[Laparoscopic adrenalectomy: a case report].
The authors report the first case of laparoscopic adrenalectomy for Conn's disease. The operative technique and clinical results are thoroughly discussed.
Adrenalectomy↗
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[The reaction of the hypothalamo-hypophyseal-adrenal cortex system in rats to unilateral adrenalectomy in hypoparathyroidism].
Parathyroidectomy and subsequent hypocalcemia were shown to inhibit the response of the hypothalamo-hypophyseal-adrenocortical system (HHACS) to unilateral adrenalectomy, as expressed by a lesser compensatory hypertrophy of intact adrenal gland and a lower concentration of 11-oxycorticosteroids in adrenal gland and in plasma. The greatest activity of the HHACS was revealed in 3-month old rats. The data obtained suggest an interaction between parathyroid and adrenal glands.
11-Hydroxycorticosteroids↗
Effects of maternal adrenalectomy and glucocorticoid administration on the development of rat hippocampus.
Optic and electron microscopic analysis were performed on the hippocampus of fetuses of 20 days gestation, from pregnant rats bilaterally adrenalectomized on day 1 of gestation (ADX) and control (C), in an attempt to determine the incidence of maternal glucocorticoids on morphological parameters in fetal development. In addition, we studied 20 day old fetuses from pregnant rats betamethasone-injected on days 15, 16 and 17 (BET), and adrenalectomized on day 1 and betamethasone-injected on days 15, 16 and 17 (ADX + BET). The adrenalectomy led to a decreased total cell number and a marked depletion of the dentate gyrus of the hippocampus, and also to widespread indifferentiation, both in the pyramidal cell layer of the Ammon's horn and the dentate gyrus, as well as a decreased cell number in CA3 stratum pyramidale. No differences in cell number were found in CA1. So, the ADX effect is in relation to the neurogenic gradient. The main effect of the exogenous glucocorticoid treatment was increased maturation in relation to the control group. Betamethasone injection in adrenalectomized animals prevented the lower degree of maturation of the adrenalectomized group but not the impaired cell number. These results show that glucocorticoids participate in prenatal hippocampus in control mechanisms of cellular division and in maturation.
Adrenalectomy↗
[Circadian rhythm of the number of DNA-syns and following adrenalectomy].
The diurnal changes of mitosis and DNA-synthesizing cells count in the tongue epithelium of intact and adrenalectomized mice were studied. A partial desynchronization of mitotic division, as well as diminution of mitotic index variation amplitude and prolongation of high mitotic activity were observed in the operated animals in the course of 24 hours. The average 24-hour mitotic index in the basal layer of the tongue epithelium was the same in the intact and the operated animals. The rhythm of the DNA synthesis failed to differe from control. Thus, adrenalectomy in mice led to distrubances of the diurnal mitotic rhythm in the tongue epithelium, but had no effect on the rhythm of the DNA synthesis and the level of the proliferative activity.
Adrenalectomy↗
Thymocyte and splenocyte subpopulations in normal and leukemia-bearing mice after adrenalectomy.
Mice with i.p. inoculated leukemia L1210 cells had lower total number of thymocytes, and reduced number of CD4+8+ thymocytes, but increased CD4+8- subpopulation. Adrenalectomy reduced the CD4-8+ subset of thymocytes. Leukemia in adrenalectomized animals induced similar changes in the number of thymocyte subpopulations as observed in normal animals. However, a decrease in CD4+8- thymocytes was noted and the animals had decreased number of CD4-8- cells as well. Splenocytes of CD4+8- subpopulation were more numerous in adrenalectomized animals. Leukemia induced increase in the number of CD4+8- and CD4-8+ splenocytes in both normal and adrenalectomized animals.
Adrenal Glands↗
The alteration of glucocorticoid receptor-immunoreactivity in the rat forebrain following short-term and long-term adrenalectomy.
To examine the effect of short-term and long-term adrenalectomy (ADX) on the glucocorticoid receptor (GR) expression, we performed an immunohistochemical study on the rat forebrain. One day after ADX, the GR-immunoreactivity significantly decreased or disappeared in most forebrain structures, while relatively strong GR-immunoreactivity was still found within the hypothalamus especially in the arcuate nucleus (ARC) and the parvocellular paraventricular nucleus (PVN). Two weeks following ADX, GR-immunoreactive cells disappeared in many structures of the forebrain including most parts of hypothalamus while moderate GR-immunoreactivity was still observable in the ARC and PVN. More than 3 months after ADX, the rats still survived when they received replacement of corticosterone during the first 2 weeks following the operation. Moderate GR-immunoreactivity in the ARC and PVN of the hypothalamus was exhibited whereas no immunoreactive cells remained in the cerebral cortex, thalamus and other forebrain structures when these animals showed obvious cell death in the granule cells of the dentate gyrus, identified with the silver impregnation method for degenerating cells. Massive cell loss in this hippocampal region is an indicator of a complete ADX, in addition to the blood corticosterone level. These results demonstrate topographic differences of GR expression in the rat forebrain after ADX with only continuous immunoreactivity in the ARC and PVN of the hypothalamus, suggesting that some neurons in the ARC and PVN could keep active GR probably in order to maintain their survival after removing the adrenal gland.
