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PubMedDate not supplied

Adrenal tissue characterization with 0.5-T MR imaging: value of T2*-weighted images.

The authors investigated the value of magnetic resonance (MR) imaging at 0.5 T for distinguishing adrenal adenomas from adrenal metastases. The series included 23 adrenal adenomas (18 nonhyperfunctioning, five hyperfunctioning) and 23 adrenal metastases from various organs. Adrenal tumor-liver signal intensity ratios on T1-, T2-, and T2*-weighted images were calculated for adrenal tissue characterization. Adrenal adenomas were more precisely distinguished from adrenal metastases on T2*-weighted images (21 of 23, 91%) than on T2-weighted images (15 of 23, 65%). T1-weighted images were not useful for this distinction. In conclusion, T2*-weighted images were better than routine T2-weighted images for distinguishing adrenal adenomas from adrenal metastases. It can be postulated that the total signal intensity of adrenal adenomas, which contain some fat components, decreased on T2*-weighted images because of an out-of-phase effect.

Adenoma↗
PubMed2002

Successful laparoscopic removal of a solitary adrenal metastasis from ovarian carcinoma: a case report.

BACKGROUND: The adrenal gland is a site of metastatic spread of some tumors. Usually the presence of adrenal metastasis signals widespread disease; however, isolated adrenal metastases have been reported. The adrenal gland, along with certain other organs, is considered a pharmacological sanctuary. Several reports describe long-term survival after adrenalectomy due to isolated adrenal metastases, in particular from non-small-cell lung cancer. There are several reports of laparoscopic resection of isolated adrenal metastases. CASE: We present a rare case of a laparoscopically resected solitary adrenal metastasis originating from ovarian carcinoma. To the best of our knowledge there was no report in the literature of an isolated adrenal metastasis from ovarian carcinoma. The patient described developed an isolated left adrenal metastasis 11 months after completion of adjuvant chemotherapy for stage III ovarian cancer. The serum CA125 dropped from 365 to 35 postoperation. CONCLUSION: Isolated adrenal metastasis from ovarian cancer is a rare event, never before described in the literature. This case report describes a laparoscopic resection of an adrenal metastasis from ovarian cancer, and the drop of CA125 levels indicated complete resection of the metastasis.

Adrenal Gland Neoplasms↗
PubMed1999

Adrenal tumors and pregnancy.

Although adrenal tumors detected during pregnancy are extraordinarily rare, the pathophysiologic repercussions of untreated adrenal neoplasms are enormous to both mother and fetus. From our computer-based registry of pregnant patients from 1975 through 1996 (n = 30,246), four cases of adrenal neoplasms associated with pregnancy were identified (0.013%), analyzed, and compared with the current medical literature. Four women ages 36, 29, 22, and 21 years had adrenal neoplasms diagnosed with pregnancy. Patient 1 had an unsuspected pheochromocytoma identified at autopsy. At 27 weeks into her pregnancy the patient suffered a myocardial infarction, and both she and the fetus died. Patient 2 was incidentally found to have adrenal and pancreatic neoplasms on screening abdominal computed tomography for von Hippel-Lindau disease. The study identified a pregnancy. She elected to terminate the pregnancy and underwent resection of both tumors. She died 3 years later of metastatic islet cell cancer. Both of these patients had previously delivered healthy babies, but both pregnancies were complicated by hypertension. Patient 3 had a functional adrenal tumor identified initially by urinary aldosterone studies because of symptoms of severe hypertension, and patient 4 had an adrenal mass diagnosed via ultrasonography at 30 weeks' gestation because of concerns for right-sided pyelonephritis. These two women underwent careful monitoring throughout the remainder of their pregnancies with eventual delivery of healthy babies. Both women later underwent successful operative resection of benign adrenal adenomas. Adrenal neoplasms discovered during pregnancy are rare. The onus, however, is on physicians to consider this diagnosis in pregnant women with hypertension, headaches, or other manifestations of adrenal disorders. Surgical management of identified adrenal lesions is thereafter straightforward. Missing the diagnosis has grave implications for these young women and their fetuses.

Adenoma, Islet Cell↗
PubMed2002

Horseshoe adrenal gland in association with asplenia: presentation of six new cases and review of the literature.

