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Adrenal Mass

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3681. Adrenal Adenoma Presenting with Ventricular Fibrillation Full Text available with Trip Pro

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

2005 Texas Heart Institute Journal

3682. Differentiation of Adrenal Adenoma and Nonadenoma in Unenhanced CT: New Optimal Threshold Value and the Usefulness of Size Criteria for Differentiation Full Text available with Trip Pro

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

2007 Korean Journal of Radiology

3683. Laparoscopic Adrenalectomy for Isolated Adrenal Metastasis Full Text available with Trip Pro

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.

2004 JSLS : Journal of the Society of Laparoendoscopic Surgeons

3684. Hypothalamic-Pituitary-Adrenal Axis Function: Relative Contributions of Perceived Stress and Obesity in Women Full Text available with Trip Pro

Hypothalamic-Pituitary-Adrenal Axis Function: Relative Contributions of Perceived Stress and Obesity in Women A range of behavioral and psychosocial factors may contribute to a chronically stimulated hypothalamic-pituitary-adrenal (HPA) axis and subsequently altered diurnal patterns. The goal of this cross-sectional study was to examine associations among diurnal cortisol levels, perceived stress, and obesity patterns.Seventy-eight women (aged 24-72 years) employed in a rural public school (...) system completed the perceived stress scale, collected diurnal saliva samples, and underwent anthropometric assessments. Reduced peak-to-nadir cortisol values across the day were considered a sign of impairment in HPA function. A series of linear regression models determined the best predictors of diurnal cortisol variation.There was a marginal linear trend in stress levels across body mass index (BMI) categories, with obese women reporting the highest levels of stress (p = 0.07). Perceived stress

2008 Journal of Women's Health

3685. Laparoscopic Resection of Large Adrenal Ganglioneuroma Full Text available with Trip Pro

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.

2007 JSLS : Journal of the Society of Laparoendoscopic Surgeons

3686. Incidentally Discovered Adrenal Schwannoma Full Text available with Trip Pro

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

2007 JSLS : Journal of the Society of Laparoendoscopic Surgeons

3687. Response of the hypothalamic-pituitary-adrenal axis to small dose arginine-vasopressin and daily urinary free cortisol before and after alprazolam pre-treatment differs in obesity. (Abstract)

Response of the hypothalamic-pituitary-adrenal axis to small dose arginine-vasopressin and daily urinary free cortisol before and after alprazolam pre-treatment differs in obesity. Arginine vasopressin (AVP) has a central role in the response of the hypothalamic-pituitary-adrenal (HPA) axis to stress conditions. A low dose of AVP has been shown to have a modest, but significant effect on ACTH response in normal weight subjects. The aim of this study was to test the response of the HPA axis (...) and by approximately 50% in the overweight/obese subjects. These changes were unrelated to the cortisol response to the AVP test before and after APZ pretreatment. On the other hand, percent changes of 24h-UFC/creatinine after APZ were negatively related to the body mass index (BMI) but positively with waist circumference values, which indicates that the abdominal obesity phenotype may counteract the 24 h-UFC/creatinine that would be expected on the basis of BMI values.Our data further support the concept

2004 Journal of endocrinological investigation Controlled trial quality: uncertain

3688. Increased adrenal androgen secretion with inhibition of 11beta-hydroxylase in HIV-infected women. Full Text available with Trip Pro

Increased adrenal androgen secretion with inhibition of 11beta-hydroxylase in HIV-infected women. Adrenal androgen production is reduced in association with disease severity in HIV-infected women. This response may be maladaptive in terms of maintenance of lean body mass, functional status, and immune function. The aim of this study was to assess whether the use of an adrenal enzyme inhibitor of 11beta-hydroxylase might increase androgen production in this population. We conducted a randomized (...) did not change, and signs of adrenal insufficiency were not apparent. These data demonstrate that inhibition of 11beta-hydroxylase with metyrapone increases adrenal androgen secretion in HIV-infected women. Further studies are needed to assess the physiological effects of this strategy to increase anabolic hormone levels in severe stress, including detailed testing to rule out the potential risk of concomitant adrenal insufficiency.

