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Adrenal Mass

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3641. A comparison of biochemical tests for pheochromocytoma: measurement of fractionated plasma metanephrines compared with the combination of 24-hour urinary metanephrines and catecholamines. Full Text available with Trip Pro

interval, 22.1 to 156.9) for urinary total metanephrines and catecholamines. An adrenal pheochromocytoma was missed by urinary testing in two patients with familial syndromes and one asymptomatic patient with an incidentally discovered adrenal mass. An extra-adrenal paraganglioma was missed by plasma testing in one patient. In conclusion, measurements of 24-h urinary total metanephrines and catecholamines yield fewer false-positive results, an attribute preferred for testing low-risk patients

2003 Journal of Clinical Endocrinology and Metabolism

3642. Pubertal and gender-related changes in the sympathoadrenal system in healthy children. Full Text available with Trip Pro

children (ages, 5-17 yr; 37 boys and 43 girls) in relation to age, pubertal stage, gender, physical activity, body mass index, and serum levels of sex steroids, dehydroepiandrosterone sulfate, cortisol, leptin, and insulin. Plasma concentrations of the adrenomedullary hormone, epinephrine (E), and its metabolite metanephrine (MN), decreased significantly with advancing puberty and were higher in boys than in girls. E and MN correlated significantly and inversely with dehydroepiandrosterone sulfate (...) a possible modulatory role of the adrenal medulla in the body weight-related timing of adrenarche and/or gonadarche.

2002 Journal of Clinical Endocrinology and Metabolism

3643. The molecular pathogenesis of hereditary and sporadic adrenocortical and adrenomedullary tumors. Full Text available with Trip Pro

The molecular pathogenesis of hereditary and sporadic adrenocortical and adrenomedullary tumors. Modern imaging modalities lead to frequent detection of adrenal masses, most of them incidental findings. Although the majority of adrenocortical and adrenomedullary tumors are benign, there are no reliable clinical and laboratory markers to distinguish most of them from malignant neoplasms. The molecular mechanisms underlying the pathogenesis of these tumors have recently begun to be unraveled (...) . A fruitful avenue for the elucidation of tumorigenesis has been the study of adrenal tumors that are manifestations of hereditary or postzygotic genetic syndromes, because one knows the "first hit", i.e. the primary gene defect. In contrast, in sporadic adrenal tumors the first hit, possibly a somatic mutation of a tumor-related gene, is unknown, and therefore the sequence of genetic alterations is difficult to establish. In this article we review in addition to our own work the literature on molecular

2002 Journal of Clinical Endocrinology and Metabolism

3644. Long-term (15 years) outcome in an infant with metastatic adrenocortical carcinoma. Full Text available with Trip Pro

Long-term (15 years) outcome in an infant with metastatic adrenocortical carcinoma. Adrenocortical carcinoma is a rare malignancy in children, with a high mortality. Little is known about long-term outcome, especially in infants treated with mitotane. We report the successful long-term outcome of a case of metastatic adrenocortical carcinoma presenting in infancy treated with surgical resection and mitotane. The patient presented at 2 months of age with Cushing's syndrome, a large adrenal mass (...) , and elevated adrenal steroid levels. The tumor was removed surgically. Intraoperative findings included an adrenal tumor (confirmed malignant pathologically) invading the adrenal vein and vena cava. After surgery he was treated with mitotane at a dose of 2 g/d. Six months after surgery 11-deoxycortisol levels increased, and a computed tomography scan showed a pulmonary metastasis. Mitotane was increased to 2.5 g/d, and the metastasis was removed surgically. Plasma mitotane levels ranged 10-15 micro g/ml

2002 Journal of Clinical Endocrinology and Metabolism

3645. 5 alpha-reductase and 11 beta-hydroxysteroid dehydrogenase activity in prepubertal Hispanic girls with premature adrenarche. Full Text available with Trip Pro

