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Adrenal Mass

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3621. Altered 24-hour blood pressure profiles in children and adolescents with classical congenital adrenal hyperplasia due to 21-hydroxylase deficiency. (PubMed)

Altered 24-hour blood pressure profiles in children and adolescents with classical congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Children and adolescents with classical congenital adrenal hyperplasia have been shown to be at risk for obesity associated with higher insulin and leptin levels. Because these factors are also known to cause hypertension, the aim of this study was to analyze 24-h blood pressure profiles and their relation to different clinical and laboratory (...) parameters.Fifty-five subjects, aged between 5.3 and 19.0 yr, were enrolled in a prospective, cross-sectional study. All patients had genetically proven 21-hydroxylase deficiency and underwent ambulatory 24-h blood pressure monitoring during a period off school/work. RESULTS (MEDIAN, RANGE): The median body mass index of the cohort was significantly elevated [1.09 sd score (SDS), -2.45 to 3.77]. Daytime and nighttime systolic blood pressures were also significantly elevated (0.67 SDS, -1.5-4.1; 0.63 SDS, -0.91

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2006 Journal of Clinical Endocrinology and Metabolism

3622. Metabolic profile and body composition in adult women with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. (PubMed)

Metabolic profile and body composition in adult women with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. The chronic, often supraphysiological glucocorticoid doses used in congenital adrenal hyperplasia (CAH) might increase morbidity in cardiovascular disease and diabetes.Our aim was to assess risk factors for cardiovascular disease and diabetes in CAH women. SUBJECTS, METHODS, AND DESIGN: We compared 61 women, 18-63 yr, with CAH due to 21-hydroxylase deficiency with 61 age (...) - and sex- matched controls. Twenty-seven were younger than 30 yr, and 34 were 30 yr or older. Anthropometry, fat and lean mass measured by dual-energy x-ray absorptiometry, serum lipids, insulin, and adrenocortical steroids were studied.Body composition and cardiovascular risk factors were the main outcome measures.Younger patients and controls had similar waist to hip ratio, lean and fat mass, and insulin. Older patients had higher waist to hip ratio, lean mass, and insulin than controls. Fat mass

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2007 Journal of Clinical Endocrinology and Metabolism

3623. Lack of Association of the 11beta-hydroxysteroid dehydrogenase type 1 gene 83,557insA and hexose-6-phosphate dehydrogenase gene R453Q polymorphisms with body composition, adrenal androgen production, blood pressure, glucose metabolism, and dementia. (PubMed)

reductase deficiency (CRD) when at least three alleles are affected.The aim was to study the separate and combined effects of these polymorphisms on body composition, adrenal androgen production, blood pressure, glucose metabolism, and the incidence of dementia in the healthy elderly population.The Rotterdam study (n = 6105) and the Frail Old Men study (n = 347) are population-based cohort studies in the elderly.Genotype distributions and influences of (combined) genotypes on body mass index, adrenal (...) Lack of Association of the 11beta-hydroxysteroid dehydrogenase type 1 gene 83,557insA and hexose-6-phosphate dehydrogenase gene R453Q polymorphisms with body composition, adrenal androgen production, blood pressure, glucose metabolism, and dementia. Recently, it was proposed that a combination of the 83,557insA polymorphism in the 11beta-hydroxysteroid dehydrogenase type 1 (HSD11B1) gene and the R453Q polymorphism in the hexose-6-phosphate dehydrogenase (H6PD) gene interacts to cause cortisone

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2007 Journal of Clinical Endocrinology and Metabolism

3624. Hypothalamic-pituitary-adrenal axis dysregulation and memory impairments in type 2 diabetes. (PubMed)

Hypothalamic-pituitary-adrenal axis dysregulation and memory impairments in type 2 diabetes. There is evidence of both hypothalamic-pituitary-adrenocortical (HPA) axis and cognitive dysfunction in type 2 diabetes mellitus (T2DM). However, the exact nature and the associations between these abnormalities remain unclear.The aim of the study was to characterize the nature of the HPA dysregulation in T2DM and ascertain whether impaired cognition in T2DM could be attributed to these abnormalities.A (...) , and 30 age-, gender-, and education-matched controls.Basal cortisol levels, cortisol levels during the DEX/CRH test, and performance on neuropsychological tests were measured.Individuals with T2DM had elevated basal plasma cortisol levels, higher levels after DEX suppression, and a larger response to CRH (all P mass index