BACKGROUND: Asplenia syndrome is a form of heterotaxy characterized by bilateral right-sidedness. Congenital fusion of the adrenal glands ("horseshoe adrenal gland") is a less common feature of asplenia syndrome, most instances of which have been found at autopsy. PURPOSE: To present clinical and imaging features of infants diagnosed with asplenia syndrome and horseshoe adrenal gland. MATERIALS AND METHODS: Six infants with asplenia syndrome were identified as having a horseshoe adrenal gland. Medical records and imaging studies were reviewed to determine clinical presentation, associated anomalies, and outcome. The literature was reviewed for prior reports of horseshoe adrenal gland. RESULTS: Horseshoe adrenal gland was identified in five infants by sonography and one by CT, the latter confirmed by autopsy. In all cases, the horseshoe adrenal gland was pre-aortic. Besides features of asplenia syndrome, one infant also had associated vertebral anomalies and bilateral renal agenesis. Including the current cases, of 65 reported cases of horseshoe adrenal gland 34 (52%) were associated with asplenia, 24 (37%) with neural tube defects, 19 (29%) with renal anomalies, and 2 (3%) with Cornelia de Lange syndrome. Horseshoe adrenal gland has not been reported with polysplenia syndrome. CONCLUSIONS: Horseshoe adrenal gland is a less common manifestation of asplenia that may be demonstrated by imaging. Horseshoe adrenal gland may be a differentiating feature between asplenia and polysplenia.

Adrenal Glands↗
PubMed2005

Adrenal glands in beta-thalassemia major: magnetic resonance (MR) imaging features and correlation with iron stores.

This study aimed at describing the magnetic resonance (MR) imaging features of the adrenal glands in beta-thalassemic patients and at investigating the relation between adrenal and hepatic siderosis. Adrenal signal intensity (SI) was retrospectively assessed on abdominal MR studies of 35 patients with beta-thalassemia major undergoing quantification of hepatic siderosis and 12 healthy controls, using T1-(120/4/90), intermediate-(120/4/20), and T2*-(120/15/20) weighted GRE sequences. Adrenal SI was graded as grade 0 (normal SI on all sequences), grade 1 (hypointensity on T2* alone), or grade 2 (hypointensity on at least T2*). Adrenal size was measured in the thalassemic patients and compared with normative data. Liver-to-muscle (L/M) SI ratios, expressing hepatic siderosis, were estimated on each sequence. Serum ferritin levels were recorded. Adrenal hypointensity (grades 1 and 2) was noted in 24/35 (68.6%) patients. L/M ratios correlated significantly with adrenal SI in all sequences. Patients with grade 1 and grade 2 adrenal SI had significantly decreased L/M ratios compared with grade 0. Serum ferritin correlated significantly with L/M values but not with adrenal SI. Adrenal size was within normal limits. Diffuse hypointensity in normal-sized adrenals is a common MR finding in beta-thalassemic patients and correlates with the degree of hepatic siderosis.

Adrenal Gland Diseases↗
PubMed2003

Adrenal sparing surgery in the treatment of renal cell carcinoma: when is it possible?

Despite the fairly low incidence of adrenal involvement, adrenalectomy continues to be performed routinely as part of radical nephrectomy. With the recent development of modern imaging techniques and their widespread use, the frequency of small, low stage renal cell carcinomas (RCC) has grown considerably, giving rise to more conservative surgical approaches. We conducted a retrospective study in order to evaluate the incidence and characteristics of adrenal metastasis in RCC, trying to clarify the accuracy of computerized tomography (CT) in the diagnosis and the real need for adrenalectomy during surgery for RCC. The medical records of 192 patients undergoing radical nephrectomy and ipsilateral adrenalectomy for localized or advanced RCC, from 1996 to 2001, were analyzed retrospectively. We considered two subgroups of patients, 73 with stage T1-2 disease (group 1) and 119 with T3-4N0-1M0-1 disease (group 2) according to the 1997 TNM classification. In all cases, a blinded review of the preoperative abdominal CT was performed and an adrenal gland was considered to be abnormal if there was any aberration. Histopathology records of the surgical specimens were examined to determine the accuracy of the CT in identifying adrenal involvement by RCC. Descriptive statistics were used to evaluate the collected data. The overall incidence of adrenal metastasis was 4.1%. Mean renal tumor size in patients with adrenal involvement was 7.8 cm. The tumor stage correlated with the probability of adrenal spread ( P<0.05), with T1-2 tumors accounting for 1.3% of cases only. An adrenal gland was diagnosed as abnormal on preoperative CT in 20 patients (10.4%). CT scans had 87.5% sensitivity, 92.9% specificity, 99.4% negative predictive value and 35% positive predictive value for adrenal involvement by RCC. Adrenal involvement is not likely in patients with localized early stage RCC, and adrenalectomy is unnecessary in such cases, particularly when the CT is negative. However, radical nephrectomy, including removal of the ipsilateral adrenal gland, should be performed in patients with large, high risk tumors.

