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PubMed1998

Mitotane (o,p'-DDD) resistance in a dog with pituitary-dependent hyperadrenocorticism and phaeochromocytoma.

A dog was presented with a 2 year history of polyuria and polydipsia due to pituitary-dependent hyperadrenocorticism. A low-dose dexamethasone suppression test and measurement of plasma ACTH concentration confirmed the diagnosis. Treatment was instituted with mitotane at 44 mg/kg/day and then 88 mg/kg/d without complete resolution of signs. The dog collapsed with signs consistent with liver disease and was euthanased. Necropsy revealed a phaeochromocytoma of the left adrenal medulla with extensive metastases to the liver. A chromophobe adenoma of the pars intermedia of the pituitary was found.

Adrenal Cortex Function Tests↗
PubMed1977

Problems in the diagnosis of Cushing's syndrome.

The diagnosis of florid Cushing's syndrome is usually made without difficulty but diagnostic problems may arise. Five such cases are described. Difficulties may occur when the features of the syndrome are incomplete. Three such cases were encountered. In each only one clinical feature was present; these respectively were hypertension, osteoporosis and obesity. The diagnosis was confirmed, however, biochemically and eventually histologically and there was a good response to surgery in each case. Another diagnostic problem, both clinically and biochemically is the obese, hirsute, hypertensive female. Two such cases are described, in whom Cushing's syndrome was diagnosed clinically and biochemically but in whom there was no response to adrenalectomy. Retrospectively the validity of the original diagnosis is questioned. It is concluded that Cushing's syndrome may present in a very incomplete form and should be considered in the differential diagnosis, even if only one feature is present. It is stressed that obesity, hirsutism, hypertension and depression are commonly found in association with normal adrenal function. Urinary free cortisol and cortisol response to insulin induced hypoglycaemia may be of value in distinguishing these cases from those with endocrine disease.

Adenoma↗
PubMed1999

From open to laparoscopic adrenalectomy: a review of 16-year experience.

OBJECTIVE: To review the experience with adrenal surgery which was associated with significant morbidity and notable mortality in the past, although laparoscopic approach is beginning to be accepted as the procedure of choice. METHODS: The indications and results of adrenalectomy in 104 patients (36 men, 68 women) over the past 16 years were reviewed. Any potential improvement of surgical results over time was analyzed. RESULTS: Ninety-three patients (89%) had functional problems while malignancy was present in 11 patients (11%). Anterior approach was employed in 27 patients, posterior in 56, lateral in 10, and laparoscopic in 11. One patient required conversion from laparoscopic to anterior approach. No operative mortality was seen, but the morbidity occurred in 16.7%. Complication rate decreased significantly in this study period (1981-1990 versus 1991-1996, 22% versus 5%; P = 0.02). Laparoscopic adrenalectomy was successfully performed for 59% of the patients requiring adrenalectomy recently, compared to 68% of posterior adrenalectomy in the past. CONCLUSIONS: Adrenal surgery is a safe procedure, associated with acceptable morbidity, which has decreased over time. Laparoscopic adrenalectomy is becoming the preferred approach for the majority of patients requiring adrenalectomy.

Adolescent↗
PubMed1975

[Clinical contribution to the surgery of adrenal glands].

The anatomopathological and clinical features of 131 cases subjected to adrenalectomy for metastasis of breast cancer, hypercortico-adrenalism and pheochromocytoma are described. The results of surgical management are analysed.

Adrenal Gland Diseases↗
PubMedDate not supplied

[Morphology of the kidneys in arterial hypertension of adrenal genesis (according to biopsy findings)].

67 renal biopsies obtained in the course of adrenalectomy from patients with primary hyperaldosteronism, hypercorticism and pheochromocytoma were studied. Sclerotic affection of the arterioles and renal interstitium were found in long lasting adrenal arterial hypertension. This may cause residual postoperative hypertension. Endocrine nephropathy in primary hyperaldosteronism due to hypopotassemia and alcalosis manifests with vacuolar distrophy and atrophy of the epithelium, dilatation of tubular lumen, intratubular calcinosis and tubulointerstitial nephritis. Primary hyperaldosteronism was characterized by hypoplasia of the juxtaglomerular apparatus (JGA) but in massive spironolacton therapy signs of enhanced renin-secreting function of the glomerular efferent arteriola may be observed. In hypercorticism pyelonephritis is rather frequent. In patients with pheochromocytoma hypercatecholaminemia may result in JGA activation this being particularly evident in renal artery stenosis. Recurrent hypertension after pheochromocytoma removal in the absence of renal pathology may indicate recurrent tumor or missed second tumor.

Adrenal Gland Neoplasms↗
PubMed1952

Primary neoplasms of the adrenal gland; diagnosis and surgical management.

Tumors of the adrenal glands produce hormones which cause a variety of symptoms and signs including high blood pressure, excessive growth of hair on the body and precocious sexual development. By recently developed tests, it has been possible to differentiate high blood pressure due to these tumors from hypertension due to other causes. Removal of these tumors will often alleviate changes caused by them. Localization of the tumor and appraisal of the condition of the contralateral gland should be carried out preoperatively if possible. In this, several kinds of roentgen studies are helpful. Infusions of drugs during operation can be used to control the blood pressure which otherwise would vary widely. During a ten-year period (1942 to 1951) there were observed at the Los Angeles County General Hospital 100 proved cases of non-secreting and secreting primary neoplasms of the adrenal glands. In addition, there were three cases of Cushing's syndrome due to bilateral adrenal cortical hyperplasia, and ten probable cases (four, pheochromocytomas; five, Cushing's syndrome; one, adrenogenital syndrome) in which operation was not done.

Adrenal Gland Neoplasms↗