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PubMedDate not supplied

Effect of early maternal adrenalectomy on antioxidant enzymes, GSH, ascorbate, and uric acid in the rat fetal lung at term.

Previous studies have shown that the increase of the enzymatic antioxidant defense that takes place in the fetal rat lung at the end of gestation can be accelerated by the synthetic glucocorticoid dexamethasone and diminished by metyrapone, a blocker of glucocorticoid synthesis. Since it is known that the fetal adrenal does not start to synthesize corticosterone until the last 20% of gestation, pregnant rats were bilaterally adrenalectomized on the first day of gestation in order to clarify the role of the endogenous maternal hormone on the development of the enzymatic and nonenzymatic antioxidant systems of fetal lung. This early adrenalectomy did not change fetal lung catalase, glutathione peroxidase, glutathione reductase, cytochrome oxidase, GSH, ascorbate, and uric acid at term. The presence of the maternal glands is not essential for lung antioxidant development in the fetus and that the stimulus of fetal corticosterone during the last 20% of gestation is enough to achieve a normal maturation of the fetal lung enzymatic and nonenzymatic antioxidant systems.

Adrenal Glands↗
PubMed1979

Diurnal rhythm of pituitary-thyroid axis in male rats and the effect of adrenalectomy.

Levels of TSH, thyroxine (T4) and triiodothyronine (T3) were measured by radioimmunoassay in plasma (TSH, T4, T3) and pituitary (TSH) of 60-day old male Long-Evans rats. Definite diurnal rhythms were demonstrated in pituitary TSH, plasma TSH and T3 in intact rats, evidenced by the statistically significant differences between zenith and nadir for pituitary TSH, plasma TSH and T3. The zenith value of pituitary TSH and the nadir values of plasma TSH, T4 and T3 were observed at the same time (2400 h) as were the nadir value of pituitary TSH and the zenith values of plasma TSH, T4, and T3 (at 1200 h). Our results indicate that the rhythmicity of pituitary TSH content is a mirror image of that of plasma TSH. Adrenalectomy not only reduced plasma corticosterone levels to almost zero, but also decreased plasma T3 and T4 levels. In adrenalectomized rats, the absolute concentration of pituitary and plasma TSH increased at 1200 h and at 2400 h and, in both cases, the difference between values at 1200 h and at 2400 h persisted. The differences in plasma TSH, T3 and T4 between 1200 h and 2400 h were also observed in sham-adrenalectomized rats. These results suggest glucocorticoids do influence the pituitary-thyroid axis, but that the rhythmicity of the pituitary-thyroid axis does not seem to depend on the rhythmicity of glucocorticoid secretion.

Adrenalectomy↗
PubMedDate not supplied

Induction of steroid 21-hydroxylase/beta-galactosidase transgene expression by unilateral adrenalectomy.

Unilateral adrenalectomy was used to induce compensatory growth in the contralateral adrenal gland of transgenic mice bearing a steroid 21-hydroxylase promoter/beta-galactosidase reporter (21-OHase/beta-gal) transgene, in which 6.4 kb of 5'-flanking sequence of the mouse steroid 21-OHase A gene are linked to a LacZ reporter gene. 48 hours following removal of the right adrenal gland, the left gland of transgene-positive mice showed a 4.5 fold increase in specific activity of the beta-gal reporter, compared to the right gland, while left glands from sham-operated transgene-positive and unilateral adrenalectomized transgene-negative mice showed no such increase. The increased specific transgene reporter activity, relative to total adrenal gland protein, must result from up-regulation of transgene expression, rather than from the compensatory increase in adrenocortical mass. This suggests that elements regulating trophic hormone-mediated 21-OHase gene expression in vivo are located within 6.4 kb of the 21-OHase gene transcription start site.

Adrenalectomy↗
PubMed1990

Effect of angiotensinogen concentration on renin activity following nephrectomy and adrenalectomy: implications in the activation of plasma prorenin.

