SEARCH · PubMed Health

Results for “ADRENALECTOMY”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 487 records · Page 27Linked to original sources

PubMedDate not supplied

[The indications for adrenalectomy in the surgical treatment of renal-cell cancer].

To clarify the frequency of involvement of the collateral adrenal in patients with renal cell carcinoma (RCC) and to formulate indications to adrenalectomy in performing radical nephrectomy, the author assessed treatment results in 130 RCC patients (73 males and 57 females, mean age 52.6 +/- 0.3 years). 36 subjects had T2N0M0, 48--T3N0M0, 46--T4N0M0. Preoperatively, all the patients were divided into prognostic groups. Irrespective of the prognosis, 102 patients underwent radical nephrectomy. 18 patients with uncertain prognosis and 10 patients with good prognosis were subjected to nephrectomy without adrenalectomy. Metastases to the collateral adrenal were detected in 16.1%, 2.5% and 0% of patients with poor prognosis, uncertain and good prognosis, respectively. 5-year survival in groups with poor, uncertain and good prognosis was 28.6, 50 and 93.7%, respectively; in patients with uncertain prognosis after radical nephrectomy or nephrectomy without adrenalectomy it was 47.5 and 55.5%, respectively; with good prognosis--100 and 90%, respectively. In bad prognosis, the adrenal must be removed because of high metastatic risk. In RCC patients with uncertain or good prognosis in the absence of preoperative evidence on adrenal tumor adrenalectomy performed with nephrectomy does not improve 5-year treatment outcomes.

Adrenal Gland Neoplasms↗

PubMed1998

Learning curve and conversion to open surgery in cases of laparoscopic adrenalectomy and nephrectomy.

PURPOSE: We examine how the level of experience acquired by the laparoscopist affects the outcome of laparoscopic adrenalectomy and nephrectomy, and what is necessary to avoid complications in these surgeries. MATERIALS AND METHODS: We retrospectively evaluated the experience levels of 8 urological laparoscopists between 1991 and 1995. In addition, other cases that were converted to open surgery were collected from the institutes with which the 8 laparoscopists were affiliated. RESULTS: The rates of conversion to open surgery were 6.4% in 204 cases of adrenalectomy and 14.3% in 63 of nephrectomy. Conversion rates were related to blood loss volume but not operative time. The major causes of conversion were bleeding in 45% of cases and adhesion in 34%. There were no mortalities. Mean operative time decreased significantly, reaching that of open surgery as the number of procedures increased up to 20 adrenalectomies and 10 nephrectomies. The volume of blood lost remained low from the early experience. Blood transfusion rates were 4.4% for adrenalectomy and 11.1% for nephrectomy. CONCLUSIONS: Operative time of these procedures decreased significantly with surgeon experience and reached that of open surgery. Cases in which adhesion is anticipated should be restricted to avoid conversion. These laparoscopic procedures are acceptable as a standard operative techniques for adrenal and renal diseases.

Adrenal Gland Diseases↗

PubMed1997

[Laparoscopic transperitoneal adrenalectomy--technique and personal experiences].

Laparoscopic transperitoneal and endoscopic extraperitoneal adrenalectomy are two safe options in minimally invasive surgery associated with very low morbidity. The anterior transperitoneal approach we prefer yields a better exposure of the anatomic structures and allows the surgeon to orient himself more easily. In addition, various other laparoscopic maneuvers may be performed synchronously. We report on our own experience with eight laparoscopic transperitoneal adrenalectomies performed in four cases unilaterally and in two additional cases bilaterally during April, 1996, and January, 1997, in six patients aged 20 to 56 years. The indications were in four cases pheochromocytoma (operated on bilaterally in two cases), and in the remaining two cases adrenal Cushing's syndrome. The duration of surgery was approximately 240 min for bilateral adrenalectomy and 166 min for unilateral adrenalectomy, respectively, with an intraoperative blood loss of about 50 to 400 ml. Except for haematoma of the abdominal wall there were no other postoperative complications. The serum levels of interleukin 6 and 10 underline the minimal invasiveness of this technique, since there were only small increases of interleukin 6 and interleukin 10.

