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Neonatal adrenal hemorrhage detected antenatally.

This report describes two cases of neonatal adrenal mass detected antenatally by routine ultrasound (US) examination of pregnant women. Case 1 was recognized by the fetal US at 31 weeks gestation. The mass, located near the right upper pole of the kidney, was echolucent on US examination. A serial US of the mass showed changes of the internal echoes from a cystic lesion to a mixed lesion, and finally to a hyperechogenic lesion due to a neonatal adrenal hemorrhage (NAH). At 33 days, laparotomy was performed, and the pathological finding revealed an NAH owing to the mass bleeding into the adrenal cyst. Case 2 was also detected by fetal US just before birth. The mass of the right upper pole of the kidney was hyperechogenic on US examination. The baby clinically deteriorated after birth because of hypovolemia owing to NAH. A serial US of the mass showed the change from a hyperechogenic to a cystic lesion. Four months later, the mass spontaneously resolved. From the US spectrum, the mass was diagnosed as NAH. These are the second known cases of NAH detected before birth in Japan.

Adrenal Gland Diseases↗

Endocrine diagnosis by ultrasound. I. The thyroid, parathyroid and adrenal glands.

The value of ultrasounds in diagnosis endocrine disorders and especially in localizing the tumors of the endocrine glands such as the thyroid, parathyroid, ovary and adrenal has been proved. Ultrasounds are also useful in following up the structural changes occurring in these glands after drug or radioisotopic therapy.

Adrenal Gland Diseases↗

[Aspects of hypertension of endocrine and adrenal origin].

The authors discuss the results of observation of 269 patients with adrenal arterial hypertension 247 of whom underwent operation. The malignant hypertension syndrome developed in 39% of the patients. It is presumed that its development was caused by the combination of adrenal and renal affections as well as by specific hormonal shifts: relative norepinephrine hyperproduction and reduced intensity of catecholamine metabolism. In all groups of the patients with the malignant hypertension syndrome, a higher daily excretion of aldosterone and increased blood renin activity were also found. The character of the drug therapy and the late results of surgical treatment are discussed. A new variant of hyperaldosteronism, dexamethasone-inhibited form of aldosteroma, is described.

Adrenal Gland Diseases↗

[Endocrine crises].

Endocrine crises can occur in diabetes mellitus, in pituitary failure when there is a lack of ACTH, TSH or ADH secretion, in severe hyper- or hypothyroidism (thyroid storm and myxedema coma), severe hyper- or hypoparathyroidism (parathyroid crisis and tetany), in adrenal failure and in patients with pheochromocytoma or carcinoid tumors. Cushing's syndrome can be associated with psychotic crises. This review describes the most important clinical features and the basic diagnostic and therapeutic aspects of the non diabetic endocrine crises.

Adrenal Gland Diseases↗

Adrenal dysfunction in patients with renal amyloid.

Amyloidosis is a multi-system disease. Renal involvement often leads to end-stage renal failure, which carries a poor prognosis. This paper reports the adrenal status of 22 patients with renal amyloid who were considered for or who had been commenced on renal replacement therapy. Twelve patients were considered or found to have AA amyloid and the remaining 10 had AL amyloid. Of 16 patients tested, seven demonstrated an abnormal response to a synacthen test. Four patients died at Addisonian crisis and hypo-adrenalism probably contributed to the deaths of a further two patients. Amyloid deposition was found in the adrenal glands in seven patients who died of systemic amyloidosis and renal failure. It is recommended that all patients with renal amyloid should have an assessment of adrenal function performed and if abnormal replacement steroid therapy should be commenced.

Adrenal Gland Diseases↗

Overview of adrenal imaging/adrenal CT.

CT is the imaging procedure of choice for the detection of most suspected adrenal masses. But except for some patients with acute adrenal hemorrhage or fat-containing myelolipoma, the precise histologic nature of an adrenal mass is not apparent from the CT image. MIBG radionuclide scanning is useful in some patients with pheochromocytoma, whereas bilateral adrenal venous sampling for hormone assay is necessary for correct lateralization in some patients with a small aldosterone-producing adenoma. The potential value of MR imaging in the characterization of adrenal masses, especially to distinguish benign adrenal cortical adenomas from metastatic disease, is now under investigation. Currently percutaneous aspiration biopsy is still necessary to make this distinction in patients with an adrenal mass and a known extra-adrenal primary neoplasm.

Adrenal Gland Diseases↗