We have studied the effects of bilateral nephrectomy and adrenalectomy on angiotensinogen concentration, plasma renin activity, and total plasma renin activity obtained after trypsin activation in rats and compared with controls. Our results show that the plasma angiotensinogen concentration of nephrectomized (NX) rats is 5-fold higher than that of adrenalectomized (AX) rats. On the other hand, plasma angiotensinogen concentration of AX rats was about 2.5-fold lower than that of control rats. While NX rat plasma possess no renin activity, its mixing (1:1, v/v) with AX plasma results in 2-fold increase in renin activity over that observed for AX plasma alone. These results suggest that the apparent increase in renin activity upon mixing these two plasmas is at least partly due to an overall increase in angiotensinogen concentration in the mixture. To show that it is not due to activation of NX plasma prorenin by a convertase from AX plasma, prorenin-free NX rat plasma was prepared by using an anti-renin immunoaffinity column. When this prorenin-free NX plasma was mixed (1:1, v/v) with AX, again a 2-fold increase in renin activity was observed which is attributed to the overall increase in plasma angiotensinogen in the mixture. It is concluded that rat plasma prorenin is probably not activated within the circulation by a prorenin convertase from the rat kidney.

Adrenal Glands↗
PubMed2003

Laparoscopic adrenalectomy for pheochromocytoma.

OBJECTIVE: To determine the safety and results of laparoscopic resection of benign pheochromocytomas. PATIENTS AND METHODS: We retrospectively reviewed the medical charts of all patients who underwent laparoscopic adrenalectomy for benign pheochromocytomas at all 3 Mayo Clinic sites between January 1, 1992, and December 31, 2001. Demographics, comorbidities, clinical presentation, imaging studies, biochemical findings, operative intervention, and outcome were examined. Long-term follow-up was obtained via chart review and/or by direct telephone contact with the patient or a relative. RESULTS: Twenty-four women and 23 men with a mean age of 53.1 years (range, 16-81 years) underwent attempted laparoscopic resection of pheochromocytomas. In 5 patients, the procedure was converted to open laparotomy because of bleeding (2), inadequate exposure (2), and adhesions (1). The mean tumor size was 4.3 cm. The mean operative time (181.8 vs 1405 minutes; P = .03), mean hospital stay (6.00 vs 2.64 days; P < .001), and mean blood loss (340 mL vs 80 mL; P < .001) were greater in patients who underwent open laparotomy vs those who underwent laparoscopic resection. All specimens were classified as benign. The mean follow-up was 41 months (range, 10-89 months). No patients experienced a recurrence or developed metastatic disease. CONCLUSIONS: In light of surgical and anesthesia expertise, laparoscopic resection of benign pheochromocytomas is safe and effective with resultant short hospital stays. A low threshold to convert to an open procedure reduces operative times and decreases potentially serious complications. Although there have been no recurrences to date, long-term follow-up is required for all patients, especially those with hereditary forms of pheochromocytomas.

Adolescent↗
PubMedDate not supplied

[Laparoscopic retroperitoneal adrenalectomy as a minimally invasive option for the treatment of adrenal tumors].

