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Adrenal Mass

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3481. Cortisol correlates with metabolic disturbances in a population study of type 2 diabetic patients. (Full text)

Cortisol correlates with metabolic disturbances in a population study of type 2 diabetic patients. The prevalence of type 2 diabetes mellitus is increasing rapidly in industrialized countries, and adrenal glucocorticoids may intensify this disease. We sought to assess the relationship between diabetes-associated metabolic disturbances and cortisol concentrations in patients with type 2 diabetes.We investigated 190 type 2 diabetic patients who volunteered from a population study of 12,430 people (...) measured and correlated with cortisol concentrations.None of the cohort had salivary cortisol concentrations that exceeded the normally accepted range. Based on cortisol samples collected just prior to a standard lunch, the cohort was divided into tertiles. Cortisol was positively related to: fasting blood, urinary and postprandial glucose; glycosylated hemoglobin; and systolic and diastolic blood pressures (all P < 0.05). Cortisol concentrations also correlated with the relative abdominal mass (P

2006 European Journal of Endocrinology

3482. ACTH 1-24 inhibits proliferation of adrenocortical tumors in vivo. (Full text)

ACTH 1-24 inhibits proliferation of adrenocortical tumors in vivo. Although several lines of evidence suggest that the overall effects of the ACTH receptor, melanocortin 2 receptor (MC2-R), mediated signal transduction on adrenocortical growth and tumorigenesis are anti-proliferative, activation of MC2-R induces mitogens like jun, fos, and myc and activates the MAPK pathway. In vivo, potential effects of endogenous ACTH on adrenal tumori-genesis can not be separated from effects of other POMC (...) of 12 according to the following schedule: group A, control animals receiving saline injection; group B, animals receiving 5.7 ng/injection of a slow release formula of ACTH 1-24 administered i.p. three times a week (aiming at a low physiologic dose); and group C, animals receiving 57 ng/injection of ACTH 1-24 (high physiological dose).Twenty days of ACTH 1-24 treatment did not significantly affect corticosterone levels, endogenous ACTH levels or adrenal and thymus weight compared with saline

2005 European Journal of Endocrinology

3483. Molecular genetics of adrenocortical tumours, from familial to sporadic diseases. (Full text)

Molecular genetics of adrenocortical tumours, from familial to sporadic diseases. Adrenal masses can be detected in up to 4% of the population, and are mostly of adrenocortical origin. Adrenocortical tumours (ACTs) may be responsible for excess steroid production and, in the case of adrenocortical cancers, for morbidity or mortality due to tumour growth. Our understanding of the pathogenesis of ACTs is more limited than that for other tumours. However, studies of the genetics of ACTs have led (...) . More rarely, mutations in Gs protein (gsp) and the gene for ACTH receptor have been observed in ACTs. The genetics of another group of adrenal diseases that can lead to adrenal nodular hyperplasia -- congenital adrenal hyperplasia (CAH) and glucocorticoid-remediable aldosteronism (GRA) -- have also been studied extensively. This review summarizes recent advances in the genetics of ACTs, highlighting both improvements in our understanding of the pathophysiology and the diagnosis of these tumours.

2005 European Journal of Endocrinology

3484. Shift from Conn's syndrome to Cushing's syndrome in a recurrent adrenocortical carcinoma. (Full text)

Shift from Conn's syndrome to Cushing's syndrome in a recurrent adrenocortical carcinoma. Adrenocortical tumors may originate from the zona glomerulosa, zona fasciculata, or zona reticularis and be associated with syndromes due to overproduction of mineralocorticoids, glucocorticoids, or androgens respectively. We report an unusual case of recurrent adrenocortical carcinoma (ACC), which seems to contradict the paradigm of functional adrenal zonation.A male patient presented with severe primary (...) aldosteronism due to an ACC, which relapsed after adrenalectomy and adjuvant mitotane therapy. After removal of the tumor recurrence and eight cycles of chemotherapy with etoposide, doxorubicin and cisplatin, the patient presented again with ACC masses, but in association with overt Cushing's syndrome and normal aldosterone levels.Extensive pathologic examination showed that this shift in steroid hormone production was paralleled by an attenuation of tumor cell atypia and polymorphism, whereas gene

