespread constituent of large dense core vesicles which is selectively induced in PC12 cells by nerve growth factor. After adrenalectomy the mRNA levels of secretogranin II, VGF and vasopressin were increased 4- to 5-fold in the parvocellular neurons of the paraventricular nuclei. In lactating rats the message for oxytocin and secretogranin II were significantly elevated in the magnocellular neurons of the paraventricular and supraoptic nuclei, whereas for VGF only a smaller non-significant increase was observed. As shown by immunoelectron microscopy secretoneurin (a peptide derived from secretogranin II) and oxytocin are co-stored in the large dense core vesicles of the hypothalamo-neurohypophysial neurons. These results demonstrate that stimulation of both parvo- and magnocellular neurons of the hypothalamus induces a concomitant increase of the messages for secretogranin II and VGF together with those of vasopressin and oxytocin.

Adrenalectomy↗
PubMed2004

Changes of calbindin D-28k immunoreactivity in the hippocampus after adrenalectomy in the seizure sensitive gerbil.

Calbindin D-28k (CB), a calcium-binding protein, containing neurons in the hippocampus plays an important role in hippocampal excitability in epilepsy. In the present study, we investigated changes of CB immunoreactivity after adrenalectomy (ADX) in the hippocampus and dentate gyrus of the seizure sensitive gerbil, which is susceptible to seizure to identify roles of CB in epileptogenesis. The changes of the CB immunoreactivity after ADX were significant in the hippocampal CA1 region. By 24 h after ADX, CB-immunoreactive CA1 pyramidal cells and CB immunoreactivity increased. At this time, well-stained dendrites projected to the stratum radiatum. Thereafter, the CB immunoreactivity decreased time dependently by 96 h after ADX. In the dentate gyrus, the changes of CB-immunoreactive neurons were mainly observed in the granule cell layer. The number and immunoreactivity of CB-immunoreactive neurons was high at 24 h after ADX, thereafter, those decreased by 96 h after ADX. These results suggest that glucocorticoid has an important role in modulating the seizure activity and CB serves an inhibitory function, which regulates the seizure activity and output signals from the hippocampus.

Adrenalectomy↗
PubMed1997

Adrenalectomy overcomes the blunted natriuretic response to atrial natriuretic peptide during hypocapnia in rats.

1. Hypocapnia has been shown to blunt the natriuretic effect of atrial natriuretic peptide (ANP) independently of the renal nerves. In order to examine whether the adrenal glands are a limiting factor for the natriuretic effect of ANP, we evaluated the natriuretic responses of adrenalectomized rats to ANP infusion during hypocapnia. 2. Rats subjected to total adrenalectomy (ADX) or sham-operation (sham) were divided into hypocapnic and normocapnic groups depending on their arterial PCO2 levels. 3. In sham rats, ANP infusion at a rate of 12 micrograms/kg per h resulted in a smaller increase in the fractional excretion of sodium during hypocapnia (mean +/- SEM: 1.02 +/- 0.40%, n = 10) than normocapnia (3.95 +/- 0.64%, n = 9; P < 0.001). The level of fractional excretion of sodium with ANP infusion during hypocapnia was not significantly different from the level in saline-infused hypocapnic sham rats (0.93 +/- 0.62%, n = 10). In hypocapnic ADX rats (n = 11), ANP induced greater increases in the fractional excretion of sodium (5.59 +/- 1.35%) than did saline infusion (1.04 +/- 1.02%, n = 10; P < 0.002). In the absence of adrenal glands, the magnitude of natriuresis after ANP infusion during hypocapnia and normocapnia (3.32 +/- 1.07%, n = 9) were the same. 4. We conclude that the natriuretic effect of ANP is blunted during hypocapnia in the presence, but not in the absence, of adrenal glands. Our data suggest that the adrenal glands have an important role in limiting the natriuretic effect of ANP.

Adrenal Glands↗
PubMed2004

Portless endoscopic adrenalectomy via a single minimal incision using a retroperitoneal approach: experience with initial 30 cases.

