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PubMed2003

Laparoscopic anterior adrenalectomy for the treatment of adrenal metastases.

Aim of this study was to evaluate the results in 6 patients undergoing laparoscopic adrenalectomy for the treatment of solitary adrenal gland metastases. One hundred forty-five patients underwent laparoscopic adrenalectomy by transperitoneal anterior approach. In 6 patients the indication was the presence of a solitary adrenal gland metastasis. Primary tumors were the following: truncal melanoma, gastric cancer, renal cancer, lung cancer, and breast cancer. Mean age was 57 years (range 44-70 years). Three patients underwent right adrenalectomy and 3 patients a left adrenalectomy. No conversion to open surgery occurred. No mortality or intraoperative complications were observed. Mean operative time was 103 minutes (range 70-150) for right adrenalectomy and 170 minutes (range 90-280) for left adrenalectomy. No postoperative complications occurred. Mean diameter of the tumor was 3.5 cm (range 2-5 cm). Tumor free margins were obtained in every case. Mean hospital stay was 2 days (range 2-3 days). At follow-up, 2 patients have died of systemic dissemination of the disease, one 15 months and one 24 months after the operation. The remaining 4 patients are alive and disease free at a mean follow-up of 7 months (range 4-11 months). So far, no port site metastases or local recurrence have been observed. In our experience adrenal gland metastasis can be treated safely and effectively by the laparoscopic transperitoneal anterior approach.

Adrenal Gland Neoplasms↗

PubMed2006

Benefits of laparoscopic adrenalectomy: a 10-year single institution experience.

INTRODUCTION: We aimed to compare the outcomes of laparoscopic and open adrenalectomies and to assess the impact of the availability of advanced laparoscopy on adrenal surgery at our institution. MATERIALS AND METHODS: A retrospective analysis of data of all patients who underwent adrenalectomy at the University of Massachusetts Medical Center over a 10-year period. RESULTS: Sixty-four consecutive patients underwent adrenalectomy during the study periods. There were 19 open (OA) and 45 laparoscopic (LA) adrenalectomies performed. There was no significant difference between the average size of adrenal masses removed for the LA and the OA groups [4.3 vs. 5.5 cm, respectively (P=0.23)]. LA proved superior to OA, resulting in shorter operative times (171 vs. 229 min, P=0.02), less blood loss (96 vs. 371 mL, P<0.01), shorter time to regular diet (1.9 vs. 4.4 d, P<0.001), and shorter hospital stay (2.5 vs. 5.8 d, P=0.02). In addition, the average annual number of adrenalectomies increased significantly since the establishment of our advanced laparoscopic program (10.0 vs. 2.0, P=0.02). CONCLUSIONS: LA offers superior results when compared to OA in terms of operative time, blood loss, return of bowel function, duration of hospital stay, and functional recovery. The availability of advanced laparoscopy has resulted in a significant increase in the number of adrenalectomies performed at our institution without a shift in surgical indications.

Adrenal Gland Neoplasms↗

PubMed2006

Indications for laparoscopic adrenalectomy for non-functional adrenal tumor with hypertension: usefulness of adrenocortical scintigraphy.

AIM: Laparoscopic adrenalectomy is currently indicated for biochemically and clinically functional adrenal tumors and potentially malignant tumors of the adrenal glands. Non-functional adenomas greater than 5 cm in diameter of the adrenal gland are generally considered to represent potentially malignant tumors. The present study shows indications of laparoscopic adrenalectomy for non-functional adrenal tumors with hypertension in a retrospective fashion. METHODS: Between 1994 and 2004, 110 laparoscopic adrenalectomies were performed at Tokushima University Hospital. All 110 patients underwent detailed endocrinological examination before surgery. Medical and operative records of these 110 patients (57 men, 53 women), including operative parameters, histopathological findings and pre- and postoperative hypertension, were reviewed. Forty-five patients underwent laparoscopic adrenalectomy for non-functional adrenal tumors, and [(131)I]6beta-iodomethyl-19-norcholest-5(10)-en-3beta-ol (NP-59) scintigraphy was performed for patients with preoperative hypertension. RESULTS: Mean patient age was 55.0 years (range, 22-77 years). Mean maximum tumor diameter was 42 mm (range, 20-105 mm). All adrenal tumors were removed successfully by laparoscopic surgery. Hypertension was postoperatively improved in seven of the 11 patients with preoperative hypertension, without subclinical Cushing syndrome. Importantly, all patients who improved hypertension after adrenalectomy displayed strong accumulation in adrenal tumors with visualization of the contralateral gland on NP-59 scintigraphy. Conversely, blood pressure did not improve in four patients for whom scintigraphy yielded negative results. CONCLUSIONS: The indication of laparoscopic adrenalectomy for non-functional adrenal tumors is generally considered for lesions more than 5 cm diameter. However, the present study suggests that laparoscopic surgery should be considered even in patients with tumors less than 5 cm in diameter, if both hypertension and accumulation in tumors on NP-59 scintigraphy are present.

