How to Trip Rapid Review

Step 1: Select articles relevant to your search (remember the system is only optimised for single intervention studies)

Step 2: press

Step 3: review the result, and maybe amend the or if you know better! If we're unsure of the overall sentiment of the trial we will display the conclusion under the article title. We then require you to tell us what the correct sentiment is.

3,818 results for

Adrenal Mass

by
...
Latest & greatest
Alerts

Export results

Use check boxes to select individual results below

SmartSearch available

Trip's SmartSearch engine has discovered connected searches & results. Click to show

3521. Multiple Endocrine Neoplasia Type 2 (MEN 2)

. Medullary cell carcinoma of the thyroid See also separate article. In MEN2 the initial thyroid lesion is C-cell hyperplasia, which has been found as early as the age of 3 years in MEN2A and may be present at birth in MEN2B. Over the subsequent 5 to 10 years microscopic MTC develops and finally gross tumours become apparent. MTC typically presents as a neck mass or neck pain at about age 15 to 20 years. However, more than 50% of such patients already have cervical lymph node metastases. MTC may present (...) . Phaeochromocytoma [ , ] See also separate article. Phaeochromocytoma occurs in 50% of MEN2. Phaeochromocytomas in patients with MEN2 are usually found in the adrenals after presentation of MTC. About 70% are bilateral, almost all are benign and they are rarely extra-adrenal. They produce excessive adrenaline (epinephrine) secretion leading to tachycardia, palpitations, hypertension and headache. Investigations include plasma concentrations of free metanephrines (or free metanephrines in urine) and imaging

2008 Mentor

3522. Mouth and Tongue Cancer

. Alveolus. Hard palate. Anterior two thirds of the tongue. Floor of the mouth. Mucosal surface of the lip. Oral mucosal melanomas may occur, particularly affecting the palate, alveolar gingivae and lips. Virtually any malignancy can metastasise to the oral cavity but carcinomas of the breast, lung, kidney and adrenal gland are the most common. Early detection and treatment are critical, as they increase survival chances considerably, allow for simpler treatment and result in a better quality of life (...) differentiated. Because of the difficulties with direct visualisation, they may extend into the oral tongue or have clinical lymph metastases before the diagnosis is established. Tonsillar cancer More than 70% of tonsillar cancers are SCC. Most of the others are lymphomas. Metastases to the palatine tonsils are rare but there have been reports of secondaries from breast, lung, renal, pancreatic and colorectal malignancies. Patients with tonsillar carcinomas may present with a neck mass, usually

2008 Mentor

3523. Chronic Diarrhoea in Adults

. Diarrhoea persisting for more than six weeks, in a person over 60 years of age. Family history of bowel or ovarian cancer. Abdominal mass. Rectal mass. Anaemia. Raised inflammatory markers (may indicate inflammatory bowel disease). Look for other features suggesting an underlying cause (eg, recent travel abroad, laxative and other possible drug causes), features of systemic disease (eg, thyrotoxicosis, diabetes, adrenal insufficiency, systemic sclerosis), and features of pancreatic disease (eg (...) towards looser stools and/or increased stool frequency persisting for six weeks or more. Presenting with a right lower abdominal mass consistent with involvement of the large bowel. Presenting with a palpable rectal mass (intraluminal and not pelvic). 60 years or older, with a change in bowel habit to looser stools and/or more frequent stools persisting for six weeks or more with or without rectal bleeding. Men of any age with unexplained iron-deficiency anaemia and a haemoglobin level of 11 g/100 mL

2008 Mentor

3524. Renal Tumours

long-term renal dialysis, tuberous sclerosis, renal transplant recipients and acquired renal cystic disease. Presentation [ ] The use of ultrasound and CT scans has increased the detection of asymptomatic RCC. More than 50% of adult renal tumours are detected when using ultrasound to investigate nonspecific features. The classic triad of haematuria, loin pain and loin mass is not often seen now. Other presentations include fatigue, weight loss, macroscopic haematuria, palpable mass, varicocele (...) , bilateral ankle oedema, pyrexia of unknown origin and hypertension. There is often no abnormality on examination. 25-30% of patients present with symptoms of metastatic disease - eg, haemoptysis, bone pain or pathological fracture. Paraneoplastic symptoms (eg, neuromyopathy, anaemia, polycythaemia, amyloidosis, elevated ESR, hypercalcaemia and abnormal LFTs) are found in approximately 30% of patients. [ ] Spread Spread is into adjacent structures of the adrenal glands, liver, spleen, colon or pancreas