OBJECTIVES: The excision of the adrenal gland by laparoscopic approach is the gold standard for the treatment of adrenal tumors smaller than 6 cm. Most Brazilian centres favour the transperitoneal approach. The objective of the present prospective study was to show the intraoperative and postoperative results of patients undergoing adrenal laparoscopic surgery through a lateral retroperitoneal approach performed by an individual surgeon. METHODS: Between January 2000 and October 2004, 35 patients (16 males and 19 females) with adrenal lesions, including 4 Cushing's syndrome, 4 Conn's syndrome, 1 neuroganglioma, 4 pheochromocytoma, 17 nonfunctioning adenomas, 1 virilizing tumor, and 4 cases of adrenal nodule after treatment of a non-adrenal primary neoplasia, prospectively underwent retroperitoneoscopic adenomectomy by one surgeon. We describe surgical times, estimated blood losses, time to oral intake, analgesic requirements, surgical complications and conversion rates, hospital stay and time to return to usual activities, comparing our results with other series in the literature. RESULTS: All procedures were successfully completed. Mean surgical time was 135 minutes, mean estimated blood loss 235 ml, mean time to oral intake 12 hours, no patient required analgesics after the second postoperative day, mean hospital stay was 2 days, and mean time to return to usual life activities 3 weeks. There were two complications, one case of intraoperative hypercapnia and one case with postoperative pneumonia. Conversion to open surgery was not required in any case. CONCLUSIONS: Retroperitoneoscopic adrenalectomy may be performed effectively and safely, with a low complication rate, independently of the etiology of the lesion. The lateral retroperitoneoscopic access is an excellent option for the minimally invasive treatment of the adrenal glands.

Adolescent↗
PubMed2003

[Laparoscopic adrenalectomy using telementoring system].

We report on our experience in telementoring during laparoscopic adrenalectomy. An experienced laparoscopic surgeon supervised a less experienced surgeon from a control room about 100 meter away. Mentoring was accomplished over a fiber optic cable employing real-time video imaging, two-way audio communication, OES ImageTrac Video System used to control the laparoscopic image, and a telestrator. The patient was a 52-year-old male with primary aldosteronism due to a left adrenal adenoma 2 cm in diameter. The procedure was successfully performed in 195 minutes with minimal blood loss. The patient recovered without complications and returned home on postoperative day 7. As broadband telecommunication expands, telementoring will become an important method for the training and supporting of laparoscopic surgery.

Adrenalectomy↗
PubMed1976

Adrenalectomy and oophorectomy plus limited-term chemotherapy in the treatment of breast cancer.

A prospective study employing adrenalectomy and oophorectomy followed by limited-term combination chemotherapy was used in the treatment of 39 patients with advanced breast cancer. Chemotherapy was abruptly stopped at 8 weeks in order to take advantage of rebound immunocompetence. Delayed hypersensitivity was tested by dinitrochlorobenzene skin tests and responses to phytohemagglutinin. There were 22 CRs among 33 patients who entered remission. Eleven patients had a PR with greater than 50% reduction of tumor. Thirteen of 20 patients with visceral disease had a CR. There was a close association between response and competence of the cell-mediated immune system. The median duration of unmaintained remission in those patients with a CR was greater than 16 months. Four of the six failures had had recent radiation therapy to the chest wall which may have influenced immunocompetence. Responses to chemotherapy appear to be additive to endocrine ablation. Rebound of immunocompetence after chemotherapeutic immunosuppression may be related to remission induction and maintenance.

Adrenalectomy↗
PubMedDate not supplied

[Clofelin-fentanyl analgesia in adrenalectomy].

Anesthesia for adrenalectomy as exemplified in 60 patients is discussed. Anesthesia was based on a combination of fentanyl with a central adrenoagonist clofelin. This method supplemented by accurate hemodynamic monitoring ensures adequate analgesia without side effects on the hemodynamics.

Acid-Base Equilibrium↗
PubMedDate not supplied

Laparoscopic adrenalectomy with the aid of the AESOP 2000 robot.

The authors describe a left adrenalectomy for Cushing's disease with the aid of an AESOP (Automated Endoscopic System for Optimal Positioning) 2000 voice controlled robot. This device facilitated the procedure by producing a constant, stable picture allowing the operative team to concentrate principally on the dissection.

Adenoma↗
PubMed1975

Effect of adrenalectomy on the synthesis of cholinesterases.

Adrenalectomy decreased the rate of regeneration of brain and striated muscle acetylcholinesterase (EC 3.1.1.7) in mice after sublethal poisoning with diisopropylphosphofluoridate (DFP). This may explain similar findings in previous experiments in hypophysectomized animals.

Acetylcholinesterase↗
PubMed2000

[Experience with laparoscopic adrenalectomy in 25 cases].

Between July 1997, and April 1999 the authors performed 25 transperitoneal laparoscopic adrenalectomies. Conversion due to bleeding in 3 cases and due to unsuspected malignancy in 1 case was necessary. Complete resection was carried out in 22 cases. In 3 cases where a well circumscribed adenoma was visualized, only enucleation was performed. A new approach for left sided resection was also introduced. In the authors experience laparoscopy is an absolutely suitable intervention for the benign diseases of the adrenal glands. It assures a short, uncomplicated and painless postoperative period for the patients, with the same effectivity and safety compared to the conventional method.

Adrenalectomy↗
PubMed1999

[The combined use of fentanyl and clofelin in the anesthesiological support of adrenalectomy].

The analgetic effect of a combination of phentanyl and clonidine was investigated in 68 cases of adrenalectomy as an analgetic component of anesthesia. The analgesic potency of the used combination and stability of the autonomous functions were proved to be sufficient in surgical interventions for various types of adrenal tumors. It was found that the mechanism of the clonidine effect was not associated with vasodilatation and was based on its antinociceptive properties. The role of hemodynamic monitoring in prevention of possible complications and adverse effects of the described anesthetic technique was stressed.

Adolescent↗
PubMed2000

Effect of adrenalectomy and corticosterone on cocaine-induced sensitization in rats.

Effects of adrenalectomy (ADX) and corticosterone (CORT) on the development and expression of sensitization to the locomotor effect of cocaine (COC) were studied in rats. Sensitization was evoked by 5 daily injections of COC (10 mg/kg) and measured after a challenge dose of the drug (10 mg/kg) after a 5-day withdrawal (on day 10 of the experiment). ADX, performed before the start of COC administration, completely blocked the manifestation of COC-induced sensitization. In contrast, ADX performed on animals already sensitized to COC did not affect the sensitized locomotor activity response to a challenge dose of COC (on day 18). Pretreatment with CORT, 10 mg/kg, but not 5 mg/kg, before each of the 5 daily COC injections facilitated the development of COC sensitization, tested after a 5-day withdrawal. When pretreated with CORT alone (10 mg/kg), the challenge dose of COC administered on day 10 induced cross-sensitization to CORT. CORT (10 mg/kg) injected acutely before COC on day 10, potentiated the expression of COC sensitization. When given alone, on day 10 CORT (5-10 mg/kg) induced an increase in the locomotor activity of rats pretreated daily (5 injections) with COC. No drug treatment induced conditioned locomotion, as measured after saline challenge on day 8. Our results indicate that CORT facilitates the development and expression of COC sensitization, while ADX blocks the initiation of the behavioral phenomenon only. Moreover, there takes place cross-sensitization between CORT and COC, which indicates a close relationship between the drug-related mechanism and behavioral sensitization.

Adrenalectomy↗
PubMedDate not supplied

[Assessment of conventional approaches in adrenalectomy].

The choice of operative approach represents one of the main problems of adrenal gland surgery, nowadays the minimally invasive techniques (laparoscopic adrenalectomy) in selected cases may be an important alternative to conventional approaches. Retrospective analysis was performed on 140 patients with adrenal gland tumors from 1980-1997; there were 95 women and 45 men: The tumors were resected through flank extraperitoneal approach (35 patients), transabdominal (91), thoraco-abdominal (14). Operating time, perioperative blood loss, postoperative course were evaluated. The authors conclude that in functioning and non-functioning adenomas, in pheochromocytoma, smaller than 6 cm., with precise pre-operative unilateral localization, flank extraperitoneal approach may be sufficient, in patients with Cushing disease resistant to pituitary surgery or irradiation, in patients with familiar history or bilateral pheochromocytoma, in patients with suspected malignant disease, a thorough surgical exploration of the abdominal cavity is recommended.

Adolescent↗
PubMed1979

Adrenalectomy-oophorectomy and combined chemotherapy for carcinoma of the breast with metastases.

Thirty-one patients with carcinoma of the breast with metastases were treated by adrenalectomy-oophorectomy and randomized either for combined chemotherapy, vincristine, fluorouracil, methotrexate and thiotepa, beginning within one week after operation and continuing for three months or no chemotherapy. Statistical analyses were Gehan's modification of the Wilcoxon test for censored data, chi-square tests and life table analysis. Pretreatment characteristics--menopausal status, age, disease-free interval, prior hormone treatment and sites of metastases--of both groups were similar. Objective response occurred in 73 per cent of 11 patients in the treatment. A group compared with 47 per cent of 15 patients in the treatment B group, p greater than 0.50. Median duration to relapse in responders was 16 months in the treatment A group and 15 months in the treatment B group, p greater than 0.50. Median survival was 19 months in the treatment A group and 20 months in the treatment B group, p greater than 0.50. Results were not significant, and inclusion of five patients with less than three months of treatment, did not alter the results. Hence, the group receiving early symptomatic treatment did not show an improved response rate, improved duration of remission or enhanced survival time from ablative treatment.

Adenocarcinoma↗
PubMed2000

A case report of the use of magnesium sulphate during anaesthesia in a patient who had adrenalectomy for phaeochromocytoma.

INTRODUCTION: Patients with phaeochromocytoma have haemodynamic instability during adrenalectomy. CLINICAL PICTURE: A case showing major swings of blood pressure during tumour handling. TREATMENT: Magnesium sulphate infusion alone failed to prevent severe hypertension. OUTCOME: The patient had to be given phentolamine and sodium nitroprusside to control the severe hypertension. CONCLUSION: The greatest value of magnesium sulphate is in controlling catecholamine release at induction and intubation, and in association with other agents in controlling arrhythmias and hypertension during tumour handling.

Adrenal Gland Neoplasms↗
PubMed2001

Effects of prenatal ethanol exposure on hypothalamic-pituitary-adrenal regulation after adrenalectomy and corticosterone replacement.

BACKGROUND: Previous studies have demonstrated that rats prenatally exposed to ethanol (E) exhibit hypothalamic-pituitary-adrenal (HPA) hyperresponsiveness, demonstrated by increased and/or prolonged elevations of adrenocorticotropin (ACTH) and/or corticosterone (CORT) after stress. This study investigated possible mechanisms of HPA hyperresponsiveness in E rats by manipulating CORT feedback regulation of HPA activity via adrenalectomy (ADX) with or without CORT replacement. METHODS: Male Sprague-Dawley rat offspring from prenatal E, pair-fed (PF) and ad libitum-fed control (C) groups were tested at 90 to 120 days of age. Rats were either sham-operated or underwent ADX, with or without CORT replacement. CORT (25 microg/ml) was replaced via the drinking water to achieve basal plasma CORT levels and maintain a phasic CORT signal. Seven days after surgery, animals were decapitated at the diurnal peak either under basal conditions or after a 15-min restraint stress, and trunk blood was collected. RESULTS: After ADX, loss of the CORT feedback signal resulted in increased plasma ACTH in all groups compared with those in sham animals. In addition, under basal conditions, ADX E rats had significantly greater plasma ACTH levels than both PF and C rats. However, no differences were seen in ADX rats after stress. CORT replacement after ADX was partially effective in normalizing ACTH levels under both basal and stress conditions, with no differences among E, PF, and C animals. CONCLUSIONS: These results suggest that E males may exhibit enhanced stimulatory inputs to the hypothalamus, increased pituitary sensitivity to secretagogues, or both, which may be revealed after ADX. In contrast, E animals seem similar to controls in their ability to use an exogenous CORT signal to regulate HPA activity.

Adrenal Glands↗