5 alpha-reductase and 11 beta-hydroxysteroid dehydrogenase activity in prepubertal Hispanic girls with premature adrenarche. Girls with idiopathic premature adrenarche, characterized by the early appearance of pubic hair and adrenal hyperandrogenism, may be at an increased risk for polycystic ovarian syndrome and its associated complications. Alterations of peripheral metabolism of adrenal steroids, specifically increased 5 alpha-reductase and 11 beta-hydroxysteroid dehydrogenase activities (...) , have been documented in patients with polycystic ovarian syndrome and proposed as an underlying mechanism for the adrenal hyperandrogenism in this syndrome. We sought to investigate whether alterations in 5 alpha-reductase and 11 beta-hydroxysteroid dehydrogenase activities are present in girls with premature adrenarche, suggesting a possible role in the pathogenesis of the hyperandrogenism of this condition. We studied C19 and C21 urinary steroid metabolites, 5 alpha/5 beta and 11 oxo/11 hydroxy

2002 Journal of Clinical Endocrinology and Metabolism

3646. Maternal consumption of a high-meat, low-carbohydrate diet in late pregnancy: relation to adult cortisol concentrations in the offspring. Full Text available with Trip Pro

Maternal consumption of a high-meat, low-carbohydrate diet in late pregnancy: relation to adult cortisol concentrations in the offspring. Recent studies have linked maternal consumption of an unbalanced high-protein, low-carbohydrate diet in late pregnancy with raised adult blood pressure in the offspring. Because high-protein diets stimulate the hypothalamic-pituitary-adrenal axis, we hypothesized that an unbalanced maternal diet might increase maternal cortisol levels, exposing the fetus (...) to excess cortisol and programming lifelong hypersecretion of cortisol. We therefore measured fasting plasma cortisol concentrations in 251 subjects, 28-30 yr old, whose mothers had been advised to eat 0.45 kg of red meat daily during pregnancy and avoid carbohydrate-rich foods. Cortisol concentrations were higher in subjects with lower body mass index (P < 0.0001) and in those who reported recent vigorous activity (P = 0.03) and greater alcohol consumption (P = 0.004). Allowing for gender, current body

2003 Journal of Clinical Endocrinology and Metabolism

3647. Neuroendocrine and metabolic effects of acute ghrelin administration in human obesity. Full Text available with Trip Pro

Neuroendocrine and metabolic effects of acute ghrelin administration in human obesity. Ghrelin stimulates appetite and plays a role in the neuroendocrine response to energy balance variations. Ghrelin levels are inversely associated with body mass index (BMI), increased by fasting and decreased by food intake, glucose load, insulin, and somatostatin. Ghrelin levels are reduced in obesity, a condition of hyperinsulinism, reduced GH secretion, and hypothalamus-pituitary-adrenal axis hyperactivity

2003 Journal of Clinical Endocrinology and Metabolism

3648. Body fat distribution and cortisol metabolism in healthy men: enhanced 5beta-reductase and lower cortisol/cortisone metabolite ratios in men with fatty liver. Full Text available with Trip Pro

cortisone within adipose by 11beta-hydroxysteroid dehydrogenase (HSD) type 1 (11HSD1) has been proposed to cause visceral fat accumulation, whereas decreased hepatic 11HSD1 may protect the liver from glucocorticoid excess. Increased inactivation of cortisol by 5alpha- and 5beta-reductases in the liver may drive compensatory activation of the hypothalamic-pituitary-adrenal axis, hence increasing adrenal androgens and 'android' central obesity. This study aimed to examine relationships between (...) these enzymes and detailed measurements of body fat distribution. Twenty-five healthy men (age, 22-57 yr; body mass index, 20.6-35.6 kg/m(2)) were recruited from occupational health services. Body composition was assessed by anthropometric measurements, bioimpedance, and cross-sectional abdominal magnetic resonance imaging scans. Liver fat content was assessed by magnetic resonance imaging spectroscopy. Insulin sensitivity was measured in a euglycemic hyperinsulinemic clamp. Cortisol metabolites were