Adenoma↗

PubMed1991

Zucker and Wistar diabetic fatty rats show different response to adrenalectomy.

The short-term effects of adrenalectomy on certain aspects of glucose homeostasis and adiposity were examined in Zucker and Wistar diabetic fatty (WDF) rats. Ten-week-old male obese and lean WDF and Zucker rats were adrenalectomized or underwent sham operation. Obese rats of each strain were pair fed the intake of obese adrenalectomized rats. Intragastric glucose tolerance tests showed that sham-operated obese rats of both strains were severely hyperinsulinemic compared with leans; adrenalectomy and pair feeding reduced palsma insulin to lean levels in Zucker but not WDF rats. At the time they were killed, sham-operated obese WDF rats were significantly hyperglycemic and hyperinsulinemic compared with other groups, but adrenalectomy reduced plasma glucose and insulin to lean levels in both strains. Adrenalectomy reduced inguinal and retroperitoneal fat pad weights more in Zucker than WDF obese rats. Although adrenalectomy decreased epididymal and inguinal fat cell size in both obese rat strains, the effect was greater in Zucker compared with WDF rats. These data suggest that the basis for the differential response to adrenalectomy in obese WDF and Zucker rats may reside in their different genetic backgrounds.

Adipose Tissue↗

PubMed1980

Adrenocorticotropin inhibits compensatory adrenal growth after unilateral adrenalectomy.

To determine the interaction between ACTH and compensatory adrenal growth after unilateral adrenalectomy, we have studied the adrenals of young male rats treated with saline, ACTH, dexamethasone, or hypophysectomy and left or sham adrenalectomy (Adx or Sham). ACTH injected at the time of adrenal surgery inhibited the normal increase in [3H]thymidine incorporation into right adrenal DNA at 12 or 18 h (P < 0.05), but increased the RNA content. ACTH treatment (2, 4, or 8 U twice daily) in Shams caused a dose-dependent increase in adrenal weight and the RNA to DNA ratio at 24 h and, subsequently, a dose-dependent increase in adrenal DNA content at 72 h. ACTH treatment of Adx prevented the increase in adrenal DNA content at 24 h (P < 0.05), while increasing the RNA to DNA ratio (P < 0.05) in a dose-dependent manner. Treatment of rats with dexamethasone decreased adrenal weight and RNA content and attenuated the normal response to Adx. ACTH (1 U) at the time of adrenalectomy or sham operation in hypophysectomized rats abolished the normal difference between right adrenal weights in the two groups at 3 days. Adrenal growth occurred in rats hypophysectomized and adrenalectomized 24 h previously compared to Sham controls. These results show that adrenal growth mediated by ACTH is a different cellular process (hypertrophy) from that growth triggered by unilateral adrenalectomy (hyperplasia). Treatment with a long acting preparation of ACTH causes adrenals in rats from both the Sham and Adx groups to grow, and the process of ACTH-mediated adrenal growth inhibits the rapid proliferative response to unilateral adrenalectomy. A proliferative response may occur by 3 days during treatment with large doses of long acting ACTH. Treatment at adrenalectomy with synthetic alpha ACTH-(1-24) abolished the normal increase in adrenal weight at 20 h.

Adrenal Glands↗

PubMed1993

Maternal adrenalectomy alters the immune and endocrine functions of fetal alcohol-exposed male offspring.