AIM: To assess the feasibility of portless endoscopic adrenalectomy via a single minimum incision that narrowly permits extraction of the specimen. METHODS: For 30 cases of adrenal tumor, portless endoscopic surgery through a single flank incision (3-9 cm; mean, 5.6 cm) was performed without gas inflation or trocar port placement. All of the instruments used during surgery were reusable. The cases included primary aldosteronism (12), Cushing's syndrome (6), preclinical Cushing's syndrome (3), pheochromocytoma (1), non-functioning cortical adenoma (6), adrenocortical carcinoma (1) and adrenocortical hemorrhage (1). RESULTS: Resection of the tumor was successfully completed, without complications, in all of the cases. Operative time was between 83 and 240 min (mean, 147 min). Estimated blood loss was 5-470 mL (mean, 139 mL). None of the patients required blood transfusion. Postoperative course was uneventful. Wound pain was mild and walking and full oral feeding were resumed on the first and second postoperative day, respectively, in the majority of cases. CONCLUSIONS: Adrenal tumors are good candidates for portless endoscopic surgery, which is safe, cost-effective, minimally invasive and matches favorably with laparoscopic surgery.

Adrenal Gland Diseases↗
PubMed2005

Thoracoscopic transdiaphragmatic adrenalectomy for isolated locally recurrent adrenal carcinoma.

A 58-year-old man who had undergone left adrenalectomy 2 years previously for adrenocortical carcinoma was diagnosed to have a left suprarenal solid mass. Thoracoscopic transdiaphragmatic excision of the tumor was conducted under the diagnosis of isolated local recurrence of adrenal carcinoma. There were no intraoperative or postoperative complications. The patient subsequently received three courses of adjuvant chemotherapy. There have been no signs of tumor recurrence during 3 years follow up after surgery. This approach provides a minimally invasive alternative to an open thoracoabdominal procedure after prior open surgery.

Adrenal Cortex Neoplasms↗
PubMed2006

Clinical outcomes and learning curve of a laparoscopic adrenalectomy in 103 consecutive cases at a single institute.

OBJECTIVE: We examined the clinical outcomes and the learning curve for a laparoscopic adrenalectomy (LA) in 103 consecutive cases performed by three surgeons at our institute, according to the type of adrenal disorder. PATIENTS AND METHODS: One hundred and three patients with adrenal tumors, including 38 cases of primary aldosteronism, 33 cases of Cushing syndrome (including preclinical Cushing syndrome), 15 cases of pheochromocytoma, and nine cases of non-functioning adenoma were evaluated, while focusing on the approaches, intraoperative and postoperative data, and the learning curve of LA, according the type of adrenal disorder. RESULTS: There was no significant difference in the operation time, estimated blood loss, incidence of conversion to open surgery and blood transfusion, or postoperative recovery among the patients treated by LA for aldosteronoma, Cushing adenoma, pheochromocytoma, and non-functioning adenoma. In the cases of aldosteronoma and Cushing adenoma, the learning curve for the operation time and blood loss in each operator tended to decrease as the number of operations increased. On the other hand, in the cases treated by LA for pheochromocytoma, no trends in either the operation time or blood loss were observed. However, there has been neither any conversion to open surgery nor blood transfusion in cases treated by LA since 1998 (our 42nd case), even after the changes in the operators. CONCLUSIONS: Our results clearly indicate that LA is becoming safer than before, probably due to improvements in the technique, education, and training of surgeons, in addition to the increased number of cases now treated by LA.

Adrenal Gland Neoplasms↗
PubMed1983

Long term follow-up of surgical adrenalectomy for breast cancer.

A long term follow-up of 300 patients treated by bilateral adrenalectomy for advanced breast cancer is presented. The notable features are the lengthy remissions and survival times which occurred in some patients. This is further evidence of at least two important biological subsets within the general population of breast cancers. Of the responders, 11% were still in remission at four years and 10% were alive at 10 years. Responders also enjoyed a good quality of life. These results are of considerable importance in assessing the relative merits of newer methods of treatment.