2008 Mentor

3525. Renal Cell Carcinoma

mass, varicocele, bilateral ankle oedema, pyrexia of unknown origin and hypertension. There is often no abnormality on examination. 25-30% of patients present with symptoms of metastatic disease - eg, haemoptysis, bone pain or pathological fracture. Paraneoplastic symptoms (eg, neuromyopathy, anaemia, polycythaemia, amyloidosis, elevated ESR, hypercalcaemia and abnormal LFTs) are found in approximately 30% of patients. [ ] Spread Spread is into adjacent structures of the adrenal glands, liver (...) risk factors include long-term renal dialysis, tuberous sclerosis, renal transplant recipients and acquired renal cystic disease. Presentation [ ] The use of ultrasound and CT scans has increased the detection of asymptomatic RCC. More than 50% of adult renal tumours are detected when using ultrasound to investigate nonspecific features. The classic triad of haematuria, loin pain and loin mass is not often seen now. Other presentations include fatigue, weight loss, macroscopic haematuria, palpable

2008 Mentor

3526. Puberty - Normal and Abnormal

unilateral, is the first obvious sign of puberty. Breast buds may initially be unilateral. Gradually the breast diameter increases and the areola darkens and becomes more prominent. In the UK, breast buds will have appeared in 50% of girls by the age of 11.3, with near-full development in 50% of girls by the age of 13.3. [ ] Pubic and axillary hair growth in girls is a sign of adrenal androgen secretion. It starts at about the time of apocrine gland sweat production and the common complaint of axillary (...) . Spermatozoa become present in early morning urine samples from a mean age of 13.4 (spermarche). Progressive signs of androgen excess without an increase in testicular volume should raise concern about precocious pseudopuberty (androgenic effect from another source such as congenital adrenal hyperplasia or testicular tumour). Penile and scrotal enlargement occur typically about a year after testicular enlargement is noticed. Signs of change in penis (growth), scrotum (reddening and thinning) and pubic hair

2008 Mentor

3527. Benign Intracranial Hypertension

evidence, UK and European Guidelines. You may find the article more useful, or one of our other . In this article In This Article Idiopathic Intracranial Hypertension In this article Synonyms: pseudotumour cerebri, benign intracranial hypertension in the absence of a mass lesion or of hydrocephalus. It is often idiopathic. Idiopathic intracranial hypertension (IIH) appears to be due to impaired cerebrospinal fluid (CSF) absorption from the subarachnoid space across the arachnoid villi into the dural (...) of IIH was calculated as 10.9 per 100,000 (85.7 per 100,000 in obese women). Risk factors It mostly occurs in young obese females in their third or fourth decade. There is an increased risk in women with menstrual irregularity. Female-to-male ratio is between 3:1 to 8:1. Up to 90% of patients are overweight. In women it may coincide with recent weight gain, fluid retention, the first trimester of pregnancy and the postpartum period. Aetiology Known associations include: Endocrine: adrenal

2008 Mentor

3528. Acromegaly

compression symptoms may occur, especially carpal tunnel syndrome (20-40%). Cardiac features include hypertension (40%), left ventricular hypertrophy, cardiomyopathy and arrhythmias. Type 2 diabetes mellitus (40-52%) and glucose intolerance (28-46%) due to insulin resistance. Colonic polyps. Vertebral fractures, possibly due to low-quality bone despite high bone mass. Due to associated hyperprolactinaemia - eg, galactorrhoea, amenorrhoea: in one third of patients with a GH-producing adenoma, the adenoma (...) . If the glucose load fails to suppress the GH level below 1.0 mcg/L this confirms the diagnosis of acromegaly. Random GH is not recommended; secretion is episodic and the half-life is short. GHRH concentration can be obtained if clinically indicated. The major IGF-1 binding protein, IGFBP3, is not useful for diagnosis or monitoring of disease [ ] . Assessment of other pituitary hormones as clinically indicated: prolactin, adrenal, thyroid and gonadal hormones. MRI scan of pituitary and hypothalamus: more

