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Objective:To analyze the early identification, clinical characteristics, diagnosis and treatment of gestational hypertension crisis combined with adrenal disease.Methods:The clinical data of 23 patients of HCP complicated with adrenal disease admitted from Jul. 2009 to Jul. 2019 were retrospectively studied. The clinical characteristics, imaging characteristics, treatment and clinical transfer were studied.Results:The occurrence of all the 23 cases were acute. Among them, 16 cases had eclampsia combined with Cushing’s syndrome, 4 cases were pregnancy combined with primary aldosteronism (PA) and extreme hypokalemia, and 3 cases had eclampsia combined with pheochromocytoma (PHEO) . After admission, the patients were given symptomatic support treatment for sedation, analgesia, blood pressure control, dehydration, cranial pressure reduction, electrolyte balance and spasmolysis, and patients with severe preeclampsia and preeclampsia terminated their pregnancy in time. After treatment, 3 patients gave live birth, 12 received postpartum surgical treatment and 10 received drug treatment. The clinical symptoms improved and imaging examination suggested the lesions in the brain narrowed and disappeared, except one patient had major cerebral hemorrhage and died of multiple organ failure.Conclusions:In case of HCP and severe hypokalemia, relevant examinations should be improved in combination with symptoms to comprehensively diagnose whether it is complicated with adrenal diseases. The treatment methods and process of HCP with adrenal diseases need to be optimized, so as to judge the timing of termination of pregnancy, and minimize the impact on mother and fetus.
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More and more cases of aldosterone-and cortisol-producing adenoma (A/CPA) have been reported in recent years.In order to further understand the clinical characteristics of patients with A/CPA,we report 2 cases of A/CPA treated in our hospital,and analyzes them in combination with domestic reports.We recommend that clinicians routinely perform Low Dose Dexamethasone Suppression Test on every primary aldosteronism patient prior to adrenal vein sampling (AVS) or adrenal adenoma surgery to rule out the possibility of Cushing's syndrome so as to avoid the wrong judgment of AVS results and avoid adrenal hypofunction or adrenal crisis after operation.
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An adrenal incidentaloma is an adrenal mass found in an imaging study performed for other reasons unrelated to adrenal disease and often accompanied by obesity, diabetes, or hypertension. The prevalence and incidence of adrenal incidentaloma increase with age and are also expected to rise due to the rapid development of imaging technology and frequent imaging studies. The Korean Endocrine Society is promoting an appropriate practice guideline to meet the rising incidence of adrenal incidentaloma, in cooperation with the Korean Adrenal Gland and Endocrine Hypertension Study Group. In this paper, we discuss important core issues in managing the patients with adrenal incidentaloma. After evaluating core proposition, we propose the most critical 20 recommendations from the initially organized 47 recommendations by Delphi technique.
Subject(s)
Humans , Adrenal Glands , Delphi Technique , Hypertension , Incidence , Obesity , PrevalenceABSTRACT
Adrenocorticotropin-independent adrenal hyperplasias are rare diseases, which are classified into macronodular (>1 cm) and micronodular (≤1 cm) hyperplasia. Micronodular adrenal hyperplasia is subdivided into primary pigmented adrenocortical disease and a limited or nonpigmented form 'micronodular adrenocortical disease (MAD)', although considerable morphological and genetic overlap is observed between the 2 groups. We present an unusual case of a 44-month-old girl who was diagnosed with Cushing syndrome due to MAD. She had presented with spotty pigmentation on her oral mucosa, lips and conjunctivae and was diagnosed with multiple bone tumors in her femur, pelvis and skull base at the age of 8 years. Her bone tumor biopsies were compatible with osteoblastoma. This case highlights the importance of verifying the clinicopathologic correlation in Cushing syndrome and careful follow-up and screening for associated diseases.
Subject(s)
Child , Child, Preschool , Female , Humans , Biopsy , Conjunctiva , Cushing Syndrome , Femur , Follow-Up Studies , Hyperplasia , Lip , Mass Screening , Mouth Mucosa , Osteoblastoma , Pelvis , Pigmentation , Rare Diseases , Skull BaseABSTRACT
Ageing of population is now a phenomenon of the world and has considerable consequences for public services.Ageing is always accompanied with dysfunction of multiple organs,including hypothalamic-pituitaryadrenal axis.Here,we summarized alterations of hormone secretion of adrenal glands in the elderly and their relationships with Alzheimer' s disease.Moreover,we discussed characteristics of pheochromocytoma,primary aldosteronism,and Cushing's syndrome in the elderly.Lack of typical manifestations usually makes difficulty in diagnosis.