Adrenal Gland Neoplasms↗
PubMed1982

Metabolism of benzo [a] pyrene by guinea pig adrenal and hepatic microsomes.

Studies were carried out to compare the metabolism of benzo [a] pyrene (BP) by adrenal and hepatic microsomes obtained from adult male guinea pigs. Adrenal microsomes produced fluorescent metabolites (primarily phenols) approximately three to four times more rapidly than hepatic microsomes, but the differences in the rates were considerably smaller when total BP metabolism was assessed using an isotopic assay. The apparent discrepancy between the two assays is attributable to differences in the profiles of BP metabolites produced by adrenal and liver. Separation of metabolites by high pressure liquid chromatography revealed that adrenal microsomes converted BP to primarily a phenolic metabolite with a retention time identical to that of 3-hydroxy-BP. Liver microsomes, by contrast, produced approximately equal amounts of compounds co-chromatographing with 3-hydroxy-BP and BP-4,5-dihydrodiol. Small amounts of other metabolites were also produced by adrenal and hepatic microsomes. Liver microsomes catalyzed the conversion of BP to metabolites that became covalently bound to exogenous DNA. The amount of binding was dependent upon the duration of incubation and concentration of microsomal protein. Adrenal microsomes, by contrast, did not promote BP binding to DNA. Inhibition of microsomal epoxide hydratase activity with trichloropropene oxide (TCPO) blocked the formation of dihydrodiol metabolites of BP by adrenal and liver microsomes. In the presence of TCPO, liver microsomes produced large amounts of a BP metabolite co-chromatographing with BP-4,5-oxide. TCPO also increased the rate of production of DNA-binding metabolites by liver microsomes but had no effect on the formation of DNA-binding metabolites by adrenal microsomes. The results demonstrate major differences in the pathways of BP metabolism by guinea pig adrenal and hepatic microsomes. Although adrenal microsomes metabolize BP more rapidly than hepatic microsomes, far greater amounts of reactive metabolites are produced by the liver. Thus, adrenal metabolism of BP may be of little toxicological significance.

Adrenal Glands↗
PubMed1986

Effects of dietary sodium on dopamine content of rat adrenal cortex.

Dopamine occurs in the adrenal cortex and appears to provide maximum tonic inhibition of aldosterone secretion. In the present experiments, the effects of high or low sodium (Na+) intake on concentrations of dopamine in the adrenal cortex of adult male Sprague-Dawley rats were examined. In the first experiment, sham-operated and adrenal demedullated rats were provided with 1.5% NaCl or tap water for drinking for 5 days. In the second experiment, sham-operated and adrenal demedullated rats were fed regular laboratory chow (approximately 0.45% NaCl) or low Na+ chow (0.001-0.005% NaCl) for 5 days. High Na+ intake was attended by dramatic increases in fluid consumption, urine production and Na+ excretion. However, high Na+ intake did not affect levels of dopamine, norepinephrine or epinephrine in the adrenal glands. Approximately 45% of adrenal dopamine but less than 4% of either norepinephrine or epinephrine was localized in the adrenal cortex. In the second experiment, animals fed a diet low in Na+ had a significant reduction in Na+ excretion but levels of adrenal catecholamines were unaffected. Approximately 36% of adrenal dopamine but less than 5% of either norepinephrine or epinephrine was localized in the adrenal cortex. These findings suggest that adrenal cortical dopamine concentrations remain relatively constant in spite of presumed differences in turnover rates of this neurohormone.

Adrenal Cortex↗
PubMed1987

Neural mechanisms of somatic sensory regulation of catecholamine secretion from the adrenal gland.

The reflex regulation of catecholamine secretion of the adrenal gland by various somatic afferent stimuli via sympathetic nerves in the efferent limb of the reflex has been of physiological interest since W.B. Cannon studied the subject. The reflex regulation is characteristically interfered with by emotional involvement which made it difficult to analyze the neural mechanisms in conscious subjects and delayed these studies. However, for the last several years, electrophysiological and endocrinological approaches have advanced with the aid of anesthesia. Recent studies on anesthetized animals have proven that the adrenal sympatho-medullary functions are influenced by various somatic afferent stimuli, either natural or electrical stimulation, and that the somatically induced adrenal sympathetic reflex responses result in changes in catecholamine secretions from the adrenal gland. Somato-adrenal sympathetic reflexes contain both spinal and supraspinal reflex components, the spinal component having a segmental reflex organization, whereas the supraspinal component is generalized and non-segmental. The reflexes are excitatory or inhibitory, depending on the stimuli and species of animals, e.g., excitatory by pinching and inhibitory by brushing in rats. The excitatory responses are mainly mediated by somatic unmyelinated C afferent fiber activation, whereas the inhibitory responses are carried by somatic myelinated A afferent activation. The recent finding that sympatho-adrenal medullary function increases at rest in normal rats during aging, and in SHR-SP even during their youth was reviewed. Although no neural mechanism governing the increase in adrenal sympathetic nerve activity for these cases has been determined, the reflex regulation of such activity by somatic afferent and arterial baroreceptor afferent stimulation is well maintained in aged normal rats. These facts suggest the possibility that the sympatho-adrenal medullary functions can somatically be regulated in the aged. The recent study demonstrating that i.c.v. administered CRF increases in sympatho-adrenal medullary functions was reviewed, because central CRF seems to play an important role in controlling the somatically induced sympatho-adrenal medullary reflex. Finally, all these findings from anesthetized animals seem useful in understanding the neural mechanism of the somato-adrenal sympathetic reflex in conscious subjects.

Adrenal Medulla↗
PubMed1989

Developmental expression of proenkephalin A mRNA and phenylethanolamine N-methyltransferase mRNA in foetal sheep adrenal medulla.

The ontogenic expression of proenkephalin A (ProEnk A) mRNA and phenylethanolamine N-methyltransferase (PNMT) mRNA was examined in the foetal sheep adrenal medulla by the use of specific oligodeoxyribonucleotide probes. Northern blot analysis of RNA extracts from foetal adrenals demonstrated that ProEnk A mRNA was expressed as early as 60 days of gestation, a time at which the foetal adrenal is not functionally innervated. In situ hybridization on sections of foetal adrenals revealed that at 110-140 days gestation ProEnk A mRNA was expressed in chromaffin cells at the outer margin of the adrenal medulla but at earlier stages of gestation (e.g. 95 days) appeared to be expressed homogeneously throughout the whole of the adrenal medulla. In comparison, PNMT mRNA was expressed preferentially in cells at the outer margin of the adrenal medulla from the earliest stage detectable. Both PNMT mRNA and ProEnk A mRNA co-localized in cells at the outer margin of foetal adrenal of late gestations (110-140 days), a similar pattern to that seen in the adult adrenal medulla. These results indicate that, as with adult animals, in foetuses of late gestation, adrenal enkephalins are co-stored within adrenaline cells. It is likely therefore that enkephalins are co-released from the foetal adrenal with adrenaline in response to intra-uterine stress.

Adrenal Medulla↗
PubMed1991

IGF1 and 2 in two models of adrenal growth.

Insulin-like growth factors (IGFs) 1 and 2 were measured in the adrenal glands of rats undergoing either compensatory growth following left unilateral adrenalectomy or adrenal regeneration following bilateral adrenal enucleation. In normal rat adrenal gland, the tissue concentration of IGF2 (7.45 +/- 0.99 pg/micrograms protein) wa higher than IGF1 (1.26 +/- 0.23 pg/micrograms protein), both peptides being more abundant in the inner zones of the adrenal gland compared to the capsule-glomerulosa. During compensatory growth of the right adrenal gland, IGF1 and 2 increased significantly compared with control right adrenal glands at 24 h following left unilateral adrenalectomy (P less than 0.001). At 68 h, the increase remained significant for IGF1 (P = 0.012). The two peptides were measured in the regenerating adrenal gland at 7, 14 and 21 days following bilateral enucleation. Whilst there was a trend towards an increase in the IGF1 and 2 content of regenerating adrenal glands, the increase was significant only for IGF2 in the left adrenal gland at 21 days following enucleation. Plasma IGF1 and 2 did not increase compared to controls during the experiments (110.97 +/- 1.95 and 46.33 ng/ml, respectively), suggesting that the changes in tissue IGF reflect increased local production during rapid growth of the adrenal gland.

Adrenal Glands↗
PubMed2004

Adrenal cortical cell transplantation.

PURPOSE: The adrenal cortex is a critical component of the hypothalamic-pituitary-adrenal/gonadal axis that coordinates the stress response and maintains homeostasis. The authors hypothesize that adrenal cortical cells can be transplanted in adrenal insufficiency states to regenerate the adrenal cortex. METHODS: Murine adrenal glands were dissociated into adrenal cortical cells. Cells cultured in a collagen matrix were transplanted under the renal capsule. The implants were retrieved 1, 2, 4, and 8 weeks later. Total RNA was extracted from the retrieved specimens and was analyzed by real-time polymerase chain reaction. RESULTS: All animals survived the surgical procedure. At implant retrieval, a distinct organoid could be visualized under the renal capsule. The expressions of adrenal-specific markers including Sf1, Dax1, Star, Cyp11a, Cyp11b1, and Cyp21 were detectable in the retrieved specimens up to 8 weeks posttransplantation. CONCLUSION: Primary adrenal cortical cells retained their gene expressions after heterotopic transplantation. Ex vivo gene transfer followed by adrenal cortical cell transplantation may lead to curative therapy for patients with adrenal insufficiency.

Adrenal Cortex↗
PubMed2004

Importance of adrenal incidentaloma in patients with a history of malignancy.

BACKGROUND: Adrenal incidentaloma presents a frequent finding in patients with a history of malignancy. This study was carried out to determine whether imaging techniques can discriminate between a malignant and a benign adrenal tumor and subsequently select candidates for adrenal surgery. METHODS: Beginning in July 1995, oncologic patients with adrenal incidentaloma underwent abdominal ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and [ 18 ]fluoro-2-deoxy-D-glucose positron emission tomography (18-FDG-PET). Consecutively in all patients adrenalectomy was performed. Histologic findings were compared with the imaging results. RESULTS: In 42 patients, 33 to 79 years old (mean age, 58 years), 44 adrenal lesions were detectable. Two patients presented with bilateral adrenal masses. At operation, 43 adrenal resections and 3 biopsies were performed. Histologic examination revealed 31 metastases (71%) and 13 adrenal adenomas (29%). In metastases the sensitivity of ultrasonography, CT, MRI, and 18-FDG-PET was 66%, 81%, 100%, and 100%, respectively. For adrenal adenoma, the sensitivity of ultrasonography, CT, MRI, and 18-FDG-PET was 46%, 39%, 100%, and 54%, respectively. CONCLUSIONS: In oncologic patients with indeterminate adrenal tumors MRI and 18-FDG-PET provide accurate differentiation between metastases and benign adenomas. Positive results of these 2 imaging modalities are highly suggestive for metastatic disease. In cases of negative MRI and 18-FDG-PET results the adrenal lesion corresponds to a benign adenoma that needs no surgical intervention.

Adenoma↗
PubMed1994

Adrenal involvement from renal cell carcinoma: predictive value of computerized tomography.

Although adrenal involvement from renal cell carcinoma is rare, removal of the adrenal during radical nephrectomy continues to be standard practice. To assess the actual need for adrenalectomy, we elected to evaluate whether malignant involvement of the adrenal gland could be reliably diagnosed preoperatively by a computerized tomogram (CT) of the abdomen. A blinded retrospective review of preoperative abdominal CT in 157 patients with renal cancer revealed an abnormality of the ipsilateral adrenal gland in 38. Histopathology confirmed malignant involvement of the adrenal in 10 patients. Significantly, all 119 adrenal glands judged to be normal on the preoperative CT were confirmed to be uninvolved by the renal cancer on histopathological study. We conclude that abdominal CT is reliable in the preoperative evaluation of the ipsilateral adrenal gland and assessment of its noninvolvement with renal carcinoma. In such cases adrenal sparing nephrectomy may be considered (76% of our patients). None of these 119 patients had either macroscopic or microscopic adrenal involvement. When the adrenal is not identified, displaced or enlarged on CT (24% of our patients) adrenalectomy should be routinely performed as part of radical nephrectomy. Even in this select group adrenal involvement was present in only 26% of the cases.

Adrenal Gland Neoplasms↗
PubMed1998

Effects of cocaine on adrenal sympathetic nerve discharge in anesthetized rats.

Cocaine increases the circulating levels of plasma catecholamines, presumably via the activation of the sympathoadrenal axis. However, a number of reports have shown that the predominant response to cocaine is a generalized decrease in sympathetic nerve activity. One possible explanation for the increase in plasma catecholamines may be that the adrenal sympathetic nerve is less sensitive to the sympathoinhibitory actions of cocaine than are other nerves. This study compared the effects of cocaine on adrenal and renal sympathetic nerve discharge (SND) recorded simultaneously in pentobarbital-anesthetized rats. Cocaine produced dose-related decreases in both renal and adrenal SND; however, the decreases in adrenal SND were significantly smaller than in renal SND. Cocaine also elicited pressor responses in these rats. The decreases in adrenal SND were similar in baroreceptor intact and sinoaortically denervated rats, indicating that pressor-mediated baroreceptor reflex activation was not responsible for the decrease in adrenal SND. In a separate group of rats, i.v. administration of desipramine decreased both adrenal and renal SND. As with cocaine, the decreases in adrenal SND after desipramine were smaller, suggesting that the differences in the neural responses did not reflect a differential local anesthetic effect of cocaine on the two nerves. In conclusion, these studies showed that cocaine decreases adrenal SND in pentobarbital-anesthetized rats. However, the adrenal sympathetic nerve is less sensitive than the renal nerve to the sympathoinhibitory actions of cocaine. Whether the adrenal SND remaining after cocaine contributes to the increase in plasma catecholamines produced by this drug remains to be determined.

Adrenal Glands↗
PubMed1997

Role of growth factors in the developmental regulation of the human fetal adrenal cortex.

Development of the human fetal adrenals is characterized by rapid growth and high levels of steroidogenic activity during the latter two-thirds of pregnancy. By midgestation, the human fetal adrenals are composed of two distinct cortical zones: the predominant fetal zone, which occupies 80-90% of the cortical volume and produces large amounts of the delta 5-steroid dehydroepiandrosterone sulfate, and the narrow definitive zone, which surrounds the fetal zone. Late in gestation, the peripheral portion of the fetal zone develops into a third, functionally distinct compartment, the transitional zone, which is the likely site of cortisol synthesis. Soon after birth, the adrenal cortex is remodeled and the fetal zone disappears. The adult cortical zones are thought to arise from the definitive zone, which persists postnatally. Development of the human fetal adrenals is regulated primarily by corticortropin (ACTH) secreted from the fetal pituitary. However, as ACTH is not a mitogen per se, its proliferative actions on human fetal adrenal cortical cells are thought to be mediated by autocrine/paracrine growth factors produced by adrenal cortical cells in response to ACTH. In addition, these growth factors appear to modulate the functional response of fetal adrenal cortical cells to ACTH. The roles of several growth factors, including the insulin like growth factors I and II (IGF-I and IGF-II), epidermal growth factor (EGF), basic fibroblast growth factor (bFGF), activin, inhibin, and the transforming growth factors alpha and beta (TGF-alpha and TGF-beta) have been examined. In cultured human fetal adrenal cortical cells, EGF, bFGF, and IGF-I and -II are mitogenic, whereas activin and TGF-beta inhibit proliferation. IGF-II, activin, and TGF-beta also modulate ACTH-stimulated steroidogenesis. Human fetal adrenal cortical cells express IGF-II, bFGF and the activin/inhibin subunits, and the abundance of mRNAs for each of these factors is up-regulated by ACTH, suggesting that these growth factors are autocrine/paracrine mediators of ACTH action. Thus, although human adrenal development is primarily regulated by ACTH, its actions appear to be mediated/modulated by a cohort of locally expressed growth factors, the net effect of which results in the unique growth and steroidogenic activity of the human fetal adrenal cortex.