Exposure to ethanol in utero compromises the offspring's developing immune and endocrine systems. Persistent functional changes, particularly in T-cell-dependent aspects of immunity and in hypothalamic-pituitary-adrenal activity, are commonly seen. The present study examined the degree to which fetal alcohol exposure (FAE) during development suppressed the lymphocyte proliferative response to Concanavalin-A (Con A). We also examined the effect of maternal adrenalectomy on the expression of glucocorticoid-regulated genes and the response to Con A in FAE offspring. Con A-stimulated lymphocyte proliferation was stably suppressed (between 28-46%) in FAE males compared to isocalorically pair-fed offspring at 7, 21, 40, and 60 days of age. In contrast, lymphocyte proliferation in the immature or peripubertal FAE female was totally unaffected. In 60-day- old male rats, maternal adrenalectomy reversed the FAE-induced suppression of Con A-stimulated proliferation, but had no effect on lymphocyte proliferation. FAE increased anterior pituitary POMC (the precursor of ACTH) mRNA levels dramatically in males, and this increase was also reversed by maternal adrenalectomy. In both sexes, anterior pituitary glucocorticoid receptor mRNA levels were unaffected by prenatal alcohol exposure alone, but were significantly decreased in male and increased in female offspring of adrenalectomized dams ingesting alcohol. Furthermore, in male, but not female, offspring, hypothalamic levels of glucocorticoid receptor and CRF mRNA were increased significantly by FAE alone or in combination with maternal adrenalectomy. In female, but not male, offspring, maternal adrenalectomy with concomitant alcohol exposure increased anterior pituitary POMC mRNA levels compared to that in sham/pair-fed offspring. In summary, FAE induced a gender-specific impairment of Con A-stimulated lymphocyte proliferation. This deficit is present both before and after puberty, demonstrating its stability into adulthood. Furthermore, in males, maternal adrenalectomy reversed these FAE-induced deficits in T-cell function as well as the effect of FAE on anterior pituitary POMC expression. This supports the hypothesis that maternal adrenal hormones participate in the immunosuppressive "imprinting" of the FAE fetus and are, therefore, causally implicated in the sexually dimorphic T-cell dysfunction found in FAE offspring.

Adrenalectomy↗

PubMed1997

Regulation of pituitary V1b vasopressin receptor messenger ribonucleic acid by adrenalectomy and glucocorticoid administration.

Regulation of the number of pituitary vasopressin (VP) receptors plays an important role in controlling pituitary responsiveness during alterations of the hypothalamic pituitary adrenal axis. The mechanisms regulating these VP receptors were studied by analysis of the effects of adrenalectomy and glucocorticoid administration on V1b receptor (V1b-R) messenger RNA (mRNA) by Northern blot and by in situ hybridization in the rat. Adrenalectomy transiently decreased V1b-R mRNA levels by 18 h (77% and 62% for the 3.7-kb and 3.2-kb bands in the Northern blots, and 50% by in situ hybridization), returning to basal levels after 6 days. The decrease in V1b-R mRNA after 18 h adrenalectomy was fully prevented by dexamethasone (100 microg s.c.) but not by elimination of hypothalamic CRH and VP by paraventricular nucleus lesions or median eminence deafferentation. In sham-operated rats, dexamethasone increased receptor mRNA by 50% after 6 days. In contrast to Sprague-Dawley rats, in Brattleboro rats (di/di), which lack hypothalamic VP, adrenalectomy caused a sustained decrease in V1b-R mRNA levels (<50% of controls by 6 days). The data show that pituitary V1b-R mRNA is positively regulated by glucocorticoids and that the recovery of V1b-R mRNA levels after prolonged adrenalectomy is probably mediated by VP. In addition, the data suggest that the down-regulation of VP binding after long-term adrenalectomy is due to posttranscriptional events rather than to changes in V1b-R mRNA.

Adrenalectomy↗

PubMed2001

Laparoscopic adrenalectomy for adrenocorticotropin-dependent Cushing's syndrome.

Bilateral adrenalectomy is indicated for the treatment of ACTH-dependent Cushing's syndrome when the tumorous source of ACTH hypersecretion cannot be identified or removed. Potential advantages of laparoscopic over open adrenalectomy include shorter hospitalization, decreased requirement for postoperative analgesia, and decreased postoperative morbidity due to incisional complications. Bilateral laparoscopic adrenalectomy performed for the treatment of ACTH-dependent Cushing's syndrome was attempted in 19 patients at our institution between 1995 and 1998. Conversion to an open procedure was required in three patients. All patients who underwent bilateral laparoscopic adrenalectomy were subsequently followed to assess the outcome of this intervention. Twelve patients with pituitary-dependent Cushing's syndrome and four with ectopic ACTH syndrome underwent successful bilateral laparoscopic adrenalectomy. All patients experienced resolution of the signs and symptoms (e.g. proximal myopathy, hirsutism, and emotional lability) of Cushing's syndrome as well as weight loss, improved glucose tolerance, and improved control of blood pressure. No residual cortisol secretion was detected in the patients. Bilateral laparoscopic adrenalectomy is a safe and effective treatment for Cushing's syndrome when the ACTH-secreting neoplasm cannot be removed.

