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Cysts of the adrenal gland are very rare in the neonatal period and are always diagnosed either at surgery or at autopsy. Two patients are reported. One is an infant born at term in whom a mass in the left loin was discovered on the 3rd day of life. At surgery a suprarenal tumour was discovered and a polycystic adrenal was removed: recovery was uneventful. Histology showed a cystic haemangioma in the adrenocortical tissue. The diagnosis made was that of a cystic haemangioma. The other patient is an infant born at 38 weeks gestation who became jaundiced and developed a haemolytic streptococcal septicaemia. A mass was found in the right lumbar region on the 3rd day. The calcified egg-shell appearance, renal arteriography and an intravenous pyelogram demonstrated the cystic appearance of the adrenal. The cystic mass and the adrenal gland were removed and the patient recovered. Histological examination suggested that a pseudocyst had arisen secondary to a haemorrhagic infarct caused by a septic embolus. Adrenal cysts are classified as true cysts and pseudocysts (which must be distinguished from unilateral haematomas). The histological appearances are reviewed. These patients may be added to the 11 neonatal case reports in the literature (9 haemorrhagic pseudocysts, only 2 true cysts). To our knowledge cystic haemangioma has not previously been reported.
Many women have some facial hair, and most patients who seek advice will be at the far end of the normal distribution curve for hair. In a second group there is a slight excessive production of androgens with associated hirsutism, either idiopathic or associated with polycystic ovarian disease. An extremely small fraction of patients will have serious disorders of the adrenals or ovaries and significant elevations in androgen levels.
The accuracy of prospective diagnosis of functional adrenal disorders by computed tomography (CT) was evaluated in 65 patients strongly suspected of having such disorders. Thirty-seven patients also underwent adrenal venography and selective adrenal venous sampling. Of the 65 patients, 21 had a hyperfunctioning cortical adenoma, 25 had cortical or medullary hyperplasia, and 11 pheochromocytoma, while 10 had no functional adrenal disease. Diagnosis by CT alone was correct in 66%; diagnosis by CT and venous sampling was correct in 89%. Incorrect prospective CT diagnosis resulted most often from a normal appearance of functionally hyperplastic glands (9 cases), nodular hyperplasia simulating a focal adenoma (8 cases), or an incidental nonfunctioning mass (3 cases). This study emphasizes the need to correlate CT findings with biochemical evaluation and the usefulness of venous sampling in selected cases to avoid inappropriate surgery. When CT is interpreted in correlation with complete biochemical analysis, correct diagnosis can usually be made. A small number of cases may still require adrenal venous sampling.
OBJECTIVE: To evaluate the effectiveness of endoscopic retroperitoneal adrenalectomy (ERA). SUMMARY BACKGROUND DATA: Minimally invasive adrenalectomy has become the procedure of choice for benign adrenal pathology. Although the adrenal glands are located in the retroperitoneum, most surgeons prefer the transperitoneal laparoscopic approach to adrenal tumors. METHODS: Clinical characteristics and outcomes of 111 ERAs from January 1994 to December 1999 were evaluated. RESULTS: Ninety-five patients underwent 111 ERAs (79 unilateral, 16 bilateral). Indications were Cushing syndrome (n = 22), Cushing disease (n = 8), ectopic adrenocorticotropic hormone syndrome (n = 6), Conn's adenoma (n = 25), pheochromocytoma (n = 19), incidentaloma (n = 11), and other (n = 4). Tumor size varied from 0.1 to 8 cm. Median age was 50 years. Unilateral ERA required 114 minutes, with median blood loss of 65 mL. Bilateral ERA lasted 214 minutes, with median blood loss of 121 mL. The conversion rate to open surgery was 4.5%. The complication rate was 11%. Median postoperative hospital stay was 2 days for unilateral ERA and 5 days for bilateral ERA. The death rate was 0.9%. At a median follow-up of 14 months, the recurrence rate of disease was 0.9%. CONCLUSION: For benign adrenal tumors less than 6 cm, ERA is recommended.
In previous works we have demonstrated plasma CoQ10 alterations in pituitary diseases, such as acromegaly or secondary hypothyroidism. However, pituitary lesions can induce complex clinical pictures due to alterations of different endocrine axes controlled by pituitary itself. A further rationale for studying CoQ10 in pituitary-adrenal diseases is related to the common biosynthetic pathway of cholesterol and ubiquinone. We have therefore assayed plasma CoQ10 levels in different conditions with increased or defective activity of pituitary-adrenal axis (3 subjects with ACTH-dependent adrenal hyperplasia, 2 cases of Cushing's disease and 1 case of 17-alpha-hydroxylase deficiency; 10 subjects with secondary hypoadrenalism, including three subjects with also secondary hypothyroidism). CoQ10 levels were significantly lower in isolated hypoadrenalism than in patients with adrenal hyperplasia and multiple pituitary deficiencies (mean +/- SEM: 0.57 +/- 0.04 vs 1.08 +/- 0.08 and 1.10 +/- 0.11 microg/ml, respectively); when corrected for cholesterol levels, the same trend was observed, but did not reach statistical significance. These preliminary data indicate that secretion of adrenal hormones is in some way related to CoQ10 levels, both in augmented and reduced conditions. However, since thyroid hormones have an important role in modulating CoQ10 levels and metabolism, when coexistent, thyroid deficiency seems to play a prevalent role in comparison with adrenal deficiency.
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Ultrasound investigations, which are non-invasive and have a relatively low cost, are of primary importance nowadays in the diagnosis of a number of abdominal diseases. Nevertheless, their use to study adrenal masses still gives rise to different interpretations, as the small dimensions, deep position within the retroperitoneum and fatty envelopment of the normal adrenal gland make it difficult to identify using this method. However, the introduction of new equipment and probes with a higher image resolution, combined with increasing experience on the part of the operators, is greatly improving the situation. The percentage of visualization of the normal adrenal gland, which in the past was only 78% on the left and 44% on the right, according to Yeh, now oscillates between 90 and 95% on the left and 70 and 90% on the right. The overall sensitivity of ultrasound investigations found by the A.A. on a total of 44 expanding processes successively subjected to surgery, was 86.3% (96% on the right, 68.4% on the left, with a sensitivity of 100% for all masses greater than 3 cm. These results confirm the role of ultrasound in the diagnosis of adrenal masses.
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