Adrenalectomy↗
Recurrence of endogenous cortisol secretion after bilateral total adrenalectomy--2 cases.
Bilateral total adrenalectomy is a common treatment for Cushing's Syndrome in underdeveloped countries where limited resources restrict the use of extensive investigations, where the source of ACTH secretion is not identified or where neurosurgical facilities are minimal. Two cases of recurrence of cortisol secretion managed at the University Hospital of the West Indies are presented. The aetiology is discussed.
Adrenalectomy↗
[Dynamics of EKG changes in patients with Itsenko-Cushing disease before surgery, and following the 1st and 2d stages of adrenalectomy].
The results of examination of ECG in 44 patients suffering from Itsenko-Cushing's disease at different stages of surgical treatment are presented. The data obtained were compared with the blood potassium and sodium levels, 17-KS, and 17-OCS levels in the urine, arterial pressure and cholesterol content. Various ECG changes before the operation were revealed in 39 patients. Signs of enlargement of the left ventricle and deformity of the end part of the ventricular complex (negative T wave and or reduction of S-T segment in I, II, avL V5-6 leads) were found in 8 patients, and deformity of the end part of the ventricular complex without any signs of enlargement of the left ventricle--in 18 patients. There proved to be a significant dependence of the changes in the end port of the ventricular complex on increased urinary excretion of 17-OCS, hypokaliemia and hypernatriemia. Negative ECG changes after bilateral total adrenalectomy was significantly connected with postoperative hypocorticism.
17-Hydroxycorticosteroids↗
Effects of adrenalectomy and adrenergic antagonists on potassium metabolism.
We had previously reported that drugs which stimulate beta-2 adrenergic receptors decreased the hyperkalemia produced by infused KCI and thus protected animals against KCI intoxication; these effects were mediated by an action of beta-2 agonists which enhanced tissue uptake of K+. In this study, cats were given an i.v. infusion of KCI which was not lethal in control animals. Acute adrenalectomy markedly increased the hyperkalemic and mortality responses to infused KCI. This impairment in K+ metabolism was corrected by the administration of epinephrine but not by hydrocortisone. Pretreatment with propranolol (which blocks beta-1 and beta-2 receptors) and H35/25 (which blocks beta-2 receptors) produced a similar impairment in K+ metabolism; on the other hand, practolol (which blocks beta-1 receptors) had little or no effect on the mortality and hyperkalemic responses to infused KCI. Evidence that KCI stimulates an adrenal release of catecholamines is presented. This stimulation of adrenal release may be important in conferring resistance to intoxication produced by infused KCI since the released amines can attenuate the KCI-induced hyperkalemia via a beta-2 action which enhances tissue uptake of K+.
Adrenalectomy↗
Technical improvements in laparoscopic adrenalectomy.
Laparoscopic adrenalectomy has been believed to be the most difficult operation because of the deep location of the adrenals but also because of the lack of standard technology and specific instruments. Herein, we introduce the technique using flexible electron scope (EL2-TF2, Fujinon) and laparoscopic coagulation shears (LCS; Harmonic Scalpel). Use of these two instruments provides a better view on the monitors and faster completion of surgery because of easy dividing procedures of abundant fatty tissues around the adrenal. Our results show shorter operating time compared to the group using conventional instruments. These results reflect an improvement of quality of life of the patients with functional and/or non-functional adenomas in the adrenals.
Adenoma↗
The in vivo time course for elimination of adrenalectomy-induced apoptotic profiles from the granule cell layer of the rat hippocampus.
Although apoptotic cellular degeneration has been reported to be extremely rapid with the use of in vitro models, the time needed to clear apoptotic neurons in the in vivo brain is unknown. In this study we used a simple morphological approach to solve this problem. Four days after adrenalectomy (ADX), all of the operated rats morphologically displayed hippocampal granule cell apoptosis that was prevented completely by corticosterone replacement immediately after ADX. Therefore, we intravenously injected the rats with corticosterone 4 d after ADX and subsequently maintained them on corticosterone replacement in saline drinking water. This corticosterone replacement could protect healthy granule cells promptly and continuously against hormone-deficient apoptosis, because the normal glucocorticoid receptor immunoreactivity within the granule cell nuclei, which disappeared after ADX, was identified 1 hr after corticosterone replacement was started, and this effect persisted for several days. However, this corticosterone treatment could not prevent the irreversible apoptosis of the already degenerated granule cells at various stages of the same progressive apoptotic process. Then we successively traced the disappearance of apoptotic granule cells throughout the hippocampus at different time points by Nissl and silver staining. Given that the apoptotic cells at the earliest stage of the degenerating process when the ADX rats received corticosterone injection were the last to disappear, the period from corticosterone injection until the disappearance of the last degenerating debris of apoptotic cells was taken to represent the time course for elimination of apoptotic neurons in vivo. We discovered that the elimination of apoptotic granule cells took 72 hr.
Adrenalectomy↗
Regulation of corticotropin-releasing hormone secretion by ACTH at different times after adrenalectomy.