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This article reviews the major advances of basal and clinical research on the adrenal diseases at home and abroad from 2010 to 2012.There are many advances including the diagnostic value of steroidogenic factor-1 in adrenal tumors,the pathogenesis and new diagnostic methods of aldosterone-producing adenoma,the treatment for severe ACTH-dependent Cushing's syndrome,approach to the patient with an adrenal incidentaloma and subclinical hypercortisolism,screening test for subclinical hypercortisolism in the patients with diabetes or osteoporosis,the characterization of macronodular adrenocortical hyperplasia of the zona reticularis,as well as genetic testing for pheochromocytoma and paragangliomas,etc.
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Primary pigmented nodular adrenal disease (PPNAD) is a kind of autosomal dominant inherited disease. Patient in the study presented with Cushing's syndrome, and clinical and pathological diagnosis of PPNAD was confirmed. It is now confirmed that there are two relevant genes and their mutations may lead to PPNAD. This study showed no mutations in the patient, surpecting if there would be an alternative mechanism or a new gene in playing the role.
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ObjectiveTo investigate the expressions and significance of insulin-like growth factor Ⅱ and basic fibroblast growth factor in adrenal disease. MethodsThe experiment was divided into groups of adrenal pheochromocytoma,corticomedullary hyperplasia,cortical adenoma,normal adrenal tissue.Every group was 15 cases.Expression of IGF-Ⅱ and bFGF were detected by immunohistochemistry in adrenal disease. ResultsThere was a significant difference among the four groups(all P＜0.05).IGF-Ⅱ and bFGF expression was higher in adrenal pheochromocytoma tissue than that of corticomedullary hyperplasia and cortical adenoma.In the normal adrenal gland group was low expression or no expression.In each group,IGF-Ⅱ and bFGF protein expression was positively correlated(all P＜0.05).There also was a positive correlation between IGF-Ⅱ and bFGF positive cell and blood pressure in adrenal pheochromocytoma,corticomedullary hyperplasia and cortical adenoma(all P＜0.05). ConclusionIGF-Ⅱ and bFGF protein were closely related to the occurrence and development of human adrenal corticomedullary hyperplasia,cortical adenoma,pheochromocytoma,and played a role in hypertension caused by them.At the same time there was a synergistic effect between the IGF-Ⅱ and bFGF protein in adrenal disease.
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Objective To investigate the clinical application of laparoscopic adrenalectomy and summarize the experience in laparoscopie adrenalectomy.Methods From August 2002 to March 2007,21 cases of benign adrenal tumors were treated with retroperitoneal laparoscopy in this hospital.There were 9 cases of adrenocortical adenoma, 7 cases of primary aldosteronism,3 cases of adenocorticol macronodular hyperplasia,1 case of pheochromccytoma,and 1 case of adrenal gangliocytoma.Results Retroperitoneal laparoscopy was successfully applied in 21 cases.Operating time was between 65 and 130min with an average of 95 min.All patients did not receive blood transfusion and had no obvious complications.Conclusion Laparoscopic adrenalectomy had the advantages of minimal morbidity,mini- mal postoperative discomfort and a short hospital stay,whieh had a good prospect for application in the clinical prac- tice.
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Objective To consider the clinical significance of retroperitoneal laparoscopic adrenalectomy for adrenal diseases. Methods We analyzed 33 cases of adrenal diseases treated by retroperitoneal laparoscopic adrenalectomy in this hospital from October 1996 to December 2001. Results Retroperitoneal laparoscopy was successfully applied in 31 cases, whereas conversions to open adrenalectomy were required in the other 2 cases. The mean operation time was 158 min (120 min～200 min). The mean intraoperative blood loss was 150 ml, without blood transfusion needed. The mean length of hospital stay was 6.4 days. Conclusions Compared with open surgery, retroperitoneal laparoscopic adrenalectomy has the advantages of minimal invasion, less blood loss, fewer complications, quicker recovery and shorter hospital stay length. This procedure can be applied to in the absence of contraindications (such as tumor size being more than 10cm, metastatic carcinoma and vital organs or blood vessels being involved).
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Between 1980 and 1989, our experience of surgical management with 21 adrenal diseases was presented. There were 3 cases of Cushing's syndrome, 3 of primary aldosteronism, 6 of pheochromo cytoma, 5 of neuroblastoma, 2 of extraadrenal paraganglioma, 1 of adrenocortical carcinoma and 1 of adrenal cyst. The use of advanced radiographic and laboratory procedures resulted in the refinement of diagnosis and localization of tumors, enabling better surgical management of adrenal disorders. Among those, 19 cases underwent unilateral adrenalectomy and 2 cases of Cushing's disease underwent bilateral adrenalectomy. Surgