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Diabetes insipidus and adrenal insufficiency in a patient with metastatic breast cancer.

A patient previously treated for bilateral breast cancer with mastectomy, radiation therapy and in remission on hormonal therapy for more than five years presented with abdominal symptoms from breast cancer relapse. She developed inappropriate polyuria and hypernatraemia, which responded to desmopressin. In combination with the absence of a high signal from the posterior lobe of the pituitary on MRI , these data indicated the presence of partial central diabetes insipidus. The anterior pituitary showed partial failure (low follicle-stimulating hormone, luteinising hormone and insulin-like growth factor-1 levels). Furthermore, primary adrenal insufficiency had developed, ascribed to bilateral tumour invasion of the adrenals. This rare combination of endocrinological failures in a patient with metastatic breast cancer is discussed.

Adrenal Gland Neoplasms↗

[Aspiration puncture biopsy in the preoperative diagnosis of adrenal tumors].

The results of fine-needle aspiration puncture (AP) and cytologic examination in the preoperative period in 4 patients with various lesions of the adrenals are discussed. AP was conducted under local anesthesia and control by ultrasonic examination; no complications occurred. Analysis of the cytologic findings allowed preoperative morphological verification of the process, as a result of which the initial clinical diagnosis was changed in 2 of the 4 cases. With an exactly established preoperative cytologic diagnosis a rational therapeutic tactics can be chosen, and the necessity of using complicated examination methods, diagnostic laparotomy among others, obviated.

Adenoma↗

[The diagnostic value of radiological examinations in Conn's syndrome: angiographic findings in 58 cases (author's transl)].

Selective adrenal phlebography with measurement of hormone levels was used to investigate the majority of 58 cases of primary hyperaldosteronism. The authors stress the importance of pre-operative diagnosis of the lesion as surgery is indicated for adenomas only, and because of their small size they are often missed in adrenal scintigrams and on manual exploration during operation. They are in agreement with most other authors that adrenal phlebography is the most valid investigation, as it gives a precise diagnosis of the lesion in 92% of cases. The angiographic findings in the most common lesions are described, the difficulty in diagnosing peripheral small adenomas stressed, and the problems associated with the diagnosis of nodular hyperplasias outlined. They also underline the fundamental importance of selective hormone levels measurement, as these results are of equal value to those of the images themselves.

Adenoma↗

The dexamethasone-modified adrenal scintiscan in hyporeninemic aldosteronism (tumor versus hyperplasia). A comparison with adrenal venography and adrenal venous aldosterone.

The dexamethasone-modified adrenal scintiscan, a noninvasive procedure, is described for the preoperative distinction between primary aldosteronism (aldosterone-producing ademona) and idiopathic aldosteronism (bilateral hyperplasia) and for the preoperative localization of aldostersone-producing adenomas. This procedure has been carried out on 17 subsequently proved cases of primary aldosteronism and nine cases (four unexplored) of idiopathic aldosteronism. In the tumor cases, it indicated correctly the side of the tumor in 88 per cent. It was correct in predicting the existence of bilateral hyperplasia in all of the five cases explored. It produced the same response in four more cases believed to have bilateral hyperplasia, in which surgical exploration has not been carried out. Many of the same patients had, in addition, standard adrenal scintiscans (SS), adrenal venography, and determinations of aldosterone in adrenal venous blood. These results are compared with those of the dexamethasone scintiscan (DS). In tumor localization, the 88 per cent figure for the DS was only moderately better than that of the other three (71 per cent, SS; 80 per cent, venography; 80 per cent, adrenal venous aldosterone levels). However, in predicting bilateral hyperplasia, the DS was 100 per cent correct, as were the levels of aldosterone in adrenal venous blood. The SS and adrenal venography failed in bilateral hyperplasia and gave many false-positive results indicating tumor. The DS, a relatively simple outpatient procedure, appears to be at least as effective, both in lateralizing tumors and distinguishing between tumor and bilateral hyperplasia, as the more difficult, expensive, and sometimes hazardous invasive procedure of bilateral adrenal vein catheterization.

Adolescent↗

Primary neoplasms of the adrenal gland; diagnosis and surgical management.

Tumors of the adrenal glands produce hormones which cause a variety of symptoms and signs including high blood pressure, excessive growth of hair on the body and precocious sexual development. By recently developed tests, it has been possible to differentiate high blood pressure due to these tumors from hypertension due to other causes. Removal of these tumors will often alleviate changes caused by them. Localization of the tumor and appraisal of the condition of the contralateral gland should be carried out preoperatively if possible. In this, several kinds of roentgen studies are helpful. Infusions of drugs during operation can be used to control the blood pressure which otherwise would vary widely. During a ten-year period (1942 to 1951) there were observed at the Los Angeles County General Hospital 100 proved cases of non-secreting and secreting primary neoplasms of the adrenal glands. In addition, there were three cases of Cushing's syndrome due to bilateral adrenal cortical hyperplasia, and ten probable cases (four, pheochromocytomas; five, Cushing's syndrome; one, adrenogenital syndrome) in which operation was not done.

Adrenal Gland Neoplasms↗