ACTH Syndrome, Ectopic↗

PubMed2002

The effect of adrenalectomy on leptin levels and some metabolic parameters in rats with diet-induced obesity.

Recently, there has been many investigations on the relationship between leptin and obesity, which is the main health problem in developed countries. In some reports, it has been claimed that the adrenalectomy has lead to weight loss and thus prevented obesity induced in rodents in various ways. It has also been accepted that diet-induced obesity in animals is very similar to obesity in humans beings. In this study, obesity has been developed with high-calorie diet given for 8 weeks in Sprague-Dawley rats. Then, it has been investigated how leptin and some metabolic parameters change in blood samples obtained from rats 15 d after adrenalectomy. Leptin levels was determined with Radio Immun Assay (RIA, Linco Research Co) method. Our study showed that, there were statistically significant increases in leptin (p<0.001), glucose (p<0.05), triglyceride (p<0.01) levels in diet-induced obese rats (n=19) when compared with the findings of control rats, lean ones (n=16), (Tables 3, 4). Adrenalectomy led to decreased serum leptin (p<0.001) and triglyceride (p<0.01) levels both in the obese and lean rats (Table 5). As a conclusion, it could be claimed that the decrease in leptin levels may be attributed to reduced adipose tissue due to adrenalectomy. On the other hand, the decreases in glucose and triglyceride levels might be the consequence of reduced lipogenesis and impaired gluconeogenesis with the effect of adrenalectomy. It was concluded that adrenalectomy might prevent obesity by affecting leptin and intermediate metabolism.

Adrenalectomy↗

PubMed1988

Effects of adrenalectomy on pharmacokinetics and antinociceptive activity of morphine in rats.

The effects of adrenalectomy on the pharmacokinetics and antinociceptive activity of morphine were investigated to elucidate the mechanism of adrenalectomy-induced potentiation of morphine antinociception in rats. Plasma concentrations of morphine were estimated specifically and serially in each rat by high performance liquid chromatography with an electrochemical detector. After the intravenous administration of 10 mg/kg morphine, the plasma half-life of morphine was significantly prolonged by adrenalectomy without any effect on the volume of morphine distribution. After the subcutaneous administration of 7 mg/kg morphine, pharmacokinetic parameters were changed by adrenalectomy in the same manner as after intravenous administration. In contrast, after the subcutaneous injection of 3.5 mg/kg morphine, adrenalectomy failed to change the pharmacokinetic parameters. The antinociceptive potency of subcutaneously administered morphine was enhanced by adrenalectomy for both doses of morphine (3.5 and 7 mg/kg). Morphine antinociception at the dose of 3.5 mg/kg, s.c., in the adrenalectomized group was equipotent with that of 7 mg/kg, s.c., in the sham-operated group, but plasma morphine concentrations for 3.5 mg/kg, s.c., in the adrenalectomized group were significantly lower than those for 7 mg/kg morphine, s.c., in the sham-operated group. These results suggest that the enhancement of morphine antinociception by adrenelectomy can not be explained by the increased morphine level alone.

Adrenalectomy↗

PubMed2003

Unilateral adrenalectomy improves insulin resistance and diabetes mellitus in a patient with ACTH-independent macronodular adrenal hyperplasia.