2003 Journal of Clinical Endocrinology and Metabolism

3649. Early endocrine, metabolic, and sonographic characteristics of polycystic ovary syndrome (PCOS): comparison between nonobese and obese adolescents. Full Text available with Trip Pro

and metabolic alterations in adolescents with PCOS and to determine whether differences between nonobese and obese women with PCOS are present early in its course. We studied an ethnically heterogeneous group of 48 adolescents: 11 nonobese with PCOS [age, 16.1 +/- 1.9 yr; body mass index (BMI), 22.5 +/- 1.5 kg/m(2)], 22 obese with PCOS (age, 15.5 +/- 1.4 yr; BMI, 35.9 +/- 6.2 kg/m(2)), and 15 obese controls (age, 14.4 +/- 1.5 yr; BMI, 35.8 +/- 7.1 kg/m(2)). Fasting levels of glucose, insulin, proinsulin (...) . Our findings indicate a more pronounced alteration in the hypothalamo-pituitary-adrenal axis in nonobese adolescents with PCOS and a more marked dysregulation of insulin levels and impairment of insulin sensitivity in their obese counterparts. Our data also suggest differences in the IGF system between nonobese and obese adolescents with PCOS.

2003 Journal of Clinical Endocrinology and Metabolism

3650. Identification and quantification of diadenosine polyphosphate concentrations in human plasma. Full Text available with Trip Pro

and suprarenal vena cava: adrenal veins: Ap3A, 4.05+/-1.63; Ap4A, 6.18+/-2.08; Ap5A, 0.53+/-0.28; Ap6A, 0.59+/-0.31; infrarenal vena cava: Ap3A, 1.25+/-0.66; Ap4A, 0.91+/-0.54; Ap5A, 0.25+/-0.12; Ap6A, 0.11+/-0.06; suprarenal vena cava: Ap3A, 1.40+/-0.91; Ap4A, 1.84+/-1.20; Ap5A, 0.33+/-0.13; Ap6A, 0.11+/-0.07 (micromol/L; mean +/- SEM; each P<0.05 (concentration of adrenal veins versus infrarenal or suprarenal veins, respectively).The presence of diadenosine polyphosphates in physiologically relevant (...) concentrations in human plasma was demonstrated. Because in adrenal venous plasma significantly higher diadenosine polyphosphate concentrations were measured than in plasma from the infrarenal and suprarenal vena cava, it can be assumed that, beside platelets, the adrenal medulla may be a source of plasma diadenosine polyphosphates in humans.

2003 Thrombosis and Vascular Biology

3651. High rate of detection of primary aldosteronism, including surgically treatable forms, after 'non-selective' screening of hypertensive patients. (Abstract)

aldosteronism.This approach allowed PAHHU to diagnose, within 2 years, 54 patients [only seven (13%) hypokalaemic] with primary aldosteronism. All tested negative for glucocorticoid-remediable aldosteronism. Aldosterone production was lateralized to one adrenal in 15 patients (31%; only six hypokalaemic) and was bilateral in 34 (69%; all normokalaemic) of 49 patients who underwent adrenal venous sampling. Among patients with lateralizing adrenal hyperplasia, computed tomography revealed an ipsilateral mass (...) of detection of aldosterone-producing adenoma (as opposed to bilateral adrenal hyperplasia) reflect differences in the procedures used for diagnosis of primary aldosteronism, and the methods used to identify aldosterone-producing adenomas.In the newly established Princess Alexandra Hospital Hypertension Unit (PAHHU), we used procedures developed by Greenslopes Hospital Hypertension Unit (which reports that more than 30% of patients with primary aldosteronism have aldosterone-producing adenomas) to diagnose

2003 Journal of Hypertension

3652. Synchronous presentation of primary non-small cell lung carcinoma and pheochromocytoma. (Abstract)

Synchronous presentation of primary non-small cell lung carcinoma and pheochromocytoma. A 54-year-old man was diagnosed with a 3.2-cm primary right lower lobe non-small cell lung cancer and a synchronously present 2.5-cm right adrenal gland mass. Workup of the adrenal lesion revealed a pheochromocytoma. The patient underwent combined mediastinoscopy, laparoscopic right adrenalectomy, and right thoracotomy with right lower lobectomy. This case illustrates the importance of establishing a firm (...) diagnosis for all synchronously present adrenal lesions that are discovered in the setting of primary lung carcinoma.

