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PubMed1996

Factors influencing outcome of surgery for primary aldosteronism.

OBJECTIVE: To identify factors that influence the outcome of surgery for primary aldosteronism. DESIGN: A retrospective clinical series, with a mean follow-up of 106 months (range, 12-280 months), of 42 patients who underwent adrenalectomy for primary aldosteronism between the years 1970 and 1993. SETTING: All patients were operated on at the Boston University Medical Center Hospital. PATIENTS AND INTERVENTION: We reviewed the records of 22 women and 20 men, ranging in age from 25 to 68 years, who underwent adrenalectomy for primary aldosteronism. Tests performed for preoperative classification of the adrenal pathological abnormalities included adrenal venous sampling, postural stimulation test, iodocholesterol I 131 scintigraphy, and computed tomography. MAIN OUTCOME MEASURES: The surgical outcome was classified as follows: response, normal blood pressure measurement (< 160/95 mm Hg) without medication; incomplete response, normal blood pressure measurement with medication or blood pressure measurement greater than 160/95 mm Hg despite antihypertensive treatment. RESULTS: Twenty-five patients (60%) became normotensive following surgery. The following factors were associated with a complete response to adrenalectomy by univariate analysis: adenoma classification (odds ratio [OR] = 9.6, P = .002); preoperative response to spironolactone (OR = 8.3, P = .007); age younger than 44 years (OR = 6.2, P = .009); and duration of hypertension less than 5 years (OR = 5.1, P = .03). Response to spironolactone was predictive only in cases classified as adenoma (P = .004). Duration of hypertension showed a strong correlation with age (r = 0.62). Using stepwise logistic regression, adenoma pathological classification, response to spironolactone, and duration of hypertension less than 5 years contributed independently to a predictive model. Micronodular hyperplasia alone was associated with incomplete response. The presence of coexisting micronodular hyperplasia in patients with adenoma did not affect the odds for a complete response. Computed tomography for preoperative diagnosis of adenoma showed the same level of accuracy (75%) as that for postural stimulation test and iodocholesterol scintigraphy, but less than that for adrenal venous sampling (91%). CONCLUSIONS: The study showed that the main determinants of a surgical cure of hypertension in primary aldosteronism were presence of adenoma and preoperative response to spironolactone. We favor computed tomography as the initial test to establish preoperative diagnosis of adenoma because of its reproducibility and high specifity.

Adenoma↗
PubMed1999

Adrenal neuroblastoma in an adult with tumor thrombus in the inferior vena cava.

We describe the appearance of an adrenal neuroblastoma associated with tumor thrombus occurring in an adult patient. The tumor measured 14 x 12 x 12 cm, showed heterogeneous signal intensity on both T1-weighted and T2-weighted images, and displayed peripheral nodular enhancement on early post-gadolinium images. Tumor thrombus was identified within the inferior vena cava, which extended into the right atrium.

Adrenal Gland Neoplasms↗
PubMed2000

Clonal patterns in phaeochromocytomas and MEN-2A adrenal medullary hyperplasias: histological and kinetic correlates.

The relationship among histological features, cell kinetics, and clonality has not been studied in adrenal medullary hyperplasias (AMHs) and phaeochromocytomas (PCCs). Thirty-four PCCs (23 sporadic and 11 MEN-2A (multiple endocrine neoplasia type 2A)-related tumours, the latter associated with AMH) from females were included in this study. Representative samples were histologically evaluated and microdissected to extract DNA and evaluate the methylation pattern of the androgen receptor alleles. At least two tissue samples (from the peripheral and internal zones in each tumour) were analysed with appropriate tissue controls run in every case. The same areas were selected for MIB-1 staining and in situ end labelling (ISEL). Malignant PCCs were defined by histologically confirmed distant metastases. All monoclonal AMH nodules from the same patient showed the same X-chromosome inactivated. Six sporadic PCCs revealed liver metastases (malignant PCC) and eight additional sporadic PCCs showed periadrenal infiltration (locally invasive PCC). All informative PCCs were monoclonal, except for five locally invasive PCCs and one benign PCC that revealed polyclonal patterns. Those cases also showed a fibroblastic stromal reaction with prominent blood vessels, focal smooth muscle differentiation, and significantly higher MIB-1 (126.8+/-29.9) and ISEL (50.9+/-12.8) indices. Concordant X-chromosome inactivation in nodules from a given patient suggests that MEN-2A AMH is a multifocal monoclonal condition. A subgroup of PCCs characterized by balanced methylation of androgen receptor alleles, high cellular turnover, and stromal proliferation also shows locally invasive features.