2006 American journal of physiology. Endocrinology and metabolism Controlled trial quality: predicted high

3689. Moderate weight loss reduces renin and aldosterone but does not influence basal or stimulated pituitary-adrenal axis function. (Abstract)

Moderate weight loss reduces renin and aldosterone but does not influence basal or stimulated pituitary-adrenal axis function. Body fat mass and nutrition influence secretion of the adrenocortical hormones--aldosterone and cortisol--via several mechanisms. However, there are no data on adrenocortical function following widely prescribed mild diet-induced weight loss (10%) in obese subjects. In the present study, 25 healthy obese volunteers (BMI 32.9+/-4.3 kg/m (2)) followed a 30% calorie (...) restricted diet over 12 weeks. Hypothalamic-pituitary-adrenal (HPA) axis function was assessed by 24-hour urine free cortisol/cortisone and a 1 mcg ACTH stimulation test with measurement of total and free cortisol and corticosteroid-binding globulin (CBG). The renin-angiotensin-aldosterone system (RAAS) was assessed by measurement of plasma aldosterone and renin under salt depleted (30 mmol/d) and loading (250 mmol/d) conditions. Volunteers' weight fell by 8.5+/-0.8 kg (8.9+/-0.7%) and seated systolic

2007 Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme Controlled trial quality: uncertain

3690. Adrenal neoplasms: CT-guided radiofrequency ablation--preliminary results. (Abstract)

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

3691. Bilateral adrenal neuroblastoma and nephroblastoma occurring synchronously in a child with Fanconi's anemia and VACTERL syndrome. (Abstract)

(horseshoe kidney, cerebella hypoplasia, microcephaly, sacral agenesis) and esophageal atresia, which was repaired in neonatal period. Such association led quickly to the diagnosis of FA. At age of 11 months, she developed simultaneously a renal tumor in a horseshoe kidney and bilateral adrenal tumors. The left adrenal mass was removed, and partial nephrectomy was performed. Histological analysis concluded to adrenal neuroblastoma and nephroblastoma. We also evaluated the c-kit expression in these tumors (...) Bilateral adrenal neuroblastoma and nephroblastoma occurring synchronously in a child with Fanconi's anemia and VACTERL syndrome. Fanconi's anemia (FA) is an autosomal recessive inherited syndrome with a predisposition to malignancy. The association between FA and solid pediatric tumors is extremely rare. The authors report a rare case of VACTERL syndrome associated with FA and multiple solid pediatric tumors occurring in a very young girl. This child had numerous congenital anomalies

2006 Journal of Pediatric Surgery

3692. Diagnosis of adrenocortical tumor in a neonate by detection of elevated blood 17-hydroxyprogesterone measured as a routine neonatal screening for congenital adrenal hyperplasia: a case report. (Abstract)

after birth revealed a round solid tumor 40 mm in diameter in the right suprarenal area. The precise diagnosis of ACT was unexpectedly obtained based on results from the Japanese neonatal mass screening program. Blood 17-hydroxyprogesterone is routinely measured as a part of this program for early detection of congenital adrenal hyperplasia in Japan. Abnormally elevated level of 17-hydroxyprogesterone was reported in the patient and, thus, led to the diagnosis of ACT. Surgical resection was safely (...) for neonatal suprarenal mass because precise diagnosis will enable the physician to develop appropriate treatment strategies.

2008 Journal of Pediatric Surgery

3693. Adrenal incidentalomas: experience in a developing country. (Abstract)

incidentalomas managed at a tertiary referral hospital in northern India.This is a retrospective study (January 1991-December 2005) of 59 patients with adrenal incidentaloma managed at our department. The mean tumor diameter was 7.8 +/- 4.0 cm. In all cases, clinical details, radiology findings, laboratory findings, intervention details, histology findings, and follow-up data were noted. Six patients in which the mass was ultimately found to arise from extra-adrenal tissue were excluded from final (...) Adrenal incidentalomas: experience in a developing country. The incidence of adrenal incidentalomas is rising worldwide. There is a concern about malignancy in large incidentalomas. There are few published articles from developing countries on this entity. The aim of this study was to analyze the clinical presentation, functional status, and final diagnosis of adrenal incidentalomas and, in particular, to look into the incidence of adrenal cortical carcinoma (ACC) in large adrenal

2008 World Journal of Surgery

3694. The role of adrenal venous sampling in the surgical management of primary aldosteronism. (Abstract)

at the Surgical Pathology Institute, University of Padua since 1993. All the patients underwent a CT scan. Adrenal venous sampling was performed in those patients with negative or equivocal findings on imaging studies.Computed tomography was non-contributory in 12 patients and frankly misleading in 2 patients, demonstrating a probable mass lesion in the contralateral but not in the ipsilateral adrenal. Eighteen patients had selective venous sampling that was successful in altering the management of 14 cases (...) . Eleven patients who biochemically had an adrenal adenoma, had normal/equivocal CT, while the remaining 3 had bilateral or contralateral adrenal masses. Venous sampling localized aldosterone secretion and an adenoma, less than 1 cm in diameter, was removed, curing their hypertension. Eleven patients were treated by open adrenalectomy and 35 by the lateral transperitoneal laparoscopic approach. Histological examination revealed 45 Conn's adenomas, of which 13 had a diameter of less than 1 cm (range 0.3