2008 Mentor

3529. Amenorrhoea

dysfunction may cause menstruation to cease. Causes include: stress, excessive exercise, eating disorders, depression, chronic systemic illness and tumours. Loss of weight : this can cause amenorrhoea, especially if rapid. Body mass index (BMI) is rarely above 19 where this is the case, and at least 10% of normal body weight has been lost. Anorexia nervosa and other eating disorders including should be considered. The female athlete triad is well recognised. It consists of eating disorder, amenorrhoea (...) of amenorrhoea. Both androgens and oestrogens may be normal or slightly raised so that, whilst there are signs of virilisation, there is no evidence of oestrogen deficiency. They are usually, but not always, overweight and may have insulin resistance. Fat is very important in the metabolism of the steroid sex hormones and it accounts for both the excess in PCOS and the deficiency in anorexia. : this may be spontaneous or iatrogenic. Late-onset congenital adrenal hyperplasia : produces androgens. Adrenal

2008 Mentor

3530. Ultrasound Scanning - Non-obstetric

an ultrasound scan of the liver, bile duct and pancreas. It can show tumour mass and dilated bile ducts as well as any liver metastases. However, it is less good at demonstrating tumours in the pancreatic body and tail. Endoscopic ultrasound may form part of further investigation. Further imaging is usually required when a pancreatic tumour is suspected. In , ultrasound may show a swollen pancreas, dilated common bile duct and free peritoneal fluid. The presence of gallstones may also be important. Standard (...) may be due to imminent AAA rupture. A pulsating mass is an unreliable sign with both false-positive and false-negative results. Clinical signs may be unreliable until rupture has occurred when haemorrhage is dramatic and catastrophic. Urological ultrasound The dose of radiation from an intravenous urogram is very high but ultrasound is very good at showing stones and delineating the outline of kidneys and the collecting system. The renal cortex is seen as grey with some darker circles spaced

2008 Mentor

3531. Syndrome of Inappropriate ADH Secretion (SIADH)

features Hyponatraemia. Plasma hypo-osmolality proportional to hyponatraemia. Inappropriately elevated urine osmolality (>100 mOsmol/kg) commonly > plasma osmolarity. Persistent urine [Na+] >30 mmol/L with normal salt intake. Euvolaemia. Normal thyroid and adrenal function. Extra features include an elevated ADH level and low blood uric acid level. Causes (not exhaustive) Neurological: tumour, trauma, infection, , , intracranial haemorrhage, sinus thrombosis, , . Pulmonary: , , , , , , positive (...) of laboratory error. If necessary, repeat the test. Serum potassium . If raised, consider . SIADH needs to be confirmed by results of paired serum and urine samples: serum hypo-osmolality is <275 mOsm/kg, and urine osmolality >100 mOsm/kg and sodium ≥30 mmol/L, in the absence of hypovolaemia, hypervolaemia, adrenal or thyroid dysfunction and use of diuretics. Urine sodium level . If this is >20 mmol/L, a renal cause should be sought. Serum thyroid-stimulating hormone and free thyroxine level . These should