Adrenal Gland Neoplasms↗
PubMed1984

The computed tomography-guided adrenal biopsy. An alternative to surgery in adrenal mass diagnosis.

A series of 16 patients with adrenal masses were biopsied percutaneously under computed tomography (CT) guidance with 18- to 22-gauge modified Chiba needles. Adrenal adenomas, cysts, metastases, melanoma, and adrenal hemorrhage were identified. Of nine oncologic patients, four had adrenal metastases, while five had other nonmalignant adrenal masses. Thus, an adrenal mass in an oncologic patient is not always metastases. No complications occurred. The diagnostic evaluation of an adrenal mass in selected cases should include CT-guided percutaneous aspiration as a safe and reliable alternative to open surgical biopsy. CT-guided biopsy can be performed as an outpatient procedure, avoiding the cost of hospitalization and the morbidity of surgery.

Adenoma↗
PubMed2001

Differential expression of menin in various adrenal tumors. The role of menin in adrenal tumors.

BACKGROUND: Adrenocortical tumors occur as sporadic tumors, as part of the multiple endocrine neoplasia type 1 (MEN1) syndrome, or as part of other hereditary disorders. MEN1 is a tumor suppressor gene located on chromosome 11q13 that encodes a 610-amino acid protein called menin, and plays an important role in the development of MEN1 syndrome. Recent reports indicate that heterozygous germline mutations of this gene are responsible for the disease onset of MEN1. METHODS: To investigate the role of menin in sporadic adrenocortical tumors, the authors examined a series of adrenocortical adenoma cases and a single case of carcinoma and adrenomedulary tumors with the corresponding adjacent tumor tissues using reverse transcriptase-polymerase chain reaction (RT-PCR) for menin mRNA and Western blot analysis for menin protein. Both RNA and protein from these tumors were applied to RT-PCR and Western blot analysis, respectively, although they are not truly quantitative. Primers for RT-PCR were designed to amplify the sequence between exons 2 and 3 of the MEN1 gene. A specific antibody against menin was generated in guinea pigs immunized with the recombinant peptide from the amino acid residues 443-535 of menin made by using glutathione-S-transferase gene fusion. RESULTS: Based on the results of RT-PCR and Western blot analysis, both MEN1 mRNA and menin protein appeared to be highly expressed in Cushing syndrome resulting from adrenocortical adenomas and carcinoma. However, their expression was found to be greatly decreased in primary aldosteronism compared with their expression in Cushing syndrome. Although weak expression of MEN1 mRNA also was detected in pheochromocytoma on RT-PCR, menin expression was not detected in any case of pheochromocytoma by Western blot analysis, possibly due to the lower sensitivity of this assay compared with RT-PCR. Neither MEN1 mRNA nor menin protein was detected in any of the corresponding adjacent tumor tissues examined. CONCLUSIONS: The findings of the current study indicate that menin expression appears to be up-regulated in Cushing syndrome, suggesting that adrenocortical proliferation might be one of the primary lesions in the MEN1 syndrome in which menin might play a significant role in some specific cellular functions.

Adenoma↗
PubMed2001

Adrenal adenomas: characteristic postgadolinium capillary blush on dynamic MR imaging.