2005 European Journal of Endocrinology

3485. Adipose tissue 11beta-hydroxysteroid dehydrogenase type 1 expression in obesity and Cushing's syndrome. (Full text)

Adipose tissue 11beta-hydroxysteroid dehydrogenase type 1 expression in obesity and Cushing's syndrome. To evaluate the expression of 11beta-hydrxysteroid dehydrogenase type 1 (11beta-HSD1) in omental adipose tissue of patients with Cushing's syndrome and simple obesity, compared with normal weight controls.We have performed a case-control study and studied omental adipose tissue from a total of 24 subjects (eight obese subjects, ten patients with Cushing's syndrome due to adrenal adenoma (...) , and six normal weight controls). Body mass index, blood pressure, plasma glucose, plasma insulin, plasma cortisol, urinary free cortisol and post dexamethasone plasma cortisol were measured with standard methods. 11beta-HSD1 mRNA and protein expression were evaluated in real-time PCR and western blot analysis respectively.11beta-HSD1 mRNA was 13-fold higher in obese subjects compared with controls (P=0.001). No differences were found between Cushing's patients and controls. Western blot analysis

2006 European Journal of Endocrinology

3486. Reduced 11beta-hydroxysteroid dehydrogenase type 1 activity in obese boys. (Full text)

mass (percentage of body mass), or the homeostasis model assessment of insulin resistance index.In conclusion, our findings strongly suggest that 11beta-HSD1 activity increases with age, and is reduced in obese boys. In addition, obese children have a higher total cortisol metabolites excretion suggesting a stimulated hypothalamus-pituitary-adrenal axis. (...) homeostasis.Clinical and laboratory characteristics, and anthropometric measurements were determined in 15 male and 6 female obese pubertal children (aged 12-18 years, Tanner stages 2-5). In addition, analyses of 24-h excretion rates of glucocorticoids were also performed in 21 age-, sex-, and pubertal stage-matched non-obese children using gas chromatographic-mass spectrometric (GC-MS) analysis.11beta-HSD1 activity (urinary tetrahydrocortisol (THF) + 5alpha-THF/tetrahydrocortisone (THE) ratio) was lower in obese

2007 European Journal of Endocrinology

3487. Primary breast lymphoma in a male patient. (PubMed)

Primary breast lymphoma in a male patient. Primary lymphoma of the male breast is extremely rare. We report a case of a diffuse large B-cell lymphoma in a male patient. A 67-year-old man presented with a palpable mass in the right breast and ipsilateral axillary lymphadenopathy. At operation a 6 x 5 x 4-cm mass was excised, and a frozen section demonstrated malignancy. A modified radical mastectomy was then performed, together with axillary lymph node clearance. Histological examination (...) established the diagnosis of a primary non-Hodgkin's lymphoma of the breast. The patient was referred for chemotherapy and died a year later from systemic disease involving the adrenals. The importance of early diagnosis is emphasized; this should be based on an excisional biopsy or aspiration cytology. As patients with primary breast lymphoma (PBL) have a better prognosis than those with carcinoma of the breast or patients with extranodal lymphomas, a multidisciplinary approach including surgery

2004 Breast

3488. Normotensive pheochromocytoma: institutional experience. (PubMed)

, and one patient had normal values. One patient did not undergo the urinary metanephrine assay. Imaging of the abdomen showed seven adrenal and two extra-adrenal masses (eight had computed tomography scans of the abdomen, and one underwent ultrasonography). After selective alpha-adrenergic blockade (prazosin), surgery was performed. Six patients required infusion of sodium nitroprusside intraoperatively. The final histopathology was pheochromocytoma in all patients. Metanephrine levels were normal (...) during the follow-up. Normotensive pheochromocytomas are a distinct entity, and all adrenal incidentalomas should be investigated for catecholamine hypersecretion. We support the use of preoperative alpha-adrenergic blockade, and these patients should be treated along the same lines as hypertensive pheochromocytoma.

