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PubMedDate not supplied

A follow up report: recurrent Cushing's syndrome after bilateral adrenalectomy.

This is a case report of a 23 year old female. She had earlier been diagnosed to have Cushing's syndrome due to macronodular adrenal hyperplasia, for which bilateral adrenalectomy was performed three years before. The initial full recovery was sustained for about one and a half years, following which there was progressive recurrence of obesity, hypertension and hypercalcaemia. Plasma cortisol concentrations were markedly elevated and a diagnosis of recurrent Cushing's syndrome was made. Pre-operative localisation of the source of hypercortisolism through intravenous urogram, abdominal ultrasonogram and computerised tomogram was unfruitful, thus an exploratory laparatomy was undertaken. At surgery, extensive and dense adhesions were seen which caused difficult dissection and accidental injury to the patient's liver and kidney, necessitating massive intra-operative blood transfusions. The patient died within two hours of recovery from anaesthesia of acute massive pulmonary embolism. We postulate that the recurrent Cushing's syndrome in this patient could have been due autografting of remnants of adrenal tissue within the abdominal cavity. A pre-operative localisation with radio-labelled cholesterol scanning may have made reoperation of the patient easier.

Adrenalectomy↗
PubMed1975

Mammary carcinogenesis-enhancing effect of adrenalectomy in irradiated rats with pituitary tumor MtT-F4.

Mammary carcinomas were found at autopsy 98--100 days after irradiation in 12 of 14 (86%) multiparous Fischer female rats which had been adrenalectomized and given grafts of secretory pituitary tumor strain MtT-F4 soon after exposure to gamma-rays or fission neutrons. A single carcinoma was found in 1 of 10 unirradiated, MtT-bearing, adrenalectomized animals. When adrenalectomy was not done, no tumors were found in 8 unirradiated or in 13 irradiated MtT-bearing rats rats. In view of the well-established finding that Cortisol is essential for milk production, we suggested as a working hypothesis that, in the presence of high titers of mammotropic hormone and adrenal corticoids, differentiation of a given cell for milk secretion reduced that cell's proliferative potential. When such differentiation was precluded by adrenocorticoid deficiency, more irradiation-altered mammary epithelial cells retained their high proliferative potential and contributed to carcinoma formation.

Adrenal Cortex Hormones↗
PubMed1975

The effects of adrenalectomy and corticosterone on vascular permeability responses in the skin of the rat.

The vascular permeability response induced in the rat by intracutaneous histamine or serotonin is noticeably influenced by previous adrenalectomy or treatment with corticosterone. Permeability responses were demonstrated by the local exudation of circulating Evans blue at sites of intracutaneous injection of the above permeability factors, the intensity of the responses being assessed by the diameter of the blue lesions as well as by the amount of exuded dye. In adrenalectomized rats maintained for 72-80 h on 0-9% solution of NaCl, the permeability response to histamine was enhanced about 10-fold, that to serotonin about 5-fold. When rats were given subcutaneous corticosterone, 1-0 mg/animal 1 h before testing, the responses to the same 2 permeability factors were decreased about 10-fold and 5-fold respectively. Corticosterone also decreased the enhanced responses in adrenalectomized rats to levels somewhat below those in mock adrenalectomized controls. The results support the proposal from other work that vascular exudation in experimental inflammation is regulated by an anti-inflammatory factor that accumulates in injured tissues and owes its effect to release of corticosteroids.

Adrenal Glands↗
PubMed1975

[Distribution of catecholamines in the median eminence of rats following adrenalectomy].

Distribution of adrenergic and peptidergic nerve fibers in rat median eminence was studied three weeks after bilateral adrenalectomy. Fluorescence intensity in the external zone and in some of the nerve cell-bodies proved to be increased in the nucleus arcuatus. There were many nerve fibers with a bright fluorescence in the internal zone. A great number of the peptidergic nerve fibers appeared in the external zone. Reactions in the rostral, medial and caudal regions of the median eminence differed and were described.

Adrenal Glands↗
PubMedDate not supplied

Retroperitoneoscopic adrenalectomy in a residual of neuroblastoma.

The authors report a case of retroperitoneoscopic adrenalectomy in a child with neuroblastoma previously treated by chemotherapy. Usually the presence of malignant tumours is a contraindication to retroperitoneoscopic surgery. A restaging of the tumor was done by retroperitoneoscopy. The residual adrenal gland was excised by mini-invasive surgery of the retroperitoneal space. The histopathologic examination confirmed the presence of a residual neuroblastoma in the adrenal gland. This case report shows a possible of a new indication for the retroperitoneoscopy.

Adrenalectomy↗
PubMed1975

[An acute psychotic episode following adrenalectomy in cushing's syndrome].