2002 Annals of Thoracic Surgery

3653. Abnormal levels of serum dehydroepiandrosterone, estrone, and estradiol in men with rheumatoid arthritis: high correlation between serum estradiol and current degree of inflammation. (Abstract)

Abnormal levels of serum dehydroepiandrosterone, estrone, and estradiol in men with rheumatoid arthritis: high correlation between serum estradiol and current degree of inflammation. Men with rheumatoid arthritis (RA) have a higher than normal frequency of low testosterone levels, but not much is known about other sex hormones. We investigated serum levels of estradiol, estrone, and the adrenal androgen dehydroepiandrosterone (DHEAS) in men with RA and evaluated the association of various (...) disease variables with these sex hormones.Inflammatory activity, measured as disease activity score including 28 joints (Disease Activity Score 28), and degree of disability, measured with the Health Assessment Questionnaire, were estimated in 101 men with RA. Presence of erosions, rheumatoid factor (RF), smoking habits, and body mass index were recorded. DHEAS (not measured in patients taking glucocorticoids), estradiol, and estrone were measured in patients and in healthy controls.DHEAS and estrone

2003 Journal of Rheumatology

3654. Endocrinologic and immunologic factors associated with recovery of growth in children with human immunodeficiency virus type 1 infection treated with protease inhibitors. (Abstract)

factor alpha (TNF-alpha) were measured before the start of therapy and after 24 weeks. In addition serum IGF-1 and IGFBP-3 values were determined after 48 weeks.Twenty-seven HIV-1-infected children with a median age of 5.5 years (range, 0.3 to 14.9 years) were included. Overall no significant changes in height and body mass index (BMI) z scores were observed. The median baseline plasma viral load of 68,800 copies/ml decreased to less than the detection limit of 500 copies/ml in 80% of the children (...) after 48 weeks whereas IGF-1 stabilized. The increase in IGF-1 was significantly higher in children in whom the BMI and length (after correction for age and sex) increased the most.Hypothyroidism and adrenal axis abnormalities are not associated with restoration of growth after the initiation of antiretroviral therapy in HIV-1-infected children. The combination of relatively high serum IGFBP-3 concentration and relatively lower serum IGF-1 suggests the presence of a growth hormone-resistant state

2003 Pediatric Infectious Dsease Journal

3655. Adrenarche and bone modeling and remodeling at the proximal radius: weak androgens make stronger cortical bone in healthy children. (Abstract)

status in children.Increased bone mass has been reported in several conditions with supraphysiological adrenal androgen secretion during growth. However, no data are available for normal children. Therefore, our aim was to examine whether adrenal androgens within their physiological ranges may be involved in the strengthening of diaphyseal bone during growth.Periosteal circumference (PC), cortical density, cortical area, bone mineral content, bone strength strain index (SSI), and forearm cross (...) Adrenarche and bone modeling and remodeling at the proximal radius: weak androgens make stronger cortical bone in healthy children. Adrenarche, the physiological increase in adrenal androgen secretion, may contribute to better bone status. Proximal radial bone and 24-h urinary steroid hormones were analyzed cross-sectionally in 205 healthy children and adolescents. Positive adrenarchal effects on radial diaphyseal bone were observed. Obviously, adrenarche is one determinant of bone mineral

2003 Journal of Bone and Mineral Research

3656. The screening of congenital adrenal hyperplasia. Applicability in Galicia

by CRD MeSH Adrenal Hyperplasia, Congenital; Costs and Cost Analysis; Mass Screening; Neonatal Screening Language Published Spanish Country of organisation Spain Address for correspondence Subdireccion Xeral de Aseguramento e Planificacion Sanitaria, Conselleria de Sanidade, Xunta de Galicia, San Lazaro s/n 15781 Santiago de Compostela, Spain. Tel: 34 981 541831; Fax: 34 981 542854; Email: avalia-t@sergas.es AccessionNumber 32005000346 Date bibliographic record published 18/07/2005 Date abstract (...) The screening of congenital adrenal hyperplasia. Applicability in Galicia Cribado neonatal de la hiperplasia suprarrenal congenita. Aplicabilidad en Galicia [The screening of congenital adrenal hyperplasia. Applicability in Galicia] Cribado neonatal de la hiperplasia suprarrenal congenita. Aplicabilidad en Galicia [The screening of congenital adrenal hyperplasia. Applicability in Galicia] Rey-Liste T, Garcia-Caeiro A Record Status This is a bibliographic record of a published health technology