We sought to evaluate dynamic post-gadolinium contrast enhanced magnetic resonance (MR) imaging characteristics of adrenal adenomas with comparison to those of malignant adrenal tumors. MR images, including in- and out-of-phase spoiled gradient echo (SGE) and dynamic gadolinium enhancement, of 35 adrenal adenomas in 34 patients, and 12 malignant adrenal tumors in 12 patients, were reviewed retrospectively. MR images were assessed for the presence of a capillary blush on immediate postgadolinium SGE images, and for rapid washout of contrast on 45-second postgadolinium SGE images. Thirty-five adrenal adenomas (mean size, 3.1 cm) and 12 malignant adrenal tumors (mean size, 7.4 cm) were assessed. Of 35 adrenal adenomas, 25 (71%) showed a homogeneous capillary blush on immediate postgadolinium images. Thirty-three (94%) adrenal adenomas demonstrated rapid washout on 45-second postgadolinium images (P < 0.001). Of 35 adrenal adenomas, 30 (86%) showed diminished signal intensity (SI) on out-of-phase images. Of 12 malignant adrenal tumors, none showed a homogeneous capillary blush on immediate postgadolinium images. Six (50%) malignant tumors showed negligible enhancement, four (33%) showed irregular patchy enhancement, and two (17%) showed peripheral enhancement (P < 0.001). On 45-second postgadolinium images, 11 (92%) of 12 malignant adrenal tumors showed irregular enhancement. In the majority of adrenal adenomas, an initial homogeneous capillary blush and rapid washout are demonstrated on gadolinium-enhanced dynamic MR imaging. Our preliminary results suggest that this may provide useful complementary information to the appearance of adrenal masses on in- and out-of-phase images.

Adenoma↗
PubMed1955

Adrenal cysts.

Explore the source record for details and available documents.

Adrenal Gland Neoplasms↗
PubMed1984

Current achievements and challenges in adrenal surgery.

Adrenal surgery is now done in almost ideal circumstances. Mortality and complications are rare except in Cushing's syndrome. All major adrenal hormones and their stimulators are measurable and discriminating tests abound. Imaging techniques detect small masses. Inhibitors of hormone synthesis and cell receptors allow amelioration of metabolic hazards preoperatively. Primary aldosteronism is first medically controlled, and patients are selected for operation if difficult to control and if the type of disease is responsive to adrenalectomy. Cushing's disease usually requires pituitary adenomectomy, but some of the 15-30 per cent failures, those with ectopic adrenocorticotrophic hormone (ACTH) producing tumours, or adrenal adenomas warrant adrenalectomy. Metabolic hazards are controlled pre-operatively by aminoglutethimide. Benefits of adrenalectomy are uncertain and many challenges remain. Hazards of phaeochromocytomectomy are avoided by pre-operative adrenergic blockade. Myocardial disease warrants delay. Small unilateral lesions of all types are best removed through unilateral approaches. Small masses found on imaging and without apparent effect can be observed.

Adenoma↗
PubMed1991

Clinical significance of the large adrenal mass.

Current clinical teaching indicates that large (greater than 5 cm in diameter) adrenal masses are often malignant. In a retrospective analysis of patients studied between 1977 and 1988 with computed tomography (CT), adrenal scintigraphy, and when available, magnetic resonance imaging (MRI) 45 were found to have adrenal masses greater than 5 cm (range 5-19 cm) in diameter. Thirty were benign (16 phaeochromocytomas, six adrenocortical adenomas, four adrenal cysts, two myelolipomas, an adrenal hematoma and a ganglioneuroma). Of 15 malignant masses, there were seven adrenocortical carcinomas, five adrenal metastases and three adrenal lymphomas. With the exception of the adrenal myelolipomas, cysts, and the ganglioneuroma neither CT nor MRI demonstrated sufficient diagnostic specificity to distinguish benign from malignant lesions. Functional scintigraphy with 131I-6-beta-iodomethyl-19-norcholesterol for suspected adrenocortical lesions and 131I-metaiodobenzylguanidine for suspected phaeochromocytomas frequently provided useful information.

19-Iodocholesterol↗
PubMed1993

Adrenal incidentaloma.

Improvements in ultrasonography and computed tomography have led to the problem of 'adrenal incidentaloma', an asymptomatic adrenal mass discovered during investigation of some other problem. In the light of current knowledge a management rationale for patients with such an adrenal abnormality is proposed.

Adrenal Cortex Hormones↗