2005 World Journal of Surgery

3489. MJA Practice Essentials--Endocrinology. 9: Pituitary disease in adults. (PubMed)

-onset growth-hormone deficiency results in reduced muscle mass, increased fat mass and diminished quality of life, which are reversed by growth hormone replacement therapy. While trans-sphenoidal surgery remains first-line treatment for acromegaly, drug treatment has an important role in controlling residual growth-hormone excess and, in some circumstances, as first-line treatment. Dopamine-agonist therapy (cabergoline or bromocriptine) is the treatment of choice for micro- and macroprolactinomas (...) . In patients with suggestive clinical features, elevated 24-hour urine free cortisol level is usually sufficient to diagnose endogenous Cushing's syndrome; careful additional investigation is needed to determine whether the cause is Cushing's disease (pituitary adenoma secreting adrenocorticotropic hormone [ACTH]), ectopic ACTH secretion or adrenal disease. Heightened awareness is needed to detect the sometimes subtle symptoms and signs of pituitary disease

2004 Medical Journal of Australia

3490. Potential pitfalls in the diagnosis of phaeochromocytoma. (PubMed)

Potential pitfalls in the diagnosis of phaeochromocytoma. Six patients being evaluated for phaeochromocytoma had misleading investigative findings: all initially had raised urinary catecholamine levels, and five had adrenal masses on imaging studies. Adrenalectomy in these five patients revealed only one pathologically confirmed phaeochromocytoma. Tricyclic antidepressant use produced misleading elevations in urinary catecholamine levels in three patients. 24-hour urine studies should

2005 Medical Journal of Australia

3491. Evaluation of the cardiovascular risk in patients with subclinical Cushing syndrome before and after surgery. (PubMed)

Evaluation of the cardiovascular risk in patients with subclinical Cushing syndrome before and after surgery. The widespread use of ultrasound, computerized tomography, and magnetic resonance imaging has led to an increase in the number of incidental adrenal masses identified. Asymptomatic incidentally discovered adrenal masses may indicate that subclinical Cushing syndrome (SCS) is not uncommon. We aimed to evaluate the cardiovascular risk of patients with SCS before and after surgery.An (...) autonomous cortisol-producing tumor was detected in 11 of 94 patients with adrenal incidentaloma between 1995 and 2005. Twenty-eight patients suffering from classical Cushing syndrome (CS) associated with unilateral adrenocortical adenoma, who were treated at our department in the same period, served as a control group. Cardiovascular risk factors such as blood pressure, body mass index, and lipid profile were evaluated before and 1 year after surgery.The frequency of hypertension (61% versus 63

2006 World Journal of Surgery

3492. Retroperitoneal hemangioma of infancy. (PubMed)

Retroperitoneal hemangioma of infancy. A premature infant presented with an incidental finding of a mass in the retroperitoneum adjacent to the adrenal gland seen on a renal ultrasound study. A clinical diagnosis of neuroblastoma was made based on imaging and laboratory studies; however, upon resection, histological examination revealed a cellular capillary hemangioma of infancy. Hemangioma should be considered in the differential diagnosis of asymptomatic retroperitoneal mass lesions

