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At least 19 recordsLinked to original sources
PubMed2005

Histological grading of adrenal and extra-adrenal pheochromocytomas and relationship to prognosis: a clinicopathological analysis of 116 adrenal pheochromocytomas and 30 extra-adrenal sympathetic paragangliomas including 38 malignant tumors.

Pheochromocytomas and extra-adrenal sympathetic paragangliomas show varied histological patterns, and it is difficult to diagnose malignancy or predict the clinical course using current histological criteria. In the present study, we reviewed 146 sympathetic paragangliomas including 116 adrenal (102 unilateral, 14 bilateral) and 30 extra-adrenal tumors including 38 metastatic tumors. We developed a scoring scale according to the following six factors: histological pattern, cellularity, coagulation necrosis, vascular/capsular invasion, Ki-67 immunoreactivity, and types of catecholamine produced. The tumors were classified as well (WD), moderately (MD), and poorly differentiated (PD) types according to their scores. The frequency of these tumor types were 113 WD (77%), 27 MD (19%), and 6 PD (4%). Metastasis was observed in 15 of 113 WD (13%), 17 of 27 MD (63%), and all 6 PD (100%). Five-year survivals of patients with metastases were 92% with WD, 69% with MD, 0% with PD. Respective 10-yr survivals were 83%, 38%, and 0%. Differences between groups were statistically significant. The data show that using this grading scoring system for sympathetic paragangliomas correlates with both metastatic potential and patient survival.

Adrenal Gland Neoplasms↗
PubMed1996

Serum levels of dehydroepiandrosterone sulfate in patients with asymptomatic cortisol producing adrenal adenoma: comparison with adrenal Cushing's syndrome and non-functional adrenal tumor.

The reported number of adrenal incidentalomas has been increasing because of wider application of imaging techniques. Patients with asymptomatic cortisol producing adrenal adenoma (ASCA) which secretes cortisol without clinical evidence of Cushing's syndrome has been more frequently observed than previously assumed, and they have a risk of adrenal insufficiency after adrenalectomy. Therefore patients with incidentalomas should be screened for cortisol overproduction. The aim of this study is to discover an easy screening test to uncover ASCA. We investigated the hormone profiles of 4 patients with ASCA in comparison with 11 patients with non-functional adrenal tumor and 10 patients with adrenal Cushing's syndrome. We also investigated the expression of dehydroepiandrosterone sulfotransferase (DHEA-ST) in surgically removed attached non-neoplastic adrenal tissues by immunostaining, which was considered to represent the degree of suppression of the hypothalamo-pituitary-adrenal axis. Serum dehydroepiandrosterone sulfate (DHEA-S) levels of all the patients with ASCA and adrenal Cushing's syndrome were lower than those of healthy subjects of corresponding age, but they were within the normal range in the patients with non-functional adrenal tumors. The serum DHEA-S level reflects the degree of suppression of the normal adrenal gland by cortisol hypersecretion from adrenal tumors. But the serum level of DHEA-S decreases with age, and because the normal range of serum DHEA-S is low in elderly subjects, we should be careful to evaluate the level of DHEA-S in elderly patients with adrenal Cushing's syndrome or ASCA. The immunohistochemical study showed DHEA-ST expression was noticeably suppressed in the adjacent adrenal cortex in ASCA and adrenal Cushing's syndrome. The decreased expression of DHEA-ST may reflect autonomous neoplastic cortisol secretion and subsequent ACTH suppression in ASCA and adrenal Cushing's syndrome. A single measurement of plasma ACTH or measurement of ACTH response to corticotropin-releasing hormone was not enough to screen for ASCA because of the wide variation among the cases. Dexamethasone suppression test is essential in identifying ASCA and also a single determination of serum DHEA-S is easy and may be useful for the screening of ASCA in adrenal incidentalomas in young and middle aged subjects, and is especially useful for outpatients.

Adenoma↗
PubMed1985

[Image diagnosis of adrenal disorders. III. "Nonfunctioning" adrenal adenoma, weak mineralocorticoids producing adrenal carcinoma, congenital adrenogenital syndrome due to 21-hydroxylase deficiency--simple virilizing form, and pheochromocytoma].