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2007 Journal of Clinical Endocrinology and Metabolism

3625. Cardiovascular risk factors and ultrasound evaluation of intima-media thickness at common carotids, carotid bulbs, and femoral and abdominal aorta arteries in patients with classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency. (PubMed)

Cardiovascular risk factors and ultrasound evaluation of intima-media thickness at common carotids, carotid bulbs, and femoral and abdominal aorta arteries in patients with classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency. In congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency, a tendency for obesity, high insulin, and high 24-h blood pressure levels has been reported in children and adolescents. Increased intima-media thickness (IMT) is considered (...) a measure of subclinical atherosclerosis and a predictor of myocardial infarction and stroke.The objective of the study was to evaluate glucose metabolism, lipid profile, IMT of the abdominal aorta, right and left common carotids, carotid bulbs, and common femoral arteries in adult CAH patients.Nineteen (10 females, nine males; 28 +/- 3.5 yr) patients (12 salt wasting and seven simple virilizing) and 19 (10 females, nine males) healthy subjects matched for anthropometric parameters (age, sex, body mass

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2007 Journal of Clinical Endocrinology and Metabolism

3626. Adrenal sensitivity to adrenocorticotropin 1-24 is reduced in patients with autoimmune polyglandular syndrome. (PubMed)

Adrenal sensitivity to adrenocorticotropin 1-24 is reduced in patients with autoimmune polyglandular syndrome. Autoimmune polyglandular syndromes are fairly common diseases that are classified into four constellations based on the clinical clustering of the various component diseases. In types 1, 2, and 4, primary adrenal insufficiency due to an autoimmune process is usually present, but its diagnosis is often delayed because it is difficult to detect in a subclinical phase. It is widely (...) accepted that the classical dose of 250 microg ACTH(1-24) is supramaximal, whereas 0.06 microg has been shown to be one of the lowest ACTH doses that is able to stimulate adrenal secretion in normal young subjects. The aim of this study was to clarify the sensitivity and maximal secretory response of the adrenal gland to ACTH in a group of patients with at least two autoimmune diseases, without clinical signs and symptoms of overt or subclinical hypocortisolism. Cortisol (F), aldosterone

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2004 Journal of Clinical Endocrinology and Metabolism

3627. Altered cortisol metabolism in polycystic ovary syndrome: insulin enhances 5alpha-reduction but not the elevated adrenal steroid production rates. (PubMed)

Altered cortisol metabolism in polycystic ovary syndrome: insulin enhances 5alpha-reduction but not the elevated adrenal steroid production rates. Androgen excess in women with polycystic ovary syndrome (PCOS) may be ovarian and/or adrenal in origin, and one proposed contributing mechanism is altered cortisol metabolism. Increased peripheral metabolism of cortisol may occur by enhanced inactivation of cortisol by 5alpha-reductase (5alpha-R) or impaired reactivation of cortisol from cortisone (...) with 19 lean controls who were closely matched for body mass index (BMI). Second, the impact of obesity was studied in a cross-section of 42 PCOS women of a broad range of BMI. We measured 24-h urinary excretion of steroid metabolites by gas chromatography/mass spectrometry and fasting metabolic and hormone profiles. Urinary excretion of androgens [androsterone (P = 0.003), etiocholanolone (P = 0.02), and C19 steroid sulfates (P = 0.009)], cortisone metabolites [tetrahydrocortisone (THE) (P = 0.02

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2003 Journal of Clinical Endocrinology and Metabolism

3628. Hypothalamic-pituitary-adrenal axis function and the cellular immune response in former preterm children. (PubMed)

Hypothalamic-pituitary-adrenal axis function and the cellular immune response in former preterm children. Animal data suggest that adverse early experiences may affect endocrine and immune functioning in later life.Our objective was to assess the impact of preterm delivery on hypothalamus-pituitary-adrenal axis functioning, heart rate responses, and immune function.Former preterm children [aged 8-14 yr (n = 18)], sex and age-matched full-term born control children (n = 18), data on birth weight (...) , gestational age, birth weight for gestational age (in sd units), actual body weight, height, and body mass index were assessed.Subjects were exposed to a standardized laboratory stressor ("Trier Social Stress Test for Children"). Cortisol in saliva was determined in 10-min intervals before and after the stress test; heart rates were obtained continuously during the stress test. Additional assessment of saliva cortisol was performed: 1) on 3 consecutive days after awakening and at +10, +20, and +30 min