2004 Health Technology Assessment (HTA) Database.

3657. Diagnosis and treatment of adrenal incidentaloma: a cost-effectiveness analysis

assessment on the reliability of the study and the conclusions drawn. Health technology Several health technologies were considered for the diagnosis and the treatment of adrenal incidentaloma, an adrenal mass incidentally detected during the course of abdominal diagnostic imaging, performed for another reason. The eight diagnostic tests were grouped in three sets: imaging techniques, namely I-iodomethyl-norcholesterol (NP59), magnetic resonance imaging, I-meta-iodobenzylguanidine, and computed (...) Diagnosis and treatment of adrenal incidentaloma: a cost-effectiveness analysis Diagnosis and treatment of adrenal incidentaloma: a cost-effectiveness analysis Diagnosis and treatment of adrenal incidentaloma: a cost-effectiveness analysis Kievit J, Haak H R Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical

2000 NHS Economic Evaluation Database.

3658. Diagnostic evaluation of the adrenal incidentaloma: decision and cost-effectiveness analyses

contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology Comparison of different diagnostic strategies to discriminate benign from malignant adrenal incidentalomas. Type of intervention Diagnosis. Economic study type Cost-effectiveness analysis. Study population Hypothetical cohort ofpatients with incidentally discovered unilateral, non-hypersecretory adrenal masses (...) masses. Outcomes assessed in the review The outcomes assessed were prevalence of non-hypersecretory adenomas, adrenocortical carcinomas, and adrenal metastases in adrenal incidentaloma. Additionally the diagnostic performance of biopsy and imaging procedures, and the morbidity of invasive modalities were considered. Study designs and other criteria for inclusion in the review No specific study design criteria were identified by the authors. Only articles published in English were included

1998 NHS Economic Evaluation Database.

3659. Adrenal insufficiency. Full Text available with Trip Pro

Adrenal insufficiency. A 44-year-old woman reported several weeks of fatigue, somnolence, pain in the large joints, nausea, and decreased appetite. She had also noted an unintentional 11-kg weight loss over a period of 6 months. She had a remote history of amenorrhea, but she was presently menstruating regularly. She was taking no medications, with the exception of acetaminophen as needed for knee pain. The diagnosis of adrenal insufficiency (AI) was considered. Serum cortisol level after (...) adrenocorticotropin hormone (ACTH) stimulation was abnormal. Because her plasma ACTH level was not increased, a diagnosis of secondary AI (due to deficiency in ACTH) was made. Magnetic resonance imaging of the brain performed to exclude the presence of a sellar or suprasellar mass showed reduction in size of the pituitary gland and an increased cerebrospinal fluid content within the sella, consistent with a partially empty sella. The patient's symptoms improved rapidly with hydrocortisone therapy but during

2005 JAMA

3660. Pulmonary Paraganglioma Manifesting as an Endobronchial Mass Full Text available with Trip Pro

Pulmonary Paraganglioma Manifesting as an Endobronchial Mass Thoracic paragangliomas comprise only 1-2% of all paragangliomas, including the adrenal pheochromocytomas, and these tumors are mostly found in the mediastinal compartments (1). To the best of our knowledge, there is only one case report in the pathology literature of endobronchial involvement by a primary pulmonary paraganglioma (2). We report here on the CT and bronchoscopic findings of a case of pathologically proven endobronchial (...) paraganglioma in a 37-year-old woman. In our case, bronchoscopy and CT demonstrated an endobronchial hypervascular mass, which indicated the presence of carcinoid or hypervascular metastasis based on the known incidence of such tumors.

2008 Korean Journal of Radiology

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