Adrenalectomy↗
PubMed1994

Laparoscopic retroperitoneal left adrenalectomy in a patient with Cushing's syndrome.

A technique for the extraperitoneal removal of the adrenal gland using laparoscopic instrumentation and insufflation is described. A case of Cushing's syndrome in a 42 year old female is presented with successful removal of her adrenal tumour using the laparoscopic method. This is the first report of laparoscopic adrenalectomy employing the extraperitoneal approach.

Adrenalectomy↗
PubMed1994

Laparoscopic adrenalectomy.

Minimal access surgery continues to expand its applications now including laparoscopic adrenalectomy. Two differing intraperitoneal techniques are described in six patients, three with Conn's Syndrome, one with a Cushing's tumour, one with a phaeochromocytoma and one with a large non-functioning cortical adenoma. This initial Australasian experience with the procedure followed careful preparation in the cadaver and pig.

Adrenal Gland Diseases↗
PubMed1994

Adrenalectomy: expanded indications for the extraperitoneal approach.

The adrenal glands can be removed surgically by the anterior transperitoneal approach, or by the extraperitoneal approaches, either posteriorly or posterolaterally. While the extraperitoneal routes have become accepted as the preferred approach to the adrenal glands for small benign cortical adenomas, many authors still recommend the anterior transperitoneal route as the preferred operative approach for phaeochromocytoma, large tumours, adrenal cancers or bilateral hyperplasia. A series of 51 consecutive adrenalectomies performed for a wide range of adrenal disorders is presented, including phaeochromocytoma and large malignant tumours. In 47 cases the tumours were successfully removed through an extraperitoneal approach, with minimal morbidity. The anterior approach had to be employed in only four cases, and in three of these there was pre-operative evidence of tumour invasion into either the major vessels or the liver. The extraperitoneal approach to the adrenal gland is technically simple and can be performed quickly, with a low postoperative morbidity and should be regarded as the routine approach for almost all adrenal procedures.

Adrenal Cortex Neoplasms↗
PubMed2004

Is laparoscopic adrenalectomy feasible for adrenocortical carcinoma or metastasis?

OBJECTIVE: To review our experience with laparoscopic adrenalectomy (LA), to evaluate the effectiveness and safety of this procedure in patients with adrenal malignancy. PATIENTS AND METHODS: The study included patients who underwent LA from 1995 to 2002, with histologically identified adrenocortical cancer (ACC) or metastasis. Indications for LA were adrenal masses with no radiological evidence of involvement of the surrounding structures, or solitary metastasis with well-controlled primary cancer. The variables evaluated were: size of the lesion, operative duration, estimated blood loss, intraoperative complications, local, port-site and intra-abdominal recurrence, distant metastasis, and survival time. RESULTS: Fourteen malignant adrenal lesions in 205 LAs (7%) were confirmed with histological diagnoses that showed a primary ACC in six and metastasis in another seven (in one there was bilateral metastasis). The mean (sd) size of the malignant lesions was 5.9 (2.8) cm. The 12 unilateral procedures required a mean operative duration of 164 (47) min; the bilateral procedure lasted 215 min. There was one conversion to open surgery caused by local infiltration, whereas there were no intraoperative complications. The mean follow-up was 30 months, during which three patients died, one from endoperitoneal and trocar port-site seeding. CONCLUSION: When the malignancy is confined to the adrenal gland, LA seems to be a feasible option if the principles of oncological surgery are respected. Nevertheless, further investigations are required to evaluate the appropriateness of this operation.

Adrenal Cortex Neoplasms↗
PubMed1986

Effect of adrenalectomy on gamma-aminobutyric acid concentrations in the central nervous system.

Pyridoxal-5'-phosphate (PLP) plays a crucial role in regulating the steady-state levels of gamma-aminobutyric acid (GABA) in CNS. Adrenalectomy resulted in decreased conversion of dietary vitamin B6 to PLP. As a consequence of this, GABA levels in cerebral cortex decrease, since synthesis of GABA is determined by glutamate decarboxylase, a PLP-dependent enzyme. Feeding diet supplemented with vitamin B6 elevated the GABA levels in adrenalectomized animals, because of increased availability of the coenzyme for apodecarboxylase. The data suggest a role for corticosteroids in maintaining GABA levels, through their effects on PLP formation.