Adrenal Gland Neoplasms↗

PubMed1998

[Bilateral video-endoscopic adrenalectomy in Cushing's disease. Experience in 24 patients].

The purpose of this study was to compare the results of bilateral laparoscopic adrenalectomy (BLA) to bilateral open adrenalectomy (BOA) in the treatment of Cushing's disease. Twenty-four patients (23 Cushing's disease, 1 congenital adrenal hyperplasia) were divided into 3 groups. Group 1 patients (n = 15) underwent BCA using the lateral transabdominal approach, Group while 2 patients (n = 9) underwent laparoscopic adrenalectomy on one side and conventional open adrenalectomy on the contralateral side. Groups 1 and 2 were compared retrospectively to 15 patients (Group 3) who underwent BOA as part of larger series of 61 patients. There was no difference in the degree of hypercortisolism in the 3 groups. At the beginning of the experience, the duration of surgery was longer in Groups 1 and 2 compared to the open surgery group, but this difference subsequently decreased during the study. There was no difference in intraoperative blood loss or transfusion rate. Group 1 patients experienced fewer wound and intraabdominal complications and less postoperative pain, shorter hospitalization, and quicker recovery than groups 2 and 3 patients. Technically obesity and tissue fragility are easily overcome by the laparoscopic approach. BCA also achieves success rate of hypercortisolism correction. In conclusion, BLA is the surgical procedure of choice for the treatment of Cushing's disease when surgical therapy is indicated.

Adrenalectomy↗

PubMedDate not supplied

[Laparoscopic adrenalectomy in a mexican institution].

AIM: To analyze the general characteristics and outcome of laparoscopic adrenalectomy in our institution. METHODS: The clinical and intraoperative characteristics, complications and outcome of 29 consecutive patients undergoing lateral transperitoneal laparoscopic adrenalectomy between February 1995 and January 1998 were analyzed. RESULTS: Their mean age was 34 +/- 11 years, 6 were males and 23 females. The most common preoperative diagnosis was recurrent Cushing's disease followed by functioning adenomas and pheochromocytomas. There were 17 unilateral and 12 bilateral adrenalectomies. The mean operative time was 2.5 +/- 1 hours for each gland. Two patients were converted to the open technique. There were two complications: a wound infection and a postsurgery hypoglycemia. The hypoglycemic patient also developed massive upper gastrointestinal bleeding 18 days after surgery and died. The mean postoperative hospital stay was 5 days. In a mean follow-up of one year, recurrence of one pheochromocytoma was seen. CONCLUSION: Laparoscopic adrenalectomy was a safe operation that favored early recovery.

Adrenalectomy↗

PubMed1999

Laparoscopic adrenalectomy for solitary metachronous adrenal metastasis from lung cancer: report of a case.

We report herein the case of a 69-year-old man who underwent laparoscopic adrenalectomy for a solitary adrenal metastasis 10 months after a left lower lobectomy for T2N1M0 lung cancer. A 30 x 20 mm tumor was found in the left adrenal gland, and dissected using an ultrasonically activated scalpel. Histological examination revealed metastatic squamous cell carcinoma. The patient recovered uneventfully and his condition is now stable 18 months after the second operation, with no evidence of local recurrence or metastatic disease. Although laparoscopic resection for malignant adrenal tumors is still controversial, we consider that laparoscopic adrenalectomy may be an optional treatment for metastatic adrenal tumors, provided the tumor is solitary, small in size, and well-localized. To our knowledge, only 14 cases of laparoscopic adrenalectomy for malignant tumors have been reported to date; however, this is the first case of successful laparoscopic adrenalectomy for a metastasis from lung cancer.

Adrenal Gland Neoplasms↗

PubMed1995

Adrenalectomy increases serotonin turnover in brains of obese Zucker rats.

Because adrenalectomy tends to normalize many metabolic abnormalities of obese Zucker rats, we hypothesized that it would also normalize the depressed serotonergic turnover in their ventromedial nucleus (VMN). Lean (Fa/Fa) and obese (fa/fa) male Zucker rats were adrenalectomized or sham operated when 5 wks old and sacrificed at 11 wks. Their brains were frozen, and 13 areas were dissected for HPLC-EC analysis of monoamines and metabolites. Consistent with previous studies, VMN serotonin turnover (indexed by 5-HIAA/5-HT) was lower in obese than lean sham-operated rats. Monoamine and metabolite concentrations were altered in several other brain areas as well. Adrenalectomy reduced percent body fat and elevated VMN serotonergic turnover more in obese than in lean rats. It also stimulated serotonergic turnover in almost every brain area examined. We conclude that in obese Zucker rats: monoaminergic activity is altered in several brain areas involved in regulating energy balance; adrenalectomy normalizes the reduced VMN serotonergic turnover seen in the obese rats; and adrenalectomy results in a generalized increase in central serotonergic turnover. These data are consistent with serotonin's role in inhibiting food intake and enhancing sympathetic stimulation of energy metabolism.

Adrenal Glands↗

PubMed1996

Laparoscopic Adrenalectomy.

Adrenal pathology requiring surgical intervention is relatively uncommon. Nevertheless, there are a number of conditions that warrant such consideration. Most surgically correctable diseases of the adrenal glands are associated with excess production of adrenal corticosteroids or catecholamines by an adrenal tumor. Classic open approaches toward adrenalectomy in the past have included an anterior, transabdominal, or posterior route. Laparoscopic adrenalectomy offers the advantages of excellent exposure through minimally damaging portals. This results in an expected very benign postoperative course. It has now been almost 4 years since the first reported laparoscopic adrenalectomy. Since then, numerous small series have been reported and experienced laparoscopic surgeons have proven the merits of a laparoscopic approach to adrenalectomy. This reviews the current state of the art and offers descriptions of selected approaches to both the right and left adrenal glands.

Journal Article↗

PubMed1998

Changes in the circadian rhythm of blood pressure in primary aldosteronism in response to dietary sodium restriction and adrenalectomy.

OBJECTIVE: Recently, we found that sodium restriction restored the circadian rhythm of blood pressure from non-dippers to dippers in patients with a sodium-sensitive type of essential hypertension. In the present study, we investigated the effects of sodium restriction on the circadian blood pressure rhythm in patients with primary aldosteronism, a typical sodium-sensitive form of secondary hypertension. DESIGN AND METHODS: We performed 24 h blood pressure monitoring in eight patients with primary aldosteronism due to unilateral adenoma (Conn's syndrome) during normal-sodium (7-12 g/day of NaCl) and low-sodium (1-3 g/day) diets, and after adrenalectomy. RESULTS: Sodium restriction lowered the 24 h mean arterial pressure from 116+/-14 to 109+/-12 mmHg (P< 0.01). During a normal-sodium diet, there was no change in systolic, diastolic and mean arterial pressures during the night-time compared with the daytime. In contrast, during a low-sodium diet, all night-time pressure values were significantly lower than those in the daytime. After adrenalectomy, the night-time pressures in patients on a normal-sodium diet were lower than those of the daytime. The nocturnal mean arterial pressure fall was increased by sodium restriction and adrenalectomy. CONCLUSIONS: These results indicate that the circadian rhythm of blood pressure was disturbed in patients with primary aldosteronism who maintained a relatively high sodium intake. Both adrenalectomy and sodium restriction restored a nocturnal dip in blood pressure in primary aldosteronism. Therefore, sodium restriction affects the circadian blood pressure rhythm in sodium-sensitive types of hypertension, not only in primary hypertension, but also in secondary hypertension.

Adult↗

PubMedDate not supplied

Laparoscopic vs. open adrenalectomy: experience at King Faisal Specialist Hospital and Research Centre, Riyadh.