2006 Journal of Pediatric Surgery

3493. High basal serum allopregnanolone levels in overweight girls. (Full text)

High basal serum allopregnanolone levels in overweight girls. Several studies demonstrated that obese subjects have a hyperactive hypothalamic-pituitary-adrenal axis and that sex steroid hormones have been closely related to the regulation of adiposity, either through direct or indirect physiological mechanisms. Allopregnanolone (3alpha-hydroxy-5alpha-pregn-20-one; AP) is a circulating neuroactive steroid hormone involved in the modulation of behavioral functions, stress and neuroendocrine axis (...) . The aim of our study was to evaluate basal serum AP levels in obese children.We studied 27 normal weight (NW) and 23 overweight (OW) girls. Gonadotropins and steroid hormones were assessed in all patients.Basal AP concentrations in OW girls were significantly higher than in NW controls (P=0.013). There was no difference found between the other gonadal and adrenal hormones. Considering the pubertal stage, we demonstrated that obese pubertal girls presented higher AP concentrations than prepubertal

2007 International Journal of Obesity

3494. Fetus in fetu--diagnostic criteria and differential diagnosis--a case report and literature review. (PubMed)

. Pathologic examination showed an irregular fetiforme mass, weighing 8 g, attached to an amniotic sac by a rudimentary umbilical cord with 2 rudimentary limbs, vertebral bodies, encephalus, coroidal plexus, stomach, duodenum, bowel, adrenal glands, upper and lower respiratory tissue, spleen, lymphoid tissue, single cavity heart, and kidney. Molecular analysis using an informative genetic marker, for uniparental isodisomy of chromosomes 14 and 15 showed no genetic difference between the host infant (...) Fetus in fetu--diagnostic criteria and differential diagnosis--a case report and literature review. Fetus-in-fetu (FIF) is a rare congenital condition in which a vertebrate fetus is incorporated within its twin. The authors report the case of a newborn boy with prenatal ultrasonographic diagnosis of intraabdominal mass, provoking compression of the left kidney. Plain abdominal radiography, ultrasonography, and computer tomography showed a cystic mass containing multiple calcifications

2004 Journal of Pediatric Surgery

3495. Experience with laparoscopic adrenalectomy in children. (PubMed)

and girls. Case selection was based mainly on the size of the lesion and its localized nature as seen on the imaging studies. The transperitoneal approach was used in all cases.Eleven laparoscopic adrenalectomies were performed in 10 children (1 was bilateral adrenalectomy). Presenting features were virilization (n = 3), Cushing's syndrome (n = 1), antenatally detected adrenal cyst (n = 1), hypertension (n = 1), hepatomegaly (n = 1), loin pain with hematuria (n = 1) and an incidental adrenal mass (n = 1 (...) ). One was a child with stage IV adrenal neuroblastoma postchemotherapy for resection of the residual tumor. On imaging studies, the tumors were between 2.8 and 7 cm in their largest dimension. Operating time ranged from 118 to 180 minutes in the unilateral resections, whereas the bilateral laparoscopic adrenalectomy required 330 minutes. Two had to be converted to open procedures. Postoperative hospital stay was between 2 and 15 days. Pathologic diagnoses were as follows: adrenal cortical adenoma (n

2004 Journal of Pediatric Surgery

3496. Long-term follow-up status of patients with neuroblastoma after undergoing either aggressive surgery or chemotherapy--a single institutional study. (PubMed)

complications, the authors retrospectively investigated the long-term morbidity of patients who had reached adulthood.Sixteen patients with neuroblastoma currently 18 years of age or older were incorporated into the study. All were non-mass screening cases, and 13 of the patients had undergone aggressive surgery, whereas the remaining 3 cases had received aggressive chemotherapy.In the 13 patients who had undergone aggressive surgical treatment, a unilateral atrophy of the kidney was noted in 2 cases (...) of adrenal and retroperitoneal neuroblastomas, respectively. Dry ejaculation was noted in one case of a giant presacral neuroblastoma. A maldevelopment of the unilateral lower extremity was also noted in another case with a presacral tumor, which had been resected by abdominal and sacral approaches. In the 3 patients who had undergone aggressive chemotherapy, severe hearing loss occurred in 2 cases. However, social adaptation was well preserved in all 16 cases.Treatment-specific complications were found