ACTH-independent macronodular adrenal hyperplasia (AIMAH) is a rare cause of Cushing's syndrome. Bilateral adrenalectomy is considered to be a standard therapy for AIMAH, although lifetime replacement of glucocorticoids is necessary after the procedure. This paper describes a subject with AIMAH who underwent unilateral adrenalectomy of the predominantly enlarged gland and subsequently displayed an improvement in insulin resistance and diabetes mellitus, the cardinal symptoms before the operation, concomitant with alleviation of abnormal cortisol secretion. The patient was a 61-year-old man with a body mass index of 25.6 kg/m2. He was diagnosed as having diabetes mellitus, hypertension, and hyperlipidemia at 50 years of age. Eight years after diagnosis, bilateral enlargement of the adrenal glands was revealed by chance upon computed tomography of the abdomen. Typical manifestations of Cushing's syndrome were not demonstrated. Basal levels of serum and urinary cortisol had not increased, although the serum cortisol level displayed no circadian rhythm and no response to the administration of dexamethasone. Despite sulfonylurea treatment, the patient's HbA1C level was as high as 7.6% (normal range 4.3-5.8%). Fasting insulin concentration was increased to 42.6 microU/ml, and the homeostasis model insulin resistance index (HOMA-R) was calculated to be 15.5 (with a normal range of less than 2.5), indicating severe insulin resistance. Unilateral adrenalectomy of the predominantly enlarged gland revealed that the resected gland consisted of multiple nodules of various sizes. Based on endocrinological, radiological, and pathological findings, a diagnosis of AIMAH was made. Ten months after the unilateral adrenalectomy, cortisol circadian rhythms were restored, and serum cortisol concentration was suppressed in response to the administration of low doses of dexamethasone, suggesting an improvement in the cortisol secretory pattern. Levels of HbA1C, fasting insulin, and HOMA-R decreased to 5.7%, 12.7 microU/ml, and 2.2, respectively. An improvement in hyperlipidemia was also observed. Insulin resistance and glucose intolerance are recognized as features of mild hypercortisolism. In the present case, unilateral adrenalectomy was effective in ameliorating insulin resistance and improving glycemic control. Unilateral adrenalectomy might be an alternative therapy for improvement of glucose and lipid metabolism in subjects with AIMAH.

Adrenal Gland Diseases↗

PubMed1981

Changes in distribution of molecular weight forms of biologically active and immunoreactive adrenocorticotropic hormone after adrenalectomy in rat anterior pituitary.

The concentration of ACTH in extracts of rat anterior pituitary was measured by both radioimmunoassay and bioassay at different stages following adrenalectomy. Both types of ACTH activity decreased the day immediately following adrenalectomy but increased gradually afterwards. Immunological ACTH activity increased to 250% of the control value and biological ACTH activity increased to 490% of control value 3 weeks after adrenalectomy. The increase in biological ACTH activity occurred earlier, and the rate of increase was greater, than that of the immunological ACTH activity. The distributions of molecular weight forms of ACTH in extracts of anterior pituitary lobes was determined by gel filtration. Three molecular weight forms of immunoassayable ACTH were detected. Biological ACTH activity appeared in the 2nd and the 3rd peaks. A striking change was observed after adrenalectomy in the distribution of biologically active forms of ACTH. The ratio of biological ACTH activity to immunological ACTH activity in each peak changed at various stages after adrenalectomy. This indicated the heterogenous nature of the ACTH included in each peak. At 2 and again at 3 weeks, biological activity markedly increased until it exceeded the immunological ACTH activity in the 2nd peak. Dexamethasone had little influence on the elution profile of either immunoassayable and biologically active ACTH in gel filtration. Adrenalectomy may possibly have an effect on the intracellular posttranslational processing of ACTH precursors which leads to the development of biological ACTH activity.

Adrenalectomy↗

PubMed2002

Bilateral laparoscopic adrenalectomy as a treatment for classic congenital adrenal hyperplasia attributable to 21-hydroxylase deficiency.

OBJECTIVE: Current medical therapy for congenital adrenal hyperplasia (CAH) attributable to a complete 21-hydroxylase deficiency is not optimal. Difficulties in adequate adrenal androgen suppression are common, causing short adult stature, infertility, and hyperandrogenism. We report the use of laparoscopic bilateral adrenalectomy as a definitive therapy for this condition and argue that it is superior to conventional medical therapy in selected patients. METHODS: Participants were 2 adult females with classic, salt-wasting CAH and a history of poor adrenal control were selected for adrenalectomy: case 1 was a 22-year-old woman with mild hirsutism and primary amenorrhea; case 2 was a 28-year-old woman with severe hirsutism, acne, and amenorrhea. Preoperative and postoperative hormonal profiles were performed. Both underwent laparoscopic bilateral adrenalectomy with a mean follow-up of 37 months. RESULTS: Bilateral laparoscopic adrenalectomy was performed in both patients with no complications and an uneventful recovery. Maintenance medications of glucocorticoid and mineralocorticoid replacement were reduced compared with preoperative doses. Three years postoperatively, however, rising adrenal steroid precursor levels in case 1, presumably caused by adrenal rests, prompted an increase in replacement therapy dose. Hirsutism and acne improved in both patients, and regular menstruation began 5 months (case 1) and 2 months (case 2) postoperatively. Pregnancy 3 years postoperatively was successful in case 2, who delivered a unaffected infant, full-term via Cesarian section. CONCLUSIONS: Surgical adrenalectomy should be considered in females with classic CAH attributable to 21-hydroxylase deficiency and a history of poor hormonal control. Adrenalectomy may prove to be superior to current medical therapy for these patients.