Activins↗
PubMed1997

Adrenal metastases from renal cell carcinoma: role of ipsilateral adrenalectomy and definition of stage.

OBJECTIVES: We undertook this study to establish criteria for adrenalectomy in patients with renal cell carcinoma. METHODS: We retrospectively reviewed the records of 162 patients undergoing radical nephrectomy from 1979 to 1993 at University Hospitals of Cleveland. Simultaneous ipsilateral adrenalectomy was performed in 57 patients (35%). RESULTS: Three of these 57 patients (5.3%) had ipsilateral adrenal metastases. All 3 patients had large, left-sided, upper-pole tumors that extended through the renal capsule (Stage T3a). All 3 patients with adrenal metastases had progression to disseminated disease, with an average time to progression of 7.2 months, whereas only 13 (24%) of the 54 patients without adrenal metastases developed metastatic disease (none to adrenal), with an average time to progression of 27.6 months. No patient with organ-confined disease (Stage T1 or T2) or extracapsular disease in the midkidney or lower pole had adrenal metastases identified histologically. CONCLUSIONS: The prognosis is poor for renal cell carcinoma with ipsilateral adrenal involvement, even with complete removal. Because of this poor prognosis, we believe that adrenal involvement should constitute a separate stage category. We propose that patients with ipsilateral adrenal metastases via direct extension should be classified as having pathologic Stage pT3d. If the patient has an ipsilateral adrenal metastasis not via direct extension, contralateral adrenal metastasis, or bilateral adrenal metastases, the pathologic stage should be M1. Ipsilateral adrenalectomy should only be performed if a lesion is seen preoperatively on computed tomographic scan or if gross disease is seen at the time of nephrectomy although its removal may not benefit the patient.

Adrenal Gland Neoplasms↗
PubMed2003

Trophic and steroidogenic effects of water deprivation on the adrenal gland of the adult female rat.

The effects of a 3-day water deprivation were studied in adult female rats in order to know what are the different zones of the adrenal gland and the hormonal factors involved in the growth and the activity of the adrenal gland. Water deprivation significantly increased plasma renin activity (PRA), plasma Angiotensin II (AII), vasopressin (AVP), epinephrine, aldosterone and corticosterone concentrations but did not modify the plasma adrenocorticotropin hormone (ACTH) level. Water deprivation significantly increased the absolute weight of the adrenal capsule containing the zona glomerulosa without modification of the density of cells per area unit suggesting that the growth of the adrenal capsule was due to a cell hyperplasia of the zona glomerulosa. Water deprivation significantly increased the density of AII type 1 (AT(1)) receptors in the adrenal capsule but did not modify the density of AII type 2 (AT(2)) receptors in the adrenal capsule and core containing the zona fasciculata, the zona reticularis and the medulla. The treatment of dehydrated female rats with captopril, which inhibits the angiotensin converting enzyme (ACE) in order to block the production of AII, significantly decreased the absolute weight of the adrenal capsule, plasma aldosterone and the density of AT(1) receptors in the adrenal capsule. The concentration of corticosterone in the plasma, the density of AT(2) receptors and the density of cells per unit area in the zona glomerulosa of the adrenal capsule were not affected by captopril-treatment. In conclusion, these results suggest that AII seems to be the main factor involved in the stimulation of the growth and the secretion of aldosterone by the adrenal capsule containing the zona glomerulosa during water deprivation. The low level of plasma ACTH is not involved in the growth of the adrenal gland but is probably responsible for the secretion of corticosterone by the zona fasciculata.

Adrenal Glands↗