BACKGROUND: The laparoscopic approach for adrenalectomy is now widely accepted and preferred over the conventional open approach. We describe our experience of adreanalectomy and compare the results of open and laparoscopic approach. PATIENTS AND METHODS: From March 1999 to March 2002, we performed 23 adrenalectomies. An anterior transabdominal approach was used for the open procedure, and a lateral transperitoneal approach for the laparoscopic procedure. Data from both groups were analyzed and compared. RESULTS: There was no difference in tumor size or pathology between two groups. The tumor size was smaller, operative time was longer and estimated blood loss was less in the laparoscopic procedure group, however these differences were statistically insignificant. The mean length of hospital stay was shorter (5.1 vs. 9.2 days, P<0.01), the mean use of postoperative narcotic analgesia was less (4.2 vs. 8.1 injections, P<0.05), and the mean time for resumption of oral intake was faster (1.17 vs. 2 days, P<0.01) in the laparoscopic procedure group compared to the open adrenalectomy group. CONCLUSION: Laparoscopic adrenalectomy is a safe procedure that can be performed for most adrenal pathology. It is associated with faster recovery, less postoperative pain, and shorter hospital stay.

Journal Article↗

PubMed2002

[Clinico-anatomic rationale for the access and technique in video-endoscopic adrenalectomy].

The results of surgical treatment of 60 patients with tumors of the adrenals with the help of endovideosurgical techniques were analyzed and described. The article also presents the data of experimental investigations performed in 31 corpses of subjects of different constitution and topography of the adrenals in the retroperitoneal space and different accesses to them with the help of endovideosurgical technique. The most effective and safe accesses and the method of endovideosurgical adrenalectomy have been developed, substantiated and approbated in clinical practical work. In most cases the right laparoscopic and left retroperitoneoscopic adrenalectomies should be considered the operations of choice in treatment of patients with tumors of the adrenals. It was proved that the decision for the optimal endovideosurgical access and the corresponding adrenalectomy should be made individually for each patient with special reference to the clinicoanatomical criteria found. The endovideosurgical adrenalectomy should not be opposed to open methods of surgery which are expedient in patients with large size of the tumor, signs of malignancy and possible intraoperative complications.

Adrenal Gland Neoplasms↗

PubMed2000

Laparoscopic posterior adrenalectomy: technical considerations.

HYPOTHESIS: Although laparoscopic posterior adrenalectomy (LPA) offers a more direct access to the adrenal gland, it is not as popular as laparoscopic transabdominal adrenalectomy, and the worldwide experience has been limited. We hypothesized that LPA is a safe and efficacious procedure that could best serve certain patients with adrenal tumors. DESIGN: Case series of patients undergoing laparoscopic adrenalectomy in a single institution. SETTING: University teaching hospital. PATIENTS: Medical records of 31 patients with 33 tumors who underwent LPA were reviewed. Indications for operation included hormone secretion in 23 patients (74%), suspected or known malignant neoplasms in 7 patients (23%), and local symptoms in 1 patient (3%). INTERVENTION: The LPAs were performed with the patients in prone position. Preoperative ultrasonography localized the adrenal tumor and kidney to guide balloon trocar placement for the creation of a working retroperitoneal space. The LPAs were performed with three 10-mm trocars using laparoscopic ultrasound to localize the tumor and the harmonic scalpel to perform the dissection. MAIN OUTCOME MEASURES: Demographic data, type and size of tumor, operative time, blood loss, intraoperative and postoperative complications, and hospital stay were analyzed. RESULTS: All operations were successfully completed without conversion. Excluding the bilateral cases, the mean +/- SD operative time was 176 +/- 104 minutes. Estimated blood loss averaged 32 mL (range, 10-200 mL). There were no intraoperative complications. The mean +/- SD tumor size was 3.2 +/- 1.8 cm (range, 0.8-7.0 cm). Pathological evaluation revealed benign tumors in 25 patients (81%) and malignant tumors in 6 patients. The average hospital stay was 1.4 days (range, 1-3 days). There were no deaths. CONCLUSIONS: Although technically more demanding, LPA should be considered in patients with tumors less than 6 cm, bilateral tumors, or extensive previous abdominal surgery.

Adrenal Gland Neoplasms↗

PubMed1979

The continued importance of adrenalectomy in the treatment of Cushing's disease.

Eighteen patients with pituitary-dependent Cushing's disease have been treated during a ten-year period. Eleven of these received a total of 14 alternative forms of therapy in an attempt to control the clinical manifestations of Cushing's disease prior to adrenalectomy. However, no substantial improvement was noted in these patients, who included four receiving conventional pituitary irradiation, five receiving cyproheptadine, two receiving mitotane, and one each receiving metyrapone and phenytoin. One patient had an attempted transsphenoidal hypophysectomy that could not be accomplished because of hemorrhage. A complete remission of the signs, symptoms, and laboratory abnormalities of Cushing's disease occurred in all 18 patients following bilateral adrenalectomy. There was no operative mortality and morbidity was minimal. This experience confirms that bilateral adrenalectomy is a rapid, safe, and permanent means of reversing hypercortisolism and that it should remain an integral part of the treatment of Cushing's disease.

Adolescent↗

PubMed1985

Modification of immunogenic tumor growth by adrenalectomy in a syngeneic murine system.

The immunosuppressive action of adrenal glucocorticosteroids is well-known, and depressed cell-mediated immunity and adrenal cortical hyperplasia have been described in tumor-bearing animals. This study was designed to evaluate the effect of removing the source of lympholytic steroids by adrenalectomy upon tumor growth rate, thymus weight, and thymocyte incorporation of iodine 125 (125I) deoxyuridine into DNA. Newly derived methylcholanthrene-induced immunogenic fibrosarcomas were used in male syngeneic mice. Log dosages of 10(4), 10(5), and 10(6) viable tumor cells as single cell suspension were injected subcutaneously into the popliteal space of adrenalectomized and control mice. Tumor size was followed serially with caliper measurements, and the animals were killed 4 weeks after inoculation. Adrenalectomized mice inoculated with 10(4) cells had smaller tumors (P less than 0.02), heavier thymi (P less than 0.01), and more thymic DNA synthesis (P less than 0.05) than their tumor-bearing controls. No differences were seen between populations receiving 10(5) or 10(6) tumor cell inoculations. A second experiment was carried out in which intact controls, adrenalectomized animals, and sham adrenalectomy animals were inoculated with 10(4) tumor cells and killed 28 days later. Tumor growth rate and volume were significantly decreased for the adrenalectomized mice, which had higher thymus weights and DNA synthesis. These findings suggest that pretreatment adrenalectomy slows the growth of antigenic tumor cells and prevents thymic involution after tumor growth in a syngeneic murine system.

Adrenalectomy↗

PubMed1994

Tumor suppressor p53 induction and DNA damage in hippocampal granule cells after adrenalectomy.

Tumor suppressor p53 encodes a protein that is an important regulator of the cell cycle. However, under certain conditions increased p53 expression results in programmed cell death or apoptosis. We used in situ hybridization histochemistry to investigate the role of p53 in the adrenalectomy-induced degeneration of hippocampal granule cells. Three days after adrenalectomy, a subpopulation of granule cells exhibiting morphological features of apoptosis expressed increased amounts of p53 mRNA. Both adrenalectomy-induced p53 expression and granule cell degeneration were prevented by daily administration of corticosterone. In situ end-labeling of nuclei containing fragmented DNA revealed a distribution similar to that of cells with increased p53 expression. These results demonstrate an association between p53 induction and apoptosis in the central nervous system and support the idea that cell cycle-related genes play a role in neuronal death pathways.

Adrenalectomy↗

PubMed1993

Effects of various environmental stress paradigms and adrenalectomy on the expression of autoimmune type 1 diabetes in the non-obese diabetic (NOD) mouse.