The image diagnoses of a case of so-called "nonfunctioning" adrenal adenoma, weak mineralocorticoids producing adrenal carcinoma, congenital adrenogenital syndrome due to 21-hydroxylase deficiency--simple virilizing form--, and 5 cases of pheochromocytoma were studied. In a patient with so-called "nonfunctioning" adrenal adenoma (2.3 X 3.0 X 3.3 cm), in which steroids biosynthesis was confirmed, computed tomography (CT) delineated the tumor shadow with extremely low density, and ultrasonography (US) demonstrated the round tumor echo with homogenous and low echogenicity at the superior region of the right renal pole. Adrenal scintigraphy also showed the tumor image. A weak mineralocorticoids-producing left adrenal carcinoma (3.5 X 3.5 X 3.0 cm) was shown as a heterogenous round tumor at the left lateral portion of the vertebra by CT. On adrenal scintigraphy under dexamethasone pretreatment, there was good uptake in the tumor and disappearance of the contralateral. Both bilateral adrenal images on CT in a patient with congenital adrenogenital syndrome were linear-shaped and markedly enlarged. The enlarged right adrenal was clearly demonstrated by US with an electronic sector scanner but not with an electronic linear scanner, although the left one was hardly shown by either US instruments. Three of 4 patients with pheochromocytomas examined by US were correctly detected, while in the remaining one the tumor image was judged to be a retroperitoneal tumor. CT also correctly demonstrated the former 3 pheochromocytomas, but misjudged the latter one as a pancreatic cancer. Good uptake of Adosterol by bilateral adrenals was shown in a case of extra-adrenal pheochromocytoma. Three of 4 cases of adrenal pheochromocytoma showed the isotope uptake of the contralateral normal adrenal alone. In another case of right adrenal pheochromocytoma, isotope accumulation in the colon obscured whether the isotope uptake in the right adrenal was shown or not.

Adenoma↗
PubMed1998

Intra-adrenal factors are not involved in the differential control of cortisol and adrenal androgens in human adrenals.

The differential control of adrenal androgens and cortisol may be due to intra-adrenal factors, which may be age- or sex-related, or due to extra-adrenal factors, such as circulating hormones. The purpose of this study was to identify any intrinsic differences that may exist in steroidogenic production occurring within adrenals obtained from males and females, and any maturational differences that may evolve with age. Using human adrenals from 48 transplant donors (32 males, 16 females; ages 5-60 years), the influences of age and sex on basal production of and ACTH-stimulated cortisol, androstenedione and dehydroepiandrosterone (DHEA) were examined in freshly prepared adrenal cell suspensions. Basal and ACTH-stimulated cortisol, androstenedione and DHEA production were similar in adrenals from males and females and did not correlate significantly with age when the whole group was examined. When steroidogenesis in male and female adrenals was examined separately against age, a significant correlation was observed only for basal and ACTH-stimulated androstenedione in adrenals from males in the younger age group, 5-30 years (basal: r=0.84, P=0.0001; ACTH-stimulated: r=0.52, P=0.007). Examination of the relationships between the steroids disclosed that the basal and ACTH-stimulated cortisol/androgen ratios did not correlate significantly with age, but the androstenedione/DHEA ratio showed a significant direct relationship with age in males only (basal: r=0.53, P=0.006; ACTH-stimulated: r=0.5, P=0.01). These data suggest that the influences of sex and age are minor in the modulation of adrenal steroidogenesis and support the concept that extra-adrenal factors dominate in the differential modulation of adrenal androgens and cortisol. The relationship between the androstenedione/ DHEA ratio and increasing age in men is consistent with the recently reported stimulatory effect of testosterone on adrenal steroidogenesis by induction of the conversion of DHEA to androstenedione.

Adolescent↗
PubMed1987

Adrenal cortical adenoma and adrenal medullary hyperplasia of the right adrenal gland--a case report.

The normal adrenal gland contains two types of tissue, the adrenal cortical tissue and the adrenal medullary tissue. The cortex is divided into three portions: the outermost "zona glomerulosa," the central "zona fasciculata," and the innermost "zona recticularis." The adrenal medulla is a developmentally separate organ, derived from neuroectoderm, and is the site of epinephrine and norepinephrine production. Adrenal cortical adenoma is commonly the result of a basophilic tumor of the anterior pituitary that secretes excessive amounts of ACTH. Adrenal medullary hyperplasia (or pheochromocytoma) are clinically hazardous tumors because of their excessive secretion of catecholamines. Combined adrenal cortical adenoma and adrenal medullary hyperplasia of the right adrenal gland has never been described previously.

Adenoma↗
PubMed1976

The dexamethasone-modified adrenal scintiscan in hyporeninemic aldosteronism (tumor versus hyperplasia). A comparison with adrenal venography and adrenal venous aldosterone.

The dexamethasone-modified adrenal scintiscan, a noninvasive procedure, is described for the preoperative distinction between primary aldosteronism (aldosterone-producing ademona) and idiopathic aldosteronism (bilateral hyperplasia) and for the preoperative localization of aldostersone-producing adenomas. This procedure has been carried out on 17 subsequently proved cases of primary aldosteronism and nine cases (four unexplored) of idiopathic aldosteronism. In the tumor cases, it indicated correctly the side of the tumor in 88 per cent. It was correct in predicting the existence of bilateral hyperplasia in all of the five cases explored. It produced the same response in four more cases believed to have bilateral hyperplasia, in which surgical exploration has not been carried out. Many of the same patients had, in addition, standard adrenal scintiscans (SS), adrenal venography, and determinations of aldosterone in adrenal venous blood. These results are compared with those of the dexamethasone scintiscan (DS). In tumor localization, the 88 per cent figure for the DS was only moderately better than that of the other three (71 per cent, SS; 80 per cent, venography; 80 per cent, adrenal venous aldosterone levels). However, in predicting bilateral hyperplasia, the DS was 100 per cent correct, as were the levels of aldosterone in adrenal venous blood. The SS and adrenal venography failed in bilateral hyperplasia and gave many false-positive results indicating tumor. The DS, a relatively simple outpatient procedure, appears to be at least as effective, both in lateralizing tumors and distinguishing between tumor and bilateral hyperplasia, as the more difficult, expensive, and sometimes hazardous invasive procedure of bilateral adrenal vein catheterization.

Adolescent↗
PubMed1976

[Migration inhibition of mononuclear cells in idiopathic adrenal insufficiency. Inhibition of migration of mononuclear cells with adrenal microsomes and blocking of the reaction by adrenal antibodies (author's transl)].

In 19 patients with idiopathic adrenal insufficiency and in 19 controls, cellular (as measured by the migration inhibition test) and humoral (by means of immunoflourescence) immune reaction to adrenal antigens were investigated. Significant inhibition of migration was observed in 12 patients with adrenal microsomes; migration of mononuclear cells was however within normal range in 18 out of 19 controls. Adrenal antibodies could be detected in 11 (53%) of the patients. In a further series of investigations adrenal microsomes have been preincubated with specific antibody and used in migration inhibition tests. The migration indices observed with microsomes were compared to those obtained with microsomes preincubated with adrenal antibody. Migration inhibition with microsomes could be blocked by antibody in almost all antibody-positive patients. No uniform trend on the migration of mononuclear cells was found in the antibody-negative patients. A blocking of the cellular immune reaction by specific antibody seems likely. Possible mechanisms which could lead to such phenomena as well as the biologic significance of adrenal antibodies are discussed.

Adrenal Glands↗
PubMed1975

[131I-cholesterol scanning of the adrenals: results in various adrenal diseases, especially unilateral adrenal turmours (author's transl)].

133I-cholesterol scanning of five patients with primary hyperaldosteronism due to adrenocortical adenoma, gave correct lateralization and localization in three, while in two cases lateralization was not definitively determined. In two patients with phaeochromocytoma unilateral localization was clear-cut in the scan. In two patients with hormone-producing adrenal carcinoma the adrenals were localized poorly or not at all on both sides, because of the size of the tumours and suppression of the healthy contralateral adrenal by the autonomous hormone production. In case of retroperitoneal tumour with destruction of the adrenal the scan demonstrated a hyperplastic but healthy adrenal on the other side. Because 133I-cholesterol scanning exposes the steroid-producing gonads to high radioactivity, the method should only be used for diagnosing which side a unilateral adrenal tumour is on. It should not be used to complement a diagnosis of bilateral adrenal disease achieved by other means.

Adenoma↗
PubMed1998

Circulating neuropeptide Y (NPY) and catecholamines in rat under resting and stress conditions. Arguments for extra-adrenal origin of NPY, adrenal and extra-adrenal sources of catecholamines.

Neuropeptide Y (NPY) is found in cell bodies of neurons in the brain and co-localized with noradrenaline (NA) in sympathetic nerves as well as with NA and adrenaline (A) in the adrenal chromaffin cells. The purpose of the present work is to determine whether NPY and catecholamines found in the plasma of the rat under resting and stress conditions (ether inhalation, restraint) arise from the adrenals or from extra-adrenal sites. We used adrenalectomized (adx) rats and sham-adx ones. Adrenalectomy increased plasma adrenocorticotrophic hormone (ACTH) levels but decreased drastically circulating corticosterone (B) and A (-97%). However, resting NA was slightly but not significantly decreased and NPY not affected. Ether inhalation (3 min) increased plasma levels of ACTH, B, NA and A in sham-adx rats, ACTH, NA and, weakly, A in adx ones. Restraint (30 min) increased B, NA and A in sham-adx rats, NA and, poorly, A, in adx ones. In contrast, plasma levels of NPY were not significantly affected by these stress conditions. The present data suggest that NA found in rat plasma at rest and during ether or restraint stress could arise from both adrenal medulla and noradrenergic nerve endings while A arises mainly from the adrenergic chromaffin cells of the adrenals. In contrast, NPY found in the circulation, at rest and under stress conditions, is not derived from the adrenals but emanates mainly from an extra-adrenal source.

Adrenal Glands↗
PubMedDate not supplied

Acute adrenal crisis together with unilateral adrenal mass caused by isolated tuberculosis of adrenal gland.

OBJECTIVE: To describe a patient admitted with acute adrenocortical failure and a right adrenal mass without evidence of tuberculosis, who was ultimately diagnosed with isolated adrenal tuberculosis after postoperative histopathologic evaluation. METHODS: A case report is presented, with clinical, laboratory, and imaging findings. We also discuss potential factors that may complicate the diagnosis of tuberculosis. RESULTS: A 61-year-old man was admitted with symptoms and signs of acute adrenal crisis. The patient had an erythrocyte sedimentation rate of 30 mm in 1 hour, a negative tuberculin skin test, a 6-cm right adrenal mass, and left adrenal nodularity in conjunction with normal findings on a computed tomographic scan of the chest. He recovered dramatically after intravenous corticosteroid treatment. Investigation, including acid-fast staining and cultures for tuberculosis of all available specimens, gastroduodenoscopy and rectosigmoidoscopy, intestinal x-ray imaging, and autoantibody studies, did not disclose the diagnosis. Subsequently, bilateral adrenalectomy revealed isolated tuberculosis of the adrenal glands on histopathologic evaluation. Quadruple antituberculous therapy was initiated, and continued follow-up of the patient is scheduled. CONCLUSION: Our case indicates that acute or chronic adrenocortical failure can occur as a result of tuberculosis of the adrenal gland, despite the absence of clinical and laboratory evidence of tuberculosis.

Acute Disease↗
PubMed1994

Gonadal and adrenal catheterization during adrenal suppression and gonadal stimulation in a patient with bilateral testicular tumors and congenital adrenal hyperplasia.

We report the case of a patient with bilateral testicular tumors and congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Catheterization of the left testicular and adrenal veins was performed. The presence of 11 beta-hydroxylated steroids in the spermatic veins confirmed the presence of testicular tumor secondary to adrenal rest cells. After adrenal suppression by dexamethasone combined with gonadal stimulation with hCG, a dramatic decrease in androgens and adrenal steroids was observed in the peripheral blood. Compared to the periphery, 21-deoxycortisol and 11 beta-hydroxy-delta 4-androstenedione levels remained higher than that of 21-deoxycorticosterone in the gonadal vein, but not in the adrenal vein, which seems to indicate that the nature of this ectopic tissue is unusual and that its sensitivity to dexamethasone depends on the adrenocortical zones. No rise in estradiol or testosterone was obtained after hCG stimulation, suggesting that all of the testicular tissue was inactive or destroyed. This finding was confirmed by histological examination.

Adrenal Glands↗
PubMed2001

Differential expression of a stress-modulating gene, BRE, in the adrenal gland, in adrenal neoplasia, and in abnormal adrenal tissues.

Genes that modulate the action of hormones and cytokines play a critical role in stress response, survival, and in growth and differentiation of cells. Many of these biological response modifiers are responsible for various pathological conditions, including inflammation, infection, cachexia, aging, genetic disorders, and cancer. We have previously identified a new gene, BRE, that is responsive to DNA damage and retinoic acid. Using multiple-tissue dot-blotting and Northern blotting, BRE was recently found to be strongly expressed in adrenal cortex and medulla, in testis, and in pancreas, whereas low expression was found in the thyroid, thymus, small intestine and stomach. In situ hybridization and immunohistochemical staining indicated that BRE was strongly expressed in the zona glomerulosa of the adrenal cortex, which synthesizes and secretes the mineralocorticoid hormones. It is also highly expressed in the glial and neuronal cells of the brain and in the round spermatids, Sertoli cells, and Leydig cells of the testis, all of which are associated with steroid hormones and/or TNF synthesis. However, BRE expression was downregulated in human adrenal adenoma and pheochromocytoma, whereas its expression was enhanced in abnormal adrenal tissues of rats chronically treated with nitrate or nitrite. These data, taken together, indicate that the expression of BRE is apparently associated with steroids and/or TNF production and the regulation of endocrine functions. BRE may play an important role in the endocrine and immune system, such as the cytokine-endocrine interaction of the adrenal gland.

