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PubMed1992

Renin gene expression in the adrenal and kidney of patients with primary aldosteronism.

mRNA levels for renin in the adrenal gland and kidney were measured by ribonuclease protection assay (RPA). Renin mRNA was not detected by RPA in aldosteronoma and kidney tissues obtained from two patients with primary aldosteronism (PA). In these patients, the PRA values, plasma concentrations of active renin (ARC), and total renin (TRC = ARC + prorenin) were below the assay limit (less than 0.03 ng/L.s, 2.5 ng/L, and 10 ng/L, respectively). On the other hand, renin mRNA was recognized by RPA in aldosteronoma and kidney tissues obtained from two other patients with PA treated with 50 mg/day spironolactone for more than 2 months. Their TRC values were 49.8 and 16.6 ng/L, but their PRA and ARC were undetectable. Renin mRNA content was greater in normal adrenocortical tissue and in the normal kidneys obtained from three hypertensive patients with renal cell carcinoma. In these patients, the mean values of PRA, ARC, and TRC were 0.28 +/- 0.03 (mean +/- SD) ng/L.s, 18.4 +/- 7.8 ng/L, and 110 +/- 15 ng/L, respectively. This is the first report of the lack of renin gene expression in aldosteronoma and kidney tissues obtained from untreated patients with PA. Furthermore, treatment with spironolactone resulted in an increase in the levels of renin mRNA in the aldosteronoma and kidney tissues of patients with PA.

Adrenal Cortex↗
PubMed2002

New diagnostic procedure for primary aldosteronism: adrenal venous sampling under adrenocorticotropic hormone and angiotensin II receptor blocker--application to a case of bilateral multiple adrenal microadenomas.

Formerly, the incidence of primary aldosteronism (PA) among patients with hypertension was believed to be less than 1%. However, recent studies have suggested a much higher incidence of 6.59%-14.4% among such patients. These findings suggest that many cases of PA caused by small aldosterone-producing adenoma (APA) or idiopathic hyperaldosteronism (IHA) have not been properly diagnosed. To make a more accurate diagnosis in such cases, we developed a new diagnostic procedure for localization of PA, namely, adrenal venous sampling under continuous infusion of adrenocorticotropic hormone (ACTH) and administration of angiotensin II receptor blocker (AVS with ACTH and ARB). Here, we confirm the efficacy of this procedure in the case of a 37-year-old male suspected of having PA. The anticipated diagnosis of PA was based on the presence of hypokalemia, low plasma renin activity (PRA), elevated plasma aldosterone concentration (PAC) and left adrenal mass. However, AVS with ACTH and ARB revealed the presence of bilateral multiple adrenal microadenomas. In the new AVS method, neither ACTH nor the renin-angiotensin system (RAS) exert any influence on the plasma aldosterone level, and a more accurate aldosterone secretary state and a more accurate assessment of the aldosterone secretion of both adrenal glands can be recognized than by conventional AVS. Use of this new method should enable identification of additional cases of APA among patients diagnosed with essential hypertension.

Adenoma↗
PubMed1983

Normal adrenal glands in small cell lung carcinoma: CT-guided biopsy.

Twenty-four small cell lung carcinoma patients with morphologically normal adrenal glands by computed tomographic (CT) criteria underwent percutaneous thin-needle biopsy of their adrenal glands. Of 43 glands biopsied, 29 had adequate cellular material for interpretation. Five (17%) of the 29 glands were positive for metastases; the rest had negative biopsies. This series indicates an approximate 17% false-negative diagnosis rate by CT when staging the adrenal glands in patients with small cell lung carcinoma. It also demonstrates the utility of percutaneous needle biopsy as an investigational tool to further evaluate normal-sized adrenal glands in the oncologic patient.

Adrenal Gland Neoplasms↗
PubMed1992

Pheochromocytoma and pregnancy: report of three cases.