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2007 Journal of Clinical Endocrinology and Metabolism

3629. Patients with classic congenital adrenal hyperplasia have decreased epinephrine reserve and defective glycemic control during prolonged moderate-intensity exercise. (PubMed)

Patients with classic congenital adrenal hyperplasia have decreased epinephrine reserve and defective glycemic control during prolonged moderate-intensity exercise. Patients with classic congenital adrenal hyperplasia (CAH) have adrenomedullary dysplasia and hypofunction, and their lack of adrenomedullary reserve has been associated with a defective glucose response to brief high-intensity exercise.Our objective was to assess hormonal, metabolic, and cardiovascular response to prolonged (...) moderate-intensity exercise comparable to brisk walking in adolescents with classic CAH.We compared six adolescents with classic CAH (16-20 yr old) with seven age-, sex-, and body mass index group-matched controls (16-23 yr old) using a 90-min standardized ergometer test. Metabolic, hormonal, and cardiovascular parameters were studied during exercise and recovery.Glucose did not change throughout exercise and recovery for controls, whereas CAH patients showed a steady decline in glucose during exercise

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2007 Journal of Clinical Endocrinology and Metabolism

3630. Adrenal hyperandrogenism is induced by fetal androgen excess in a rhesus monkey model of polycystic ovary syndrome. (PubMed)

of similar age, body weight, and body mass index were studied during d 2-6 of two menstrual cycles or anovulatory 30-d periods.Predexamethasone adrenal steroid levels were assessed in the first cycle (cycle 1). In a subsequent cycle (cycle 2), occurring one to three cycles after cycle 1, adrenal steroids were determined 14.5-16.0 h after an i.m. injection of 0.5 mg/kg dexamethasone (postdexamethasone levels) and after an i.v. injection of 50 microg ACTH-(1-39).Both before and after dexamethasone, serum (...) Adrenal hyperandrogenism is induced by fetal androgen excess in a rhesus monkey model of polycystic ovary syndrome. Adrenal androgen excess is found in approximately 25-60% of women with polycystic ovary syndrome (PCOS), but the mechanisms underlying PCOS-related adrenal androgen excess are unclear.The objective of this study was to determine whether adrenal androgen excess is manifest in a nonhuman primate model for PCOS.Six prenatally androgenized (PA) and six control female rhesus monkeys

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2005 Journal of Clinical Endocrinology and Metabolism

3631. Overrepresentation of the N363S variant of the glucocorticoid receptor gene in patients with bilateral adrenal incidentalomas. (PubMed)

Overrepresentation of the N363S variant of the glucocorticoid receptor gene in patients with bilateral adrenal incidentalomas. Some variants of the glucocorticoid receptor (GR) gene have been found to alter glucocorticoid sensitivity and have been associated with altered metabolic profiles.The objective of the study was to examine whether N363S and ER22/23K variants of the GR gene may be associated with the development of adrenal incidentalomas and whether these variants may contribute (...) to metabolic abnormalities frequently present in these patients.The study included 99 patients with unilateral and 44 patients with bilateral adrenal incidentalomas, 102 population-matched control subjects, and 100 patients with type 2 diabetes mellitus.Metabolic and hormonal parameters and GR gene variants were determined.When compared with control subjects, the carrier frequency for the N363S variant was markedly and significantly higher in patients with bilateral (7.8 vs. 20.5%, P < 0.05

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2006 Journal of Clinical Endocrinology and Metabolism

3632. Laparoscopic Resection of Large Adrenal Ganglioneuroma (PubMed)

Laparoscopic Resection of Large Adrenal Ganglioneuroma We report on a 23-year-old woman with a right adrenal tumor 13 cm in diameter who was treated by laparoscopy. The patient was asymptomatic, and the tumor was incidentally diagnosed on abdominal ultrasonography. A subsequent computed tomography (CT) of the abdomen confirmed a 12 x 7 x 8-cm homogenous mass of the right adrenal. Magnetic resonance imaging (MRI) showed a solid mass measuring 13 x 7 x 7.5 cm arising from the right adrenal (...) . Laparoscopic complete excision of the mass was accomplished through a transabdominal lateral approach. The postoperative period was uneventful, and the patient was discharged on the second postoperative day. Histology was consistent with an adrenal ganglioneuroma. Two years later, there is no evidence of recurrence on abdominal CT scan.