This study was undertaken to determine the short-loop negative feedback at the hypothalamic site after adrenalectomy (ADX), when the hypothalamic-pituitary axis was a different set-points. Rats were submitted to the experimental procedure 3 h and 1, 3 and 14 days after bilateral ADX or sham surgery under ether anesthesia by the dorsal approach. ADX rats were supplied with 1.5% NaCl. After decapitation, plasma samples were collected and corticosterone (B) and adrenocorticotrophic hormone (ACTH) concentrations were determined by radioimmunoassay (RIA). Using in vitro incubation of the median basal hypothalamus (MBH) fragment we studied the hypothalamic corticotrophin-releasing hormone (CRH) release under basal conditions and under the inhibitory effect of ACTH. Hypothalamic CRH secretion, determined by direct RIA, without extraction and reported as pg CRH/MBH per 1 h incubation, was inhibited by ACTH administration in a dose-dependent manner, as demonstrated by a significant negative correlation obtained by linear regression analysis of CRH secretion as a function of ACTH dose. However, the percentage of inhibition of CRH secretion was higher at 1 and 3 days than at 14 days after ADX. In conclusion, these in vitro studies demonstrated that ACTH suppressed basal CRH secretion in a dose-dependent manner, an effect compatible with a short-loop feedback mechanism. Furthermore, we demonstrated variable suppressibility of CRH secretion by ACTH at different times after ADX.
Adrenalectomy↗
Endoscopic retroperitoneal right adrenalectomy with the patient in the lateral decubitus position.
We present a case of a right adrenal aldosterone-producing adenoma resected by a novel surgical approach. We describe the technique of an endoscopic retroperitoneal adrenalectomy done with the patient in the lateral decubitus position.
Adenoma↗
[Comparisons of laparoscopic and classical adrenalectomy from personal material].
Postoperative course in 12 patients which had laparoscopic adrenalectomy performed was compared with 8 underwent classic one in terms of operating time, blood loss, blood pressure recordings, C-reactive protein blood concentration, postoperative pain and hospital stay. The advantages of the laparoscopic approach have been stressed.
Adrenal Gland Diseases↗
Hypertension and oedema caused by cortexone hyperproduction and cured by monolateral adrenalectomy. Case report.
Excess 11-deoxycorticosterone (DOC) production, mostly due to an enzyme defect 11-beta-hydroxylase, is a rare cause of secondary hypertension. Even rarer are those forms due to an adrenal adenoma or to a bilateral hyperplasia. In this paper we report the case of 23-year-old woman with excess DOC production, presenting with arterial hypertension and oedema, whom we first observed in 1961. Complete clinical remission, persisting more than 30 years later, was obtained by monolateral adrenalectomy. The literature reports of DOC-induced hypertension due to adrenal adenoma or hyperplasia are reviewed and the possible pathogenetic mechanisms are discussed.
Adrenal Glands↗
[Circadian rhythm of mitoses and number of cells synthesizing DNA following adrenalectomy in mice].
The diurnal changes in the number of mitoses and DNA-synthesizing cells were studied in intact and adrenalectomized mice. In the corneal epithelium of adrenalectomized mice the diurnal rhythm of DNA-synthesizing cells became biphasic, and the variation amplitude of the 24-hour mitotic activity was sharply intensified. In the liver the diurnal rhythm of DNA-synthesizing cells was similar in the intact and the operated on mice; as to the mitotic rhythm - it became biphasic in the operated on animals. Thus, adrenalectomy deranged the phasic structure of the mitotic and DNA-synthesizing rhythms in the tissues under study and led to dissociation in the entrance of cells into the DNA-synthesis and mitosis.
Adrenalectomy↗
[Transplantation of organic culture of adrenal grand cortical substance in the treatment of post-adrenalectomy hypocorticoidism].
The organ culture transplantation of the adrenals cortical substance of a newborn piglets was applied while 94 patients treatment to whom total adrenalectomy for Itsenko--Cushing disease was done. Significant lowering of the substitutional hormonal therapy (steroid preparations) dosage was permitted due to the noted improvement of hypocorticism clinical course and an organism hormonal security indexes. The clinical effect duration is 6-9 months. The methods physiologically substantiated, technically simple, economically advantageous, do not cause the side effects.
Adolescent↗
Oral-contraceptive-induced hypertension after adrenalectomy and hypophysectomy.
The cause of oral-contraceptive-induced hypertension in certain susceptible subjects is obscure. We describe a woman who was receiving replacement doses of fludrocortisone acetate after adrenalectomy and hypophysectomy who developed high blood pressure while ingesting an estrogen-containing oral contraceptive. Renin substrate level was increased, but renin activity was suppressed and unresponsive to tilting. The patient developed a markedly exaggerated natriuresis when infused with saline. Both blood pressure and her responses to infused sodium and tilting normalized after discontinuance of the oral contraceptive medication. In this adrenalectomized patient, the estrogenic component of the pill acting synergistically with a fixed ("nonsuppressible") replacement dose of mineralocorticoid seems to have caused a volume-related hypertension.
Adenoma, Chromophobe↗