Three cases of pheochromocytoma associated with pregnancy are reported. Two patients had adrenal pheochromocytoma coexistent with normal pregnancy and one patient had a bladder pheochromocytoma coexistent with molar pregnancy (gestational trophoblastic disease). The diagnosis was made antenatally in the two normal pregnancy patients, both underwent planned tumor resection, one at mid-trimester, complicated by postoperative miscarriage, while the other had tumor resection during cesarean section at term. Bladder pheochromocytoma, preoperatively mistaken for invasive trophoblastic tumor, was resected at the time of planned abdominal hysterectomy for molar pregnancy, pheochromocytoma was recognized only after microscopic study of the resected bladder tumor. The three patients survived with no evidence of disease.

Adrenal Gland Neoplasms↗
PubMed2003

[Malignant hormonally inactive adrenal tumors: aspects of diagnosis and treatment].

Application of computer tomography (CT) and other modern methods of topic diagnosis have permitted to reveal "silent" adrenal tumors more frequently. To conduct a timely and radical treatment it is necessary to estimate the stage of malignancy and hormonal activity of these tumors. There were analyzed the results of treatment of 90 patients with malignant hormonally--inactive adrenal tumor. The size of the tumor, as well as data of CT and magnetic resonance tomography constitutes the criterions, determining the malignant origin of the tumor and indications for operation performance. Application of fine-needle aspiration puncture biopsy is indicated for diagnosis of presumably metastatic adrenal affection. The open extraperitoneal lumbotomic adrenalectomy is the only radical method of treatment of adrenal malignant tumor. For diagnosis of presumably malignant epinephric affection application of endoscopic technique is contraindicated.

Adrenal Gland Neoplasms↗
PubMed1978

Adrenal autotransplantation.

New tools for the diagnosis of adrenal diseases and the development of successful techniques to treat patients with bilateral tumors of the kidney have increased the number of procedures involving removal of both adrenals. Offering to these patients an adrenal autograft represents more than a superfluous medical exercise, since a successful outcome of the graft will relieve them of the burdens and risks of long-term postoperative steroid replacement therapy. The aim of this review is to bring to mind the possibility of autografting adrenal glands in some clinical situations and to emphasize some points that could be relevant in obtaining successful results. The available data justify clinical trials with the procedure.

Adrenal Gland Neoplasms↗
PubMed1994

Molecular abnormalities in tumors associated with multiple endocrine neoplasia type 2.

The tumors of the MEN 2 syndromes, medullary thyroid carcinoma and pheochromocytoma, undergo defined stages of tumor progression. During these stages, several molecular abnormalities develop. These include abnormalities in growth, differentiation, and biochemistry. Recently, the germ-line abnormality in MEN 2A and familial medullary thyroid carcinoma has been identified in the ret gene. This article discusses possible molecular mechanisms for these abnormalities and attempts to place them in the context of the biology of the normal progenitor cells.

Adrenal Gland Neoplasms↗
PubMed1997

[Cytology of renal and adrenal gland masses in adults].

Fine needle aspiration cytology (FNA) of renal masses and adrenal glands don't really differ from FNA of other sites. Nevertheless, only few series have been published on this subject, and surgery remains the most conventional attitude after the clinical and radiological diagnosis of a mass. The aim of this "lesson" is to demonstrate that this technique is accurate for kidneys and adrenal glands too.

Adrenal Gland Diseases↗
PubMed1998

Aldosterone-producing adenoma associated with foci of myelolipoma.

The simultaneous occurrence of adrenal myelolipoma and endocrine disorders is rare. Myelolipomas have occasionally been found in patients with Cushing's syndrome, pheochromocytoma and hyperthyroidism. A recently published study described one well-documented case of adrenal adenoma and myelolipoma in a patient with Conn's syndrome. In this report the patient had a one-year history of treated hyperthyroidism and diagnosed aldosterone-producing adenoma. A disseminated adrenal myelolipoma was found within the adrenocortical adenoma. To our knowledge this histological finding has not been previously reported in association with both Conn's syndrome and hyperthyroidism.

Adenoma↗
PubMed1982

Narrow gauge needle aspiration of solid adrenal masses.