Adrenalectomy↗
PubMed1980

Effects of adrenalectomy and hypophysectomy on enkephalin content of the rat hypothalamus.

1 Hypothalamic content of enkephalin in rats has been measured by bioassay against methionine-enkephalin on field-stimulated mouse vas deferens after acid extraction and purification using Amberlite XAD-2 resin.2 Surgical stress lowered hypothalamic enkephalin content initially but 6 days after operation the content was higher in sham-operated than in adrenalectomized animals.3 Corticosteroid replacement therapy showed that hypothalamic enkephalin content was not related directly to circulating corticosteroid levels and that it was increased by the stress of handling and injection.4 Hypothalamic enkephalin content of rats that had undergone hypophysectomy 11 days earlier did not differ from that of intact animals but surgical stress, which lowered content in intact rats and had no effect after adrenalectomy, produced a rise in content in these hypophysectomized animals.5 The ingestion of 0.9% saline, in place of water, by sham-adrenalectomized rats altered the effect of surgical stress on hypothalamic enkephalin content without affecting the resting levels.6 Of extracts from adrenalectomized rats, 10% contained a substance that behaved atypically on the mouse vas deferens, showing a slower onset and offset of action. The mol. wt. of the substance and sensitivity to naloxone reversal appeared to be similar to enkephalin, but it was resistant to carboxypeptidase-A and protease treatment.7 It is concluded that the enkephalin content of the hypothalamus is affected by activity in the hypothalamus-pituitary-adrenal system but that it is not related in a simple manner to the levels of corticotrophin releasing hormone, corticotrophin or corticosteroids.

Adrenal Cortex Hormones↗
PubMed1989

The effect of adrenalectomy on interleukin-1 release in vitro and in vivo.

1 Peritoneal macrophages (M phi) collected from adrenalectomized (ADX) rats released more interleukin-1 (IL-1) activity and prostaglandin E2 (PGE2) than macrophages from sham-operated (SHO) rats. 2 The increase in IL-1 activity in the supernatants was confirmed by the increase of the cell-associated 33 kD IL-1 alpha precursor in ADX macrophages stimulated by lipopolysaccharide (LPS). 3 After the injection of Complete Freund's Adjuvant (CFA) to induce adjuvant arthritis, 60% of the ADX rats died, while no deaths occurred in the SHO group. 4 The in vivo administration of dexamethasone inhibited both IL-1 and PGE2 release by macrophages as well as protecting ADX animals from CFA-induced death. Indomethacin and BW 755C partially protected the animals from this lethal effect. 5 These results suggest that adrenalectomy induces an increased release of IL-1 both in vitro and in vivo, and are consistent with a feedback mechanism between IL-1 and glucocorticoid hormones.

4,5-Dihydro-1-(3-(trifluoromethyl)phenyl)-1H-pyraz↗
PubMed1994

Dexamethasone reverses adrenalectomy-induced neuronal de-differentiation in midbrain raphe-hippocampus axis.

Differentiation leads to specific morphological and biochemical characteristics. We examined whether epigenetic factors (e.g., glucocorticoids) are required to maintain neuronal differentiation in the adult brain. In the midbrain, adrenalectomy (ADX) (1-2 wk) reduced the size of tryptophan hydroxylase (WH)-immunoreactive (IR) neurons. ADX rats exposed to short-term (24-72-h) dexamethasone (ST-DEX) in the drinking saline (10 mg/l) showed an increase in WH protein, somal area and dendritic size of WH-IR neurons. In the hippocampus, ADX for 2-3 mo (long-term; LT) reduced Nissl staining, calbindin (CBD)-IR and 5-HT1A receptor mRNA in the granular cell layer, and the size of the molecular layer and its CBD-IR dendrites. Small vimentin (Vim)-IR glial cells emerged in the granular layer. ST-DEX after LT-ADX rapidly induced a recovery of 5-HT1A mRNA, Nissl labeling and CBD-IR in the granule cell layer. In the molecular layer, there was an increase in the area and in the number of CBD-IR dendrites. Furthermore, the Vim-IR glial cells were enlarged in size and branching. The rate of cell proliferation was studied in these animals. Immunostaining with antibodies against proliferating cell nuclear antigen (PCNA) and use of bromouridine argue against enhanced neurogenesis after ST-DEX in LT-ADX. We propose that glucocorticoids induce and maintain differentiation of serotonergic and CBD-IR neurons in the midbrain-hippocampal axis. A neuronotrophic role for the glial 5-HT1A receptor is suggested.

Adrenalectomy↗
PubMed2004

Excretion of electrolytes in Brown Norway and Fischer 344 rats: effects of adrenalectomy and of mineralocorticoid and glucocorticoid receptor ligands.

Our previous studies showed that adrenalectomy (ADX) has surprisingly no effect on body weight and fluid intake in the Brown Norway rat strain, suggesting that mineralocorticoid receptor (MR)-mediated effects are present even in absence of corticosteroids in this strain. Moreover, glucocorticoid receptor (GR)-mediated mechanisms are more effective in Brown Norway than in Fischer 344 rats. Such functional differences in corticosteroid receptor pathways between Brown Norway and Fischer 344 rats led us to compare the effect of ADX and MR/GR-mediated actions on sodium and potassium excretion between these two rat strains. To this end, we first measured the effect of an acute high dose of aldosterone on the urinary Na+/K+ concentration ratio in intact and ADX Brown Norway and Fischer 344 rats. Second, to discriminate mineralocorticoid from glucocorticoid actions, we treated chronically ADX rats with increasing doses of aldosterone or RU28362, a pure GR agonist, in the drinking fluid. As sodium homeostasis involves salt appetite regulation, behaviour under mineralocorticoid control, we also measured saline preference in Brown Norway and Fischer 344 rats. Our data illustrate: (1) the very limited effect of ADX on body weight, food and fluid intake, diuresis, natriuresis, kaliuresis and salt appetite in Brown Norway rats, supporting the presence of MR signalling pathways in the absence of adrenal steroids in these rats; (2) the insensitivity of MR to aldosterone in intact Brown Norway rats, and the reduced sensitivity of MR to aldosterone in ADX Brown Norway rats compared with ADX Fischer 344 rats; and (3) the greater sensitivity of GR-related mechanisms to RU28362 in Brown Norway than in Fischer 344 rats in terms of body weight gain and electrolyte excretion. Considering that both MRs and GRs regulate hypothalamic-pituitary-adrenal axis processes, such functional differences in corticosteroid receptors could be at the origin, at least partly, of the strain differences in corticotropic activity/reactivity to stress previously described.

Adrenalectomy↗
PubMed1973

The effect of adrenalectomy or pharmacological inhibition of adrenocortical function on macromolecule uptake by the new-born rat intestine.

1. Bilateral adrenalectomy in 18-day-old rats resulted in an extension by approximately 4 days of the period during which the villous epithelial cells of the small intestine took up polyvinyl pyrrolidone (PVP) of mean mol. wt. 160,000.2. The eventual termination of PVP uptake (;closure') closely resembled normal closure in control animals: the time course of the decline in uptake and the histological changes indicated that more mature ;PVP-impermeable' cells progressively ascended the villi.3. Injection of Metopirone was ineffective in animals 10 days after birth, but when injected after day 13 caused closure within 3 days.4. Metopirone injection significantly reduced the plasma concentration of corticosterone and caused a marked rise in the plasma concentration of deoxycorticosterone.5. Aminoglutethimide injection also produced precocious closure and had an effect similar to Metopirone on the plasma concentrations of corticosterone and deoxycorticosterone.6. Injection of Metopirone or aminoglutethimide increased the relative adrenal weight compared with control animals. Aminoglutethimide was more effective and caused approximately a 100% increase in adrenal weight.

Adrenal Glands↗