A marked cortisone psychosis with initial depressive symptoms developed following left adrenalectomy in a 41 year-old female patient suffering from Cushing's syndrome due to bilateral adrenal hyperplasia. On deterioration of the clinical picture with the development of delusional ideas, verbal hallucinosis with imperative voices was observed. The administration of neuroleptic drugs favourably influenced the psychosis, which disappeared with a final depressive stage, thereby enabling removal of the second hyperplastic adrenal gland. The physical signs showed a good remission, except for the severe myopathy and osteoporosis; the pathologically-altered serum potassium level and the erythrocyte potassium content returned to normal.

Adrenalectomy↗
PubMedDate not supplied

[Behavioral effects of L-tryptophan and p-chlorophenylalanine after adrenalectomy or dexamethasone administration in rats].

Effects of acute administration of L-tryptophan (L-TRP. 250.0 mg/kg, i.p.) on active avoidance conditioning and "open-field" behavior were studied in male rats after adrenalectomy of dexamethasone administration. L-TRP inhibited the acquisition and reproduction of active avoidance reaction in adrenalectomized and dexamethasone-treated rats. Moreover, L-TRP decreased horizontal locomotor activity and grooming behavior in the "open field" on adrenalectomized rats. On the contrary, p-CPA restored the active avoidance conditioning in adrenalectomized rats and rats with excess of glucocorticoids. Also, p-CPA increased the total locomotor activity and grooming behavior in the "open field" in adrenalectomized rats, but decreased horizontal locomotor activity and enhanced emotional reaction in dexamethasone-treated rats in the "open field".

Adrenalectomy↗
PubMedDate not supplied

[Effect of adrenalectomy in pregnant mice on activity and spectrum of alkaline phosphomonoesterase in placenta and fetal organs].

Unilateral adrenalectomy in mice on pregnancy day 14 stimulates activity of alkaline phosphomonoesterase in placenta on pregnancy day 21. This is often accompanied with changes in the enzyme activity in fetal liver, kidneys, bone, intestine. Additional isoforms of alkaline phosphomonoesterase appear in the electrophoretic spectrum.

Adrenalectomy↗
PubMed2002

Amphetamine induced sensitization in acoustic startle: lack of blockade by adrenalectomy and alpha-helical CRF9-41.

The present study utilized the acoustic startle response to evaluate the sensitization effect of repeated administration of amphetamine (AMPH). Intraperitoneal injections of AMPH induced a dose-dependent enhancement of startle: 5.0 mg/kg caused a robust effect, 1.0 or 3.0 mg/kg caused a negligible effect. Sensitization was generated by repeated administration of 5.0 mg/kg AMPH for 7 consecutive days and tested on the 8th and 9th days with challenge of saline and 3 mg/kg AMPH. The results showed that rats receiving chronic injections of AMPH, but not saline, showed significant enhancement of startle to 3.0 mg/kg AMPH, and this effect lasted at least for a month. To explore the role of the hypothalamo-pituitary-adrenal axis in this sensitization effect, rats received adrenalectomy, adrenal demedullation, or sham adrenal operation, and then were subjected to acute or chronic injections of 5.0 mg/kg AMPH. Removal of the whole adrenal gland or only the medulla abolished neither the startle enhancing effect of AMPH injected acutely nor the sensitization effect of AMPH injected chronically. In addition, intracerebroventricular infusion of a CRF antagonist, alpha-helical CRF9-41, prior to the challenge test failed to alter the sensitization effect of AMPH. These findings suggest that neither adrenal hormones nor CRF was indispensable for induction/expression of AMPH-induced sensitization in acoustic startle.

Acoustic Stimulation↗
PubMedDate not supplied

[Videolaparoscopic adrenalectomy in Conn syndrome. Analysis of 39 case observations].

The authors retrospectively analyse 39 patients affected by Conn's syndrome, which have been observed since 1985, and discuss the results of surgical approach using the new technologies. In particular, the introduction of laparoscopy, technique that has been applied almost exclusively since the last seven years, has revealed being the "gold standard" for the surgical treatment of this disease. The adrenal underlying lesions are indeed almost always monolateral, small in size and present very rarely malignancy in their biological behaviour. Furthermore, the authors, although lacking of personal experience, propose the possibility of a more conservative treatment of the adrenal lesions with a simple "enucleation", whose feasibility also in laparoscopy has recently been shown by some authors. Anyway, the Authors believe that this technique of a partial adrenalectomy could be chosen in selective cases of bilateral adenomas or hyperplasia or in those lesions which are placed in an easily accessible peripheral site.

Adrenalectomy↗
PubMed2004

[Laparoscopic adrenalectomy in multiple endocrine tumors, in secreting and non-secreting lesions].