Percutaneous aspiration biopsy of solid adrenal masses was performed without complication in 14 patients. CT guidance of 20-22 gauge needles was used in all but one of the biopsies. Diagnostic cytologic material was recovered in 13 (93%) of the 14 cases. The diagnoses were primary and metastatic neoplasms (10 cases), benign adenomas (two cases), and a mycotic abscess. Twelve additional aspirations were performed of surgically resected or autopsy specimens in six normal adrenals, one adenoma, three adrenal cortical carcinomas, a pheochromocytoma, and a sarcoma arising in the adrenal stoma. Percutaneous aspiration of solid adrenal masses is recommended as a safe, reliable alternative to open surgical biopsy for both benign and malignant adrenal disease.

Adenocarcinoma↗
PubMed1991

Mitochondrial P-450 activities in aldosteronoma tissues.

Adrenal P-450 activities were measured by an in vitro reconstitution system from tissues obtained from human aldosteronomata, and the results compared with those of the normal adrenal tissues from patients with Grawitz's tumor. The P-45011 beta activity was significantly increased in adenoma tissue (55.6 +/- 5.3 vs 9.0 +/- 6.2 nmol corticosterone/mg of protein/min in the control tissues, P less than 0.01). P-450scc activity in adrenal adenomata was 13.4 +/- 2.0 nmol pregnenolone/mg of protein/min, significantly higher than control (P less than 0.05). The present results suggest that increased mitochondrial P-450(11 beta) activities may be characteristic of aldosterone-producing adenomata.

Adenoma↗
PubMed2004

EUS-guided FNA of the left adrenal gland in patients with thoracic or GI malignancies.

BACKGROUND: The diagnostic yield and safety of trans-gastric EUS-guided FNA of the left adrenal gland are not well defined. METHODS: All patients with an enlarged left adrenal gland on abdominal imaging and known or suspected malignancy referred to two EUS centers over a 3-year period were included in this study. EUS-guided FNA was performed on an outpatient basis by one of 4 experienced endosonographers. RESULTS: Thirty-one consecutive patients (21 men, 10 women; mean age 64.8 years) were evaluated. Tissue adequate for interpretation was obtained in all patients; no attempt to obtain tissue was unsuccessful. The median number of needle passes was 4.5 (range 1-8). No immediate complications were encountered. EUS-guided FNA confirmed malignant left adrenal involvement in 42% (13/31) of the patients. Patients with malignant left adrenal masses were more likely to have known cancer at another site (OR 12.0: 95% CI[1.6, 87.9]). Patients with benign masses were more likely to have preservation of the normal sonographic appearance of the adrenal gland ("seagull" configuration) compared with those with malignant masses (OR 9.8: 95% CI[1.9, 51.0]). The accuracy of EUS imaging based on size (> or =3 cm) alone was 81%: 95% CI[63, 93]). Of the patients with malignant adrenal masses, 85% (11/13) died or their clinical condition deteriorated during follow-up, while 15% (2/13) were being treated and were stable clinically. CONCLUSIONS: EUS-guided FNA of the left adrenal gland is a minimally invasive, safe, and highly accurate method that confirms or excludes malignant adrenal involvement in patients with thoracic or GI malignancies.

Adrenal Gland Neoplasms↗
PubMed1996

[Computerized tomography findings score in the differentiation of adrenal tumors in patients with extra-adrenal malignomas].

PURPOSE: In a retrospective study the diagnostic accuracy of computed tomography for the differentiation of benign from malignant adrenal masses in patients with extra-adrenal malignancies was evaluated. For this differentiation a new score system was tested. PATIENTS AND METHODS: Size, density, structure, and borders of adrenal masses in 60 patients with extra-adrenal tumours were analysed and scored. The single criteria and the total score values were correlated with the final diagnosis achieved either by histology or by follow-up CT examinations. RESULTS: Score values above 4 indicated always metastases and score values below 2 were benign lesions. An overlap occurred at score values between 2 and 3 resulting in an overall accuracy of 83.3%. CONCLUSION: Single CT criteria are not reliable enough to differentiate benign from malignant adrenal lesions: better results are achieved by using our scoring system.

Adenoma↗