The effects of long-term chronic stress (induced by repeated restraint, overcrowding or both), short-term chronic stress (induced by a triad of stressors over a short period of time early in life) and adrenalectomy were investigated on the prevalence, on the degree of insulitis and various physiological and immunological parameters in the NOD mouse, a spontaneous model of type I-insulin-dependent diabetes mellitus (IDDM). Long-term chronic stress, obtained by restraint once a week or overcrowding, significantly protected NOD females, while both applied concomitantly had only a tendency to protect against diabetes. In contrast, short-term chronic stress had no significant effect on diabetes expression, whereas adrenalectomy resulted in a trend toward accelerated diabetes onset. The various long-term chronic stress paradigms exerted different effects on the progression of insulitis: repeated restraint tended to protect against insulitis, overcrowding had no effect but, when associated with restraint, significantly counteracted the beneficial effect of restraint alone. Adrenalectomy and short-term chronic stress had no significant effect on the development of insulitis. Various parameters, such as body, thymus and spleen weights, thymus and spleen cellularities, mitogen-induced spleen cell proliferation and serum corticosterone levels were also studied under the various experimental conditions. Taken together, the observations suggest that stressors modulate the expression of spontaneous autoimmune diabetes by exerting pleiotropic effects on immune and/or inflammatory components at the pancreas level and on peripheral glucose metabolism.

Adrenal Glands↗

PubMed1996

Laparoscopic right and left adrenalectomies. Surgical procedures.

BACKGROUND: Laparoscopic approach for adrenalectomy was recently described and the operative technique is not yet well defined. METHODS: Twenty-seven laparoscopic adrenalectomies were performed between 1992 and 1995. There were 18 women and nine men ranging in age from 31 to 70 years (mean, 50.8 years). The surgical procedure was a lateral decubitus transperitoneal flank approach in 26 patients, and a retroperitoneal approach in one. Twelve right and 15 left glands were removed. Adrenal diseases were primary aldosteronism in 20 patients, nonfunctional adenoma in four patients, Cushing adenoma in two, and an adrenal cyst in one. Median adrenal gland size was 2.0 cm (range 0.5-8 cm). RESULTS: Five patients were converted to laparotomy (18%)-for dissection problems in four and for an unrecognized gland in one. The median anesthesia time was 200 min and the median surgical time was 140 min. Operative morbidity was one adrenal vein injury sectioned close to the vena cava. The hemorrhage was controlled by laparoscopic suturing without conversion. This patient required a three-unit blood transfusion. No mortality occurred and postoperative morbidity was one minor chest infection. The median postoperative in-hospital stay was 4.6 days (range 2-8) for nonconverted patients. CONCLUSIONS: Laparoscopic adrenal gland removal is safe and offers fast recovery and short in-hospital stay. Laparoscopic adrenalectomy combines the advantages of both the conventional anterior and posterior approach.

Adenoma↗

PubMed1976

Simultaneous changes of the perivascular contact area and HIMOT activity in the pineal organ after bilateral adrenalectomy in the rat.

In the pineal organ of the female rat, proportional changes in the area of contact of pinealocyte processes and glial processes with the perivascular space were found after bilateral adrenalectomy. The contact area was evaluated by measuring the length of pinealocyte and glial cell membranes directly abutting on the basal lamina. In the normal female rat, 40% of the contact area is occupied by pinealocyte and 60% by glial cell processes. Fourteen days after bilateral adrenalectomy, this proportion is reversed. In addition, cell counts demonstrate that more pinealocytes gain access to the pericapillary space due to the experimental conditions. In order to prove whether or not these results indicate an increase of pineal endocrine activity, the melatonin-forming enzyme hydroxyindole-O-methyltransferase (HIOMT, E.C. 2.1.1.4) was assayed. After bilateral adrenalectomy the HIOMT activity was found to significantly increase.

Acetylserotonin O-Methyltransferase↗