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2007 JSLS : Journal of the Society of Laparoendoscopic Surgeons

3633. Incidentally Discovered Adrenal Schwannoma (PubMed)

Incidentally Discovered Adrenal Schwannoma Schwannoma is a rare tumor of neural crest cell origin that is rarely seen arising from the adrenal gland. We report a case of an adrenal mass discovered incidentally in a 70-year-old man as part of a hematuria workup. Metabolic evaluation was unremarkable, and imaging studies did not meet strict imaging criteria for a typical adenoma. Following surgical excision and pathologic evaluation with confirmatory immunohistochemical staining, the mass

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2007 JSLS : Journal of the Society of Laparoendoscopic Surgeons

3634. Differentiation of Adrenal Adenoma and Nonadenoma in Unenhanced CT: New Optimal Threshold Value and the Usefulness of Size Criteria for Differentiation (PubMed)

Differentiation of Adrenal Adenoma and Nonadenoma in Unenhanced CT: New Optimal Threshold Value and the Usefulness of Size Criteria for Differentiation To determine the optimal threshold for the attenuation values in unenhanced computed tomography (CT) and assess the value of the size criteria for differentiating between an adrenal adenoma and a nonadenoma.The unenhanced CT images of 45 patients at our institution, who underwent a surgical resection of an adrenal masses between January 2001 (...) and July 2005, were retrospectively reviewed. Forty-five adrenal masses included 25 cortical adenomas, 12 pheochromocytomas, three lymphomas, and five metastases confirmed by pathology were examined. The CT images were obtained at a slice thickness of 2 mm to 3 mm. The mAs were varied from 100 to 160 and 200 to 280, while the 120 KVp was maintained in all cases. The mean attenuation values of an adrenal adenoma and nonadenoma were compared using an unpaired t test. The sensitivity, specificity

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2007 Korean Journal of Radiology

3635. Adrenal Adenoma Presenting with Ventricular Fibrillation (PubMed)

level. Computed tomography then revealed a right adrenal mass. The patient was treated with surgical resection of the adenoma. This case emphasizes the importance of meticulous search for secondary causes of hypertension, before the occurrence of serious complications. (...) Adrenal Adenoma Presenting with Ventricular Fibrillation We report the case of a 58-year-old man who presented with ventricular fibrillation. The serum potassium level was 1.8 mEq/L after successful cardioversion. Coronary angiography showed a normal heart with no structural defects, but 12-lead electrocardiography showed indications of left ventricular hypertrophy, which was confirmed by echocardiography. Laboratory examinations showed a suppressed renin level and an elevated serum aldosterone

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2005 Texas Heart Institute Journal

3636. Laparoscopic Management of an Adrenal Leiomyoma in an AIDS Patient. A Case Report and Review of the Literature (PubMed)

Laparoscopic Management of an Adrenal Leiomyoma in an AIDS Patient. A Case Report and Review of the Literature Laparoscopic management of adrenal masses has been well described. Immunologically compromised patients can obtain significant benefit from these minimally invasive procedures. We describe a case of an enlarging smooth muscle tumor of the adrenal gland in an acquired immunodeficiency syndrome (AIDS) patient and review the sparse literature available on this subject.A 49-year-old female (...) with AIDS complaining of vague abdominal discomfort was found to have a left adrenal mass. Significant enlargement of the mass was noted during routine follow-up. The patient underwent an elective laparoscopic left adrenalectomy without complications. Pathological review found the mass to be a rare adrenal leiomyoma.Benign, smooth muscle tumors arising from the adrenal glands are rare. A review of the literature does reveal a propensity for these tumors to occur in the immunocompromised population.The

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2005 JSLS : Journal of the Society of Laparoendoscopic Surgeons