2006 World Journal of Surgery

3695. Composite pheochromocytoma associated with adrenal neuroblastoma in an infant: a case report. (Abstract)

Composite pheochromocytoma associated with adrenal neuroblastoma in an infant: a case report. A 5-year-old boy presented with headache and hypertension. Screening abdominal ultrasonography showed a 6-cm-sized mass in the left adrenal gland. Laboratory data included urine vanillylmandelic acid/creatinine (208.3 microg/mg), urine homovanillic acid/creatinine (114.3 microg/mg), serum epinephrine (237 pg/mL), and serum norepinephrine (1842 pg/mL). Metaiodobenzyl guanidine I 123 scintigram (...) , abdominal computed tomography, and abdominal magnetic resonance imaging revealed only left adrenal tumor with no metastasis. Left adrenalectomy was performed transperitoneally, and histopathological diagnosis was an adrenal composite pheochromocytoma associated with neuroblastoma. Immunoreactivity for vimentin was positive in pheochromocytoma, which was negative in neuroblastoma. After operation, the symptom of hypertension disappeared. We should examine the identification of composite pheochromocytoma

2006 Journal of Pediatric Surgery

3696. Minor morphologic abnormalities of adrenal glands at CT: prognostic importance in patients with lung cancer. (Abstract)

a focal adrenal mass at baseline CT. Two readers independently classified the morphologic features of each adrenal gland as normal, smoothly enlarged, or nodular at initial CT examination. They separately recorded the presence or absence of metastases to the adrenal glands (ie, any new focal adrenal mass) at final CT examination; a third independent reader arbitrated when interpretations were discordant (n = 11). Multivariate Cox proportional hazard models were used to assess for associations between (...) Minor morphologic abnormalities of adrenal glands at CT: prognostic importance in patients with lung cancer. To determine the prognostic importance of minor morphologic abnormalities of the adrenal glands at computed tomography (CT) in patients with lung cancer.The study was approved by the committee on human research; written informed consent was not required. The authors retrospectively identified 197 patients with lung cancer who underwent serial chest or abdominal CT and did not have

2005 Radiology

3697. Bilateral testicular adrenal rests after bilateral adrenalectomies in a cushingoid patient with von Hippel-Lindau disease. (Abstract)

Bilateral testicular adrenal rests after bilateral adrenalectomies in a cushingoid patient with von Hippel-Lindau disease. We report a case of bilateral testicular masses in a 25-year-old man with von Hippel-Lindau disease presenting with cushingoid symptoms. His medical history was significant for bilateral adrenalectomies secondary to pheochromocytomas, and he began steroid therapy at that time. After exhaustive endocrinologic, radiographic, and physical examinations, the testicular masses (...) were postulated to be active adrenal rest tissue. Bilateral testicular venous sampling found elevated glucocorticoids that were responsive to dexamethasone suppression, which confirmed the testicular masses as testicular adrenal rests without the need for surgical intervention. Successful conservative management consisted of appropriate steroid manipulation and radiographic evaluation and resulted in the resolution of presenting symptoms, a decrease in size of the bilateral testicular masses

2004 Urology

3698. Handling and pathology reporting of adrenal gland specimens. (Abstract)

Handling and pathology reporting of adrenal gland specimens. Proper treatment of resection specimens by the urologist and pathologist is critical in accurately reporting tumors and tumor-like nodules of the adrenal gland. Clinically inapparent adrenal masses are discovered, with increasing frequency, in the course of diagnostic testing or treatment for conditions that are not related to adrenal diseases. As a consequence an increasing number of relatively small tumors lacking the characteristic (...) gross features of malignancy is detected. There is a need for identification of pathological findings that can improve the diagnostic accuracy and predict patient outcome. The aim of this paper is to review the handling and pathology reporting of adrenal gland specimens in the light of recent advances in this field of pathology.

2004 European Urology

3699. Corticotroph adenoma of the pituitary in a patient with X-linked adrenal hypoplasia congenita due to a novel mutation of the DAX-1 gene. Full Text available with Trip Pro

. 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

2005 European Journal of Endocrinology

3700. Investigation of adrenal functions in patients with idiopathic hyperandrogenemia. Full Text available with Trip Pro

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

2006 European Journal of Endocrinology

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