2008 Mentor

3532. Precocious Puberty

testicular volume: Increase as with normal puberty in CPP and sometimes with testicular disorders. Volume remains prepubertal in many causes of peripheral precocious puberty, such as adrenal disorders. CNS examination - fundoscopy, cranial nerves. Testicular and pelvic examination for masses. Examination for specific causes - signs of hypothyroidism, skin lesions (MAS, neurofibromatosis). Investigations [ ] Investigations are used selectively after a thorough clinical assessment. Tests available (...) GnRH stimulation and levels of testosterone and estradiol are elevated whilst LH and FSH are suppressed. There is a flat GnRH response and no response to treatment with GnRH analogues. Causes include: . Tumours: HCG-secreting tumours in the liver (hepatomas, hepatoblastomas), choriocarcinomas (of gonads, pineal gland, mediastinum, etc) and adrenal tumours (rare). Ovarian tumours may cause either masculinisation or feminisation. Testicular Leydig-cell tumours may cause early virilisation in males

2008 Mentor

3533. Polycystic Ovarian Syndrome

-esteem. [ ] Sleep apnoea. Clinical signs These include: The presence of hirsutism, (often on the upper lip, chin, around the nipples and in a line beneath the umbilicus). This occurs in 60% of women with PCOS. [ ] Male-pattern balding, alopecia. Obesity - this is common (usually central distribution). Acanthosis nigricans - may be present and is thought to be a sign of insulin resistance. Occasionally, clitoromegaly, increased muscle mass, deep voice (more usually, these are signs of more severe (...) gain or oligomenorrhoea as side-effects, for example). Late-onset . Androgen-secreting ovarian or adrenal tumours. Ovarian hyperthecosis. If there are signs of virilisation, rapidly progressing hirsutism or high total testosterone level then suspect one of the latter three. 17-hydroxyprogesterone, measured in the follicular phase, will be raised in CAH. Consider checking levels even where testosterone is not significantly raised in those with higher risk, such as Ashkenazi Jews or people

2008 Mentor

3534. Pituitary Tumours

neuroimaging techniques have improved, pituitary tumours are more often diagnosed incidentally. About 16.7% of the general population show changes in the pituitary gland. [ ] Presentation Depends on the hormone secreted by the tumour as well as the pattern of growth of the tumour within the sella turcica. Local effects resulting from an expanding pituitary mass: An expanding mass within the pituitary fossa may give rise to headache, neuro-ophthalmological defects or facial pain according to the size (...) deterioration of vision is an immediate indication for surgery. Postoperative pituitary dysfunction may include adrenal insufficiency, diabetes insipidus, syndrome of inappropriate antidiuretic hormone, and cerebral salt wasting syndrome. Neurosurgical complications may include visual disturbance, cerebrospinal fluid leak, subdural haematoma, and epistaxis. [ ] Radiotherapy Radiotherapy is reserved for patients whose tumour has been incompletely resected or who remain hypersecretory after surgery

2008 Mentor

3535. Physiological Changes In Pregnancy

absorption of calcium. Adrenal gland and pancreas Cortisol levels increase in pregnancy, which favours lipogenesis and fat storage. Insulin response also increases so blood sugar should remain normal or low. Peripheral insulin resistance increases after early stages of pregnancy due to increased production of hormones such as cortisol, prolactin, progesterone and human placental lactogen. The combination of insulin resistance and relatively low glucose promotes the use of fat for energy, preserving (...) erythropoietin levels increase the total red cell mass by the end of the second trimester but haemoglobin concentrations never reach pre-pregnancy levels. Usually mean corpuscular volume (MCV) and mean corpuscular haemoglobin concentration (MCHC) are unaffected. A modest leukocytosis is observed. A normal pregnancy creates a demand for about 1000 mg of additional iron. This equates to 60 mg elemental iron or 300 mg ferrous sulfate per day. Serum iron falls during pregnancy whilst transferrin and total iron

2008 Mentor

3536. Phaeochromocytoma

in an adrenal gland. This may represent phaeochromocytoma, glucocorticoid excess or primary aldosteronism. The mass may even be irrelevant and misleading. Such findings are called 'incidentalomas'. If the clinical history or physical examination of a patient with unilateral incidentaloma suggests glucocorticoid, mineralocorticoid, adrenal sex hormone or catecholamine excess, which is confirmed biochemically, the treatment of choice is often adrenalectomy [ ] . In one study of 201 patients (...) may find one of our more useful. In this article In This Article Phaeochromocytoma In this article A phaeochromocytoma is a rare tumour that secretes catecholamines. It is derived from chromaffin cells, usually in the adrenal medulla; however, occasionally extra-adrenal phaeochromocytomas or paragangliomas occur [ ] . Many - but not all - authors define phaeochromocytoma as coming from the adrenal medulla and if the tumour is similar but located elsewhere, it is called a paraganglioma