3637. Laparoscopic Adrenalectomy for Isolated Adrenal Metastasis (PubMed)

Laparoscopic Adrenalectomy for Isolated Adrenal Metastasis Laparoscopic adrenalectomy is accepted by many as the standard of care for the majority of adrenal masses less than 8 cm. The question exists whether laparoscopic removal of metastatic lesions to the adrenal is more difficult than laparoscopic removal of primary adrenal lesions.We performed a retrospective analysis of all laparoscopic adrenalectomies performed at a single institution from 1998 to 2001, comparing laparoscopic (...) =332 minutes, average tumor size=7.3 cm, median hospital stay=2 days). No major complications occurred in either group.We feel laparoscopic adrenalectomy is the preferred approach for primary adrenal masses less than 8 cm. Based on our experience and a review of the literature, isolated metastatic lesions to the adrenal gland appear less amenable to laparoscopic removal than do primary lesions of the same size.

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2004 JSLS : Journal of the Society of Laparoendoscopic Surgeons

3638. Investigation of adrenal functions in patients with idiopathic hyperandrogenemia. (PubMed)

Investigation of adrenal functions in patients with idiopathic hyperandrogenemia. Some patients with hyperandrogenemia had no identifiable cause, which was named as idiopathic hyperandrogenemia (IHA). The role of the adrenal glands in these patients was investigated.Clinical study in patients with IHA at the Endocrinology Department of a University Hospital.In this study, 26 pre-menopausal women with IHA and 20 healthy women were included. Basal hormonal investigations, ACTH test and a 75 g (...) oral glucose tolerance test (OGTT) were performed. Basal levels of total testosterone, free testosterone, androstenedione (A4), sex hormone-binding globulin, DHEA sulfate (DHEAS), cortisol, 17-hydroxyprogesterone (17-OHP), 11-deoxycortisol (11-S) and ACTH-stimulated levels of cortisol, A4, DHEAS, 17-OHP, and 11-S were measured. Additionally, glucose and insulin responses to OGTT were obtained.The patients and the control subjects had similar age and body mass index. Peak and area under the curve

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2006 European Journal of Endocrinology

3639. Corticotroph adenoma of the pituitary in a patient with X-linked adrenal hypoplasia congenita due to a novel mutation of the DAX-1 gene. (PubMed)

. Three transsphenoidal operations and radiotherapy were necessary to remove the tumor mass and control ACTH secretion. Histologically, the adenoma was composed of chromophobic and basophilic neoplastic cells with positive immunostaining for ACTH. Moreover, a novel mutation was found both in the patient and his mother: a 4 bp insertion (AGCG) at nucleotide 259, in exon 1 resulting in a frame shift and premature termination.This case suggests that in adrenal hypoplasia congenita the development (...) Corticotroph adenoma of the pituitary in a patient with X-linked adrenal hypoplasia congenita due to a novel mutation of the DAX-1 gene. Mutations in the DAX-1 gene result in X-linked congenital adrenal hypoplasia. The classic clinical presentation is primary adrenal insufficiency in early life and hypogonadotropic hypogonadism at the time of expected puberty, but recent data have expanded the phenotypic spectrum of DAX-1 mutations. We report the occurrence of an ACTH-secreting adenoma

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2005 European Journal of Endocrinology

3640. Adrenal neoplasms: CT-guided radiofrequency ablation--preliminary results. (PubMed)

Adrenal neoplasms: CT-guided radiofrequency ablation--preliminary results. To evaluate initial experience with radiofrequency (RF) ablation of adrenal neoplasms.Thirteen adrenal masses in 12 patients (bilateral metastases in one patient) were treated with computed tomography (CT)-guided percutaneous RF ablation. Eleven adrenal lesions were metastases (five from lung cancer, four from renal cell carcinoma, and two from melanoma); one lesion was a pheochromocytoma and one was an aldosteronoma (...) . There were 10 men and two women (average age, 58 years; range, 40-77 years) in the study; average adrenal mass diameter was 3.9 cm (range, 1-8 cm). Average number of RF applications per adrenal mass was 2.7 (range, 1-5 applications); average time per application was 7.8 minutes (range, 4-13 minutes). An internally cooled single electrode was used in five sessions; an internally cooled cluster electrode was used in eight sessions.Average follow-up was 11.2 months (range, 1-46 months). Eleven of 13 lesions

2004 Radiology

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