AIM: Personal experience in laparoscopic adrenalectomies (LA) for secreting and non-secreting tumors is presented. METHODS: Between March 1995 and December 2001 a total of 111 LA (58 left, 49 right and 4 bilateral) were performed in 60 females and 51 males, mean age 47.5 (range 8-81) years, for: 38 Conn diseases, 24 incidentalomas, 15 pheochromocytomas, 13 Cushing diseases, 4 kysts, 3 angiomyolipomas, 1 adreno-genital syndrome, 1 hydatidosis, 1 hyperplasia, 1 ganglioneuroma, 1 oncocyte adenoma, 1 adrenal fibrous tumor, 4 cortical carcinomas and 4 metastases (from renal carcinoma, breast carcinoma, leiomyosarcoma and rabdoid sarcoma, respectively). In all cases LA was transabdominal with a lateral flank approach. RESULTS: Mean global operative time was 88.6 minutes (range 35-240). Conversion rate was 1.8% (2/111). There was low postoperative pain. Mean hospital stay was 4.3 days (range 2-13). There were 0.9% (1/111) 30-day mortality and 4.5% (5/111) morbidity. During a mean follow-up of 41 months (range 1-81), the 67 secreting patients were disease-free. Concerning 8 malignant cases, mean follow-up was 40.5 months (range 9-72) with 3 cortical carcinomas disease-free and 1 dead for stroke, 2 metastases (1 leiomyosarcoma and 1 breast carcinoma) dead for disease and 2 disease-free. There was no port-site metastases. CONCLUSIONS: LA seems safe and effective when performed in experienced Centers on endocrine surgery and laparoscopy.

Adolescent↗
PubMed2004

Effect of adrenalectomy on the activity of small intestine enzymes in monosodium glutamate obese rats.

It is well known that adrenalectomy (ADX) reverses the eating and energy balance disturbances in a variety of models of obesity associated with elevated food intake. We have previously demonstrated enhanced functional activity in the small intestine of neonatally monosodium glutamate-treated (MSG) obese rats despite the absence of overeating and we concluded that these changes might also contribute to the development of MSG obesity. The objective of the present experiments was to investigate whether ADX would affect the small intestinal functions and whether their changes would counteract attenuation or prevention of obesity development in MSG rats. Therefore the investigation was carried out in MSG-obese Wistar male rats and untreated intact rats adrenalectomized on day 40, as well as in lean littermates of MSG rats and intact rats subjected to Sham-ADX surgery. All animals had free access to a standard pellet diet after weaning. At the age of 80 days, body mass, body fat content and food consumption as well as changes of the brush-border-bound duodenal and jejunal alkaline phosphatase (AP), the dipeptidyl(amino)peptidase IV (DPP IV) and maltase activity were measured. During the postoperative period, ADX resulted in a significant decrease of mass gain in both MSG and control rats (P<0.05). ADX fully prevented the development of obesity in MSG rats (significantly decreased epididymal+retroperitoneal fat pad mass, P<0.05) and increased mean daily food intake (P<0.001). These effects were only minimal in the ADX controls suggesting that enhanced adrenal secretion is involved in the expression of MSG obesity and its complications. The AP activity in obese MSG rats was increased by about 21 % (P<0.01) in both intestinal segments when compared to the lean controls, whereas no parallel variations in the activities of DPP IV and maltase were observed in the intestinal parts mentioned. In MSG rats, ADX significantly reduced the AP activity in the duodenum and jejunum (P<0.01). A similar tendency was also seen in the DPP IV activity of adrenalectomized MSG rats as well as in lean control rats. Nevertheless, no significant effect of adrenal withdrawal on maltase activity was found. These results indicate that the decrease of enzyme activities in the small intestine and the different effectiveness of nutrient absorption might be a significant factor preventing the development of excess adiposity in glutamate-treated rats. This information contributes to a better understanding of the importance of small intestinal function for the development of obesity and its maintenance in later life.

Adrenalectomy↗
PubMed2004

[Laparoscopic adrenalectomy for neuroblastoma in children].

Since 1992 when it was described the first laparoscopic adrenalectomy in adults, few references can be found about this technique in children in Literature, and less the number of them that makes reference to neuroblastoma. For that reason we think it is interesting to describe two recent patients operated on by laparoscopy of neuroblastoma, the first in the left side and the second in the right with very good results; being the most interesting fact a 48-hours period of postsurgical stay. As conclusion we think that it is an useful technique in Pediatric Surgery, it gives a very good exposure of the retroperitoneal area, it gives small scars that laparotomy, and it reduces the hospital stay, only we object that must pass more time to be sure that it is a good technique for malignancy.

Adrenal Gland Neoplasms↗
PubMed2004

[Direct results of endovideosurgical transabdominal adrenalectomy].

Results of transabdominal adrenalectomy performed in 29 patients with different tumors of the adrenals were estimated. The lower traumaticity of the access due to using a new technology as well as taking prophylactic measures for lower aggressive influence of the pneumoperitoneum allowed performing combined operative interventions in 30% of cases and avoiding serious intra- and postoperative complications.