Adrenal Hyperplasia, Congenital↗

PubMed1980

Effects of adrenalectomy on reproduction in the mouse.

Survival of mice treated with sesame seed oil after adrenalectomy was very low and suggested no beneficial effect, whereas treatment with progesterone improved the chances of survival. Treatment with desoxycorticosterone acetate (DOCA) and methyl prednisolone acetate also increased the number of animals surviving after adrenalectomy. The corticosteroids were significantly more effective in ensuring survival than was progesterone. There was no significant difference in survival between mice receiving a single injection of 1.0 mg DOCA and those being given an injection of 1.0 mg DOCA per day for 3 days after the operation. To ensure minimum interference of exogenous corticosteroid with the experimental investigation, animals routinely received only a single injection of 1.0 mg DOCA after the operation. The chance of survival after adrenalectomy was higher in pregnant than in non-pregnant mice. There was a significant linear increase in survival during the first 5 days of pregnancy. Progesterone and prolactin both appeared to be involved in increasing the chance of survival in adrenalectomized pregnant mice. Adrenalectomy had no effect on the number of mice mating and ovulating. Adrenalectomized mice were apparently having normal cycles and 4 weeks after adrenalectomy they were able to mate and ovulate. Compensatory ovulation was seen in hemi-ovariectomized mice and was not abolished by adrenalectomy. Implantation was also unaffected by the operation.

Adrenal Glands↗

PubMed2004

Pituitary mitosis and apoptotic responsiveness following adrenalectomy are independent of hypothalamic paraventricular nucleus CRH input.

We have previously identified a series of age-dependent, temporally constrained and closely interdependent mitotic and apoptotic events in the male rat anterior pituitary that occur in response to timed single and repeated hypothalamo-pituitary-adrenal axis stimuli. One of the most dramatic of these is the short burst of apoptosis that occurs 24-48 h after exposure to dexamethasone. If bilateral adrenalectomy precedes exposure to dexamethasone by 1-2 weeks, mitotic activity is transiently increased and the subsequent apoptotic response to dexamethasone greatly enhanced. This study was designed to determine whether adrenalectomy-induced augmentation of the apoptotically sensitive pituitary cell population is mediated via glucocorticoid withdrawal at the level of the pituitary, or whether increased exposure to hypothalamo-hypophyseal trophic hormones of paraventricular origin is responsible. We used stereotaxic surgery to isolate both paraventricular nuclei without disturbing either median eminence input from the arcuate and supraoptic nuclei, or the hypothalamo-hypophyseal-portal blood flow that carries a significant proportion of the pituitary systemic supply. When bilateral adrenalectomy and paraventricular nucleus disconnection were combined, the adrenalectomy-induced increase in anterior pituitary pro-opiomelanocortin (POMC) transcript prevalence was abolished, confirming the loss of paraventricular corticotrophin-releasing hormone (CRH) input. However, the amplitude and pattern of the adrenalectomy-induced anterior pituitary mitotic response and enhancement of the apoptotic response to dexamethasone 1 week later remained completely intact. These data demonstrate that anterior pituitary trophic responses following bilateral adrenalectomy are more likely to be mediated through direct glucocorticoid withdrawal at the level of the pituitary rather than via changes in hypothalamo-hypophyseal releasing factor exposure. This finding highlights the presence of distinct control systems for pituitary hormone gene expression and pituitary mitotic and apoptotic responses.

Adrenalectomy↗

PubMed2000

Adrenalectomy reverses obese phenotype and restores hypothalamic melanocortin tone in leptin-deficient ob/ob mice.