2004 Journal of Pediatric Surgery

3497. Laparoscopic resection of a lower posterior mediastinal tumor: feasibility of using a transdiaphragmatic approach. (PubMed)

Laparoscopic resection of a lower posterior mediastinal tumor: feasibility of using a transdiaphragmatic approach. Either video-assisted thoracoscopic surgery (VATS) or a thoracotomy is usually performed for a resection of posterior mediastinal tumors. We used a laparoscopic approach to resect a lower posterior mediastinal tumor mimicking a right adrenal tumor that had been identified by a preoperative computed tomography (CT) scan, because this approach is less invasive than VATS (...) or a thoracotomy, regarding the potential to cause damage to the respiratory organs.A preoperative CT scan showed a paraspinal mass measuring 5.5 cm in diameter at the level of the 11th thoracic vertebra and gallbladder stones. A laparoscopic transdiaphragmatic excision of this lower posterior mediastinal tumor was attempted and accomplished safely. First, we used the usual laparoscopic transperitoneal approach. Thereafter, we accessed the lower posterior mediastinum by splitting the crural fibers

2007 Urology

3498. Two cases of ganglioneuroma. (PubMed)

Two cases of ganglioneuroma. Although ganglioneuroma is a relatively rare tumor of the sympathetic nervous system, detection of this tumor has increased as imaging techniques such as computed tomography and ultrasonography have become prevalent. We report 2 cases of ganglioneuroma found incidentally. Both tumors were 40 to 60 mm in size. Magnetic resonance imaging in 1 patient showed a homogeneous mass with a low signal intensity on T1-weighted imaging and a heterogeneous mass with a high (...) signal intensity on T2-weighted imaging, both characteristic of neurogenic tumor. Therefore, we performed laparoscopic adrenalectomy. Histopathologic examination demonstrated that one tumor was located on the adrenal medulla, with the other in the extra-adrenal retroperitoneal space.

2006 Urology

3499. Open versus laparoscopic simultaneous bilateral adrenalectomy. (PubMed)

Open versus laparoscopic simultaneous bilateral adrenalectomy. To compare our experience with synchronous bilateral adrenalectomy using laparoscopic and open techniques. Laparoscopic adrenalectomy has become the reference standard for management of benign unilateral adrenal pathologic findings.This was a nonrandomized retrospective chart review of 12 known patients who underwent simultaneous bilateral adrenalectomy, comparing five laparoscopic and seven open procedures. One urologic surgeon (...) performed all laparoscopic cases, and one general surgeon performed all open procedures.All patients had Cushing's disease or syndrome. The average patient age was 47.4 years (range 24 to 71) and 42.4 years (range 19 to 70), with an average body mass index of 38.2 kg/m2 and 36.0 kg/m2 for the laparoscopic and open groups, respectively. The operating time was on average 60 minutes longer for the laparoscopic group. No open conversions were necessary. The median blood loss (100 versus 500 mL, P < 0.01

2006 Urology

3500. Partial adrenalectomy: the National Cancer Institute experience. (PubMed)

, 33 patients with hereditary pheochromocytoma presented with adrenal masses. Partial adrenalectomy (open or laparoscopic) was performed if normal adrenocortical tissue was evident on preoperative imaging or intraoperative ultrasonography. Various operative parameters, as well as postoperative function of the residual adrenal remnants, were determined.Of the 33 patients, 8 underwent open partial adrenalectomy and 25 laparoscopic partial adrenalectomy during a 10-year period. Ten patients underwent (...) simultaneous, bilateral partial adrenalectomy and 8 underwent surgery on a solitary adrenal gland, 4 of whom received postoperative steroid replacement (stopped in 3 after 1 to 3 months). All other patients had normal catecholamine levels and remained tumor free by imaging at a mean follow-up of 36 months (range 3 to 102).Partial adrenalectomy can preserve adrenal function in patients with adrenal masses. The laparoscopic approach is technically safe and associated with less morbidity without compromising

2005 Urology

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