Adrenal Gland Neoplasms↗
PubMed1982

An evaluation of adrenal mass and adrenal cholesterol as measures of adrenal activity.

1. The effects of twice daily injections of corticotrophin (1 IU/kg body weight) or restriction of food intake to 75% of normal on body mass, adrenal mass and adrenal cholesterol were determined on chicks from 1 to 21 d of age. 2. Only the birds subjected to restricted feeding showed a reduced growth rate. 3. There was no adrenal hypertrophy in birds receiving corticotrophin but in the restricted group there was transient hypertrophy at 2 weeks. 4. Depletion of adrenal cholesterol was noted only in the birds receiving corticotrophin. 5. It is concluded that neither depletion of cholesterol nor hypertrophy is an inevitable consequence of enhanced adrenal cortical activity.

Adrenal Cortex↗
PubMed1998

Adrenal incidentalomas: adrenal hemangioma in a patient with congenital adrenal hyperplasia.

We describe a case of an adrenal incidentalomas in the setting of congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency. The adrenal mass was shown to be a cavernous hemangioma. Such neoplasms are rare but have the risk of retroperitoneal hemorrhage and may be difficult to differentiate from malignant adrenal tumors. The main consideration brought up by this case was that the simultaneous occurrence of an endocrinologically active disease such as CAH in association with a likely incidentalomas may lead to surgical intervention, due to the impossibility of being certain of its nonsecretory nature. Laparoscopic adrenalectomy allowed safe resection with no morbidity and a short hospitalization.

Adrenal Gland Neoplasms↗
PubMed1990

The innervation of the adrenal gland. IV. Innervation of the rat adrenal medulla from birth to old age. A descriptive and quantitative morphometric and biochemical study of the innervation of chromaffin cells and adrenal medullary neurons in Wistar rats.

The innervation of the adrenal medulla has been investigated in normal Wistar rats from birth to old age and ultrastructural findings compared with biochemical markers of the cholinergic innervation of the adrenal gland and catecholamine storage. Morphological evidence of the immaturity of the innervation during the first postnatal week is provided and using quantitative morphometry the innervation of chromaffin cells is shown to reach a mean total of 5.4 synapses per chromaffin cell during the period 26 days to 12 weeks of age. The variation in contents of synaptic profiles is discussed in the light of recent work that demonstrates a major sensory as well as visceral efferent innervation of the gland. Adrenal medullary neurons usually occur in closely packed groups, intimately associated with Schwann cells. Axodendritic and axosomatic synapses on these neurons are described and the likely origin of axonal processes innervating the neurons discussed. In old age the density of innervation remains the same as in young adult animals even though the medulla shows evidence of hyperplasia and hypertrophy of individual chromaffin cells.

Adrenal Glands↗
PubMed1995

Regulatory patterns of plasma pituitary-adrenal and pituitary-thyroid hormone secretions: indication for adrenal factor inhibiting adrenal response to ACTH.

Although organization and hormonal regulation of the hypothalamic-pituitary-adrenocortical (HPA) and the hypothalamic-pituitary-thyroid (HPT) axes share a remarkable degree of similarities, distinctive patterns of their plasma hormone secretions are observed. We measured plasma levels of ACTH-cortisol (PA) and hTSH-T3 (PT) pairs of hormones in 24-hour sequential blood specimens sampled at 30-minute intervals from 3 patients with suspected adrenal disorders and 4 normal volunteers and found the same percentage of discordant secretions of the PA and PT hormones but significantly greater coefficients of variations of the PA values than the PT values (p < 0.002). This confirms that plasma PT hormones are more tightly self-regulated between themselves than plasma PA hormones. Moreover, cluster analysis of the 24-hour plasma hormonal fluctuations revealed one or more ACTH-cortisol hyposecretory clusters only in subjects with a normal status of adrenal function. There was no similar hTSH-T3 hyposecretory cluster detected in any one of the 7 subjects. Based on these results, we postulate that there is some adrenal factor normally exerting a subtle antagonistic action against ACTH and causes the incidence of such ACTH-cortisol hyposecretory cluster.

Adrenocorticotropic Hormone↗