In genetically obese leptin-deficient ob/ob mice, adrenalectomy reverses or attenuates the obese phenotype. Relative to lean controls, ob/ob mice also exhibit decreased hypothalamic proopiomelanocortin (POMC) mRNA and increased hypothalamic agouti-related peptide (AGRP) mRNA and neuropeptide Y (NPY) mRNA. It has been hypothesized that this profile of hypothalamic gene expression contributes to the obese phenotype caused by leptin deficiency. To assess if reversal of obese phenotype by adrenalectomy entails normalization of hypothalamic gene expression, male wild-type and ob/ob mice were adrenalectomized (with saline supplementation) or sham adrenalectomized at 2 months of age. Mice were sacrificed 2 weeks after adrenalectomy, during which time food intake and body weight were monitored daily. After sacrifice, hypothalamic gene expression was assessed by Northern blot analysis as well as in situ hybridization. In wild-type mice, adrenalectomy significantly decreased AGRP mRNA but did not significantly influence POMC or NPY mRNA. In ob/ob mice, adrenalectomy reduced the levels of plasma glucose, serum insulin and corticosterone, and food intake toward or below wild-type levels, and it restored hypothalamic POMC and AGRP mRNA but not NPY mRNA to wild-type levels. These studies suggest that adrenalectomy reverses or attenuates the obese phenotype in ob/ob mice, in part by restoring hypothalamic melanocortin tone toward wild-type levels. These studies also demonstrate that factors other than leptin may play a major role in regulating hypothalamic melanocortin function.

Adrenalectomy↗

PubMed1997

Is routine ipsilateral adrenalectomy during radical nephrectomy harmful for the patient?

To investigate the effects of unilateral adrenalectomy on the postoperative course and laboratory parameters, 40 patients with a renal tumour were randomized either to undergo (n = 20) or not to undergo (n = 20) ipsilateral adrenalectomy. Adrenal hormone (cortisol, epinephrine, norepinephrine and aldosterone), adrenocorticotropic hormone, electrolyte, creatinine, growth hormone, glucose, insulin and free fatty acid concentrations were measured preoperatively and postoperatively. Cortisol and epinephrine concentrations were elevated immediately after the operation but returned to preoperative levels within the first 2 postoperative days. There were no significant differences between the adrenalectomy and non-adrenalectomy groups, except that the cortisol concentration was higher in the latter in the afternoon of the day of surgery. The conclusion is that no long-term shortage of adrenal hormones is caused by unilateral adrenalectomy. Other metabolic and endocrine responses were identical in the groups. Thus ipsilateral adrenalectomy does not seem to be harmful to the patient and the need for it must be resolved on the basis of local tumour factors.

Adrenalectomy↗

PubMed1998

Corticotropin releasing hormone antagonist does not prevent adrenalectomy-induced apoptosis in the dentate gyrus of the rat hippocampus.

Adrenalectomy in the mature rat leads to death of granule cells in the dentate gyrus of the hippocampal formation. The mechanisms underlying this cell death have not been fully clarified: It has been considered that the granule cells require adrenal steroids for their survival, since corticosterone replacement prevents their death. However, adrenalectomy-induced loss of negative feedback also increases levels of corticotropin releasing hormone (CRH) in several limbic brain regions. CRH is known to induce neuronal death in hippocampal regions rich in CRH receptors. This study tested the hypothesis that adrenalectomy-induced granule cell death is mediated via the enhanced activation of CRH receptors. The extent of granule cell degeneration was compared among 4 groups of young adult male rats: Sham-adrenalectomy controls, adrenalectomized rats, adrenalectomized rats infused with a CRH antagonist from the onset of steroid deprivation to the time of sacrifice, and adrenalectomized rats infused with vehicle only. (9-41)-alpha-helical CRH was administered using an osmotic pump into the cerebral ventricles. Adrenalectomy led to robust granule cell degeneration, which was maximal in the suprapyramidal blade of the dentate gyrus. Infusion of the CRH antagonist in doses shown to block CRH actions on limbic neurons did not decrease the number of degenerating granule cells compared with the untreated or vehicle-infused adrenalectomized groups. Therefore, blocking the actions of CRH does not prevent adrenalectomy-induced granule cell death, consistent with a direct effect of corticoids on the survival of these neurons.

Adrenalectomy↗