2008 Mentor

3537. Neuroblastomas

. [ ] The neuroblastoma originates most commonly in the adrenal or paraspinal sites. Metastases are present in approximately 60% at the time of diagnosis. Epidemiology Fewer than 100 children are diagnosed with neuroblastoma each year in the UK. However, neuroblastomas are the most common extracranial solid tumour of childhood. [ ] Neuroblastoma is the third most common paediatric cancer. Although neuroblastoma accounts for 7% of paediatric malignancies, it is responsible for more than 10% of childhood cancer-related (...) into the strategies used for a risk group staging system - see below. The most important of these is the oncogene MYCN. Amplification of the MYC family member (MYCN) is found in about 25% of cases and correlates with high-risk disease and poor prognosis. MYCN is the most established genetic marker of risk in neuroblastoma. [ ] Presentation Presentation is usually quite late and the majority of symptoms and signs occur either due to the mass effect of the tumour or as a result of metastases. Symptoms Loss

2008 Mentor

3538. Nelson's Syndrome

improved with earlier diagnosis and better management. Cushing's disease is the name given to a pituitary adenoma that secretes ACTH, also called a corticotrophinoma. Such patients have high levels of cortisol which suppress the production of corticotrophin-releasing hormone (CRH) from the paraventricular nucleus of the hypothalamus. The normal cortisol feedback mechanism of the hypothalamo-pituitary-adrenal (HPA) axis is thus disturbed, with loss of circadian rhythm, and excess cortisol production (...) of erectile dysfunction. Testicular pain. During embryogenesis, adrenal cortical cells may migrate along the line of gonadal descent and may even be sequestered in the hilum of the testes, producing adrenal rest tissue. In Nelson's syndrome, this adrenal rest tissue may become stimulated and, if in the testes, it can cause testicular pain and oligospermia. Rarely, the adrenal rest tissue can produce enough cortisol to produce normal levels or even cause recurrence of Cushing's syndrome. The tumour may

2008 Mentor

3539. loin mass

loin mass loin mass - General Practice Notebook This site is intended for healthcare professionals General Practice Notebook | Medical search loin mass Loin masses are usually the result of some enlargement of the kidneys or their collecting systems, unilaterally or bilaterally. Unusually, massive enlargement of the adrenals can cause a loin mass. Causes of loins masses include: renal tumours hydronephrosis adult polycystic disease adrenal tumours renal vein thrombosis acute tubular necrosis (...) Note that a massively enlarged liver or spleen, or a mass arising from the gastrointestinal system may cause an apparent mass in the loin. Links: General Practice Notebook General Practice Notebook The information provided herein should not be used for diagnosis or treatment of any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions. Copyright 2016 Oxbridge Solutions Ltd®. Any distribution or duplication

2010 GP Notebook

3540. flank mass

flank mass flank mass - General Practice Notebook This site is intended for healthcare professionals General Practice Notebook | Medical search flank mass Loin masses are usually the result of some enlargement of the kidneys or their collecting systems, unilaterally or bilaterally. Unusually, massive enlargement of the adrenals can cause a loin mass. Causes of loins masses include: renal tumours hydronephrosis adult polycystic disease adrenal tumours renal vein thrombosis acute tubular necrosis (...) Note that a massively enlarged liver or spleen, or a mass arising from the gastrointestinal system may cause an apparent mass in the loin. Links: General Practice Notebook General Practice Notebook The information provided herein should not be used for diagnosis or treatment of any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions. Copyright 2016 Oxbridge Solutions Ltd®. Any distribution or duplication

2010 GP Notebook

To help you find the content you need quickly, you can filter your results via the categories on the right-hand side >>>>