Abdomen↗
PubMedDate not supplied

[Cushing disease resistent to conventional therapy: role of bilateral laparoscopic adrenalectomy].

Cushing's disease is the most frequent form of endogenous hypercortisolism in the adult. It is a rare disease, whose natural history is not well known, and has a tremendous impact on patients' quality of life. Trans-sphenoidal surgery is the first therapeutic option in the management of these patients, but it is associated with a 25% long-term recurrence rate. Based on the observation of two patients, the Authors discuss the multidisciplinary approach, the indications and the timing of treatment by bilateral adrenalectomy. Also, the peculiar aspects of the laparoscopic surgical technique are outlined.

Adolescent↗
PubMed2005

[Posterior interosseous nerve palsy in a man in a lateral position for laparoscopic adrenalectomy--a case report].

A 51-year-old man with aldosteronism underwent laparoscopic left adrenalectomy. Anesthesia was induced with fentanyl 0.1 mg, propofol 140 mg and vecuronium 7 mg. Following endotracheal intubation, he was placed in a right lateral position with extension of his left side, and fixed with the Magic Bed. Canulation of the right radial artery was smoothly performed. Anesthesia was maintained with sevoflurane and thoracic epidural anesthesia (mepivacaine and ropivacaine). The operation lasted for 270 minutes and was uneventful. A few hours after surgery, he complained of inability to extend his right fingers without any sensory loss, and the local oppressive pain on his right forearm. Neurological examination revealed a posterior interosseous palsy. Symptoms improved gradually and disappeared completely in two months with the administration of vitamin B12 and physical therapy. Postoperative reproduction of the positioning of this case disclosed that the edge of the Magic Bed might potentially compress the posterior interosseous nerve at the point where the nerve is bifurcated from the radial nerve and travels within the supinator muscle going into the muscle again. This case indicated that we must be careful of nerve injuries due to devices used to maintain the patient in lateral position.

Adrenal Gland Neoplasms↗
PubMedDate not supplied

[Laparoscopic adrenalectomy: an initial experience].

Our aim was to evaluate the short-term results of a series of 65 consecutive laparoscopic adrenalectomies performed on 63 patients with benign or metastatic tumours measuring < or = 7 cm. The surgical indication was primary hyperaldosteronism in 32 cases, pheochromocytoma in 7, Cushing syndrome and disease in 5 and 2 cases, respectively, incidentaloma in 11 and metastasis in 8 cases. The mean tumour size was 3.9 cm (range 0.6-7). Operative time averaged 130 min (range 45-270). In one case we produced an iatrogenic lesion by sectioning a peripheral recurrent branch of the left renal artery with consequent partial renal infarction. The conversion rate to the open approach was 6.1%; the morbidity rate was 4.6%. The mean hospital stay was 4 days (range 3-11). All patients were re-examined 30 days after surgery and no additional complications were observed. At this time 93.2% of patients with primary secreting tumours showed normal hormonal assays. Considering the 38 patients chronically treated during the preoperative period, we noted that the intake of specific drugs was suspended in 34.2%, reduced in 36.8%, maintained in 26.4% and transitorily augmented in 2.6%. On these basis we confirm the efficacy and safety of this surgical treatment.

Adrenal Gland Neoplasms↗
PubMed2005

Long-term results of adrenalectomy in patients with aldosterone-producing adenomas: multivariate analysis of factors affecting unresolved hypertension and review of the literature.

The long-term surgical cure rate of patients with primary aldosteronism varies widely, and causes of persistent hypertension are not completely established. We reviewed retrospectively charts from 98 patients (range, 19-70 years old) with aldosterone-producing adenomas who underwent unilateral adrenalectomy. At a median follow-up of 81 months (range, 18-186 months), the mean blood pressure values improved in 95 out of 98 (96.9%) patients, although hypertension was cured only in 71 out of 98 (72.4%) patients. Multivariate analysis using a logistic regression model adjusted for duration of follow-up showed that only age of the patients and duration of the disease independently correlated with unresolved hypertension. The cumulative odds ratio (OR), obtained using the logistic regression function, was 5.38 (95% CI 1.78-16.22), and the OR of single variables were 1.32 (95% CI 0.36-19.83) and 4.56 (95% CI 1.41-14.78), respectively. By using discriminant analysis to derive a classification function for the prediction of unresolved hypertension, a maximum predictive power of 75 per cent was achieved. In conclusion, in patients with an aldosterone-producing adenoma undergoing surgery, the combination of age and duration of hypertension gave the best predictive power of a linear classification function and represented the main independent risk factors affecting hypertension cure rate.

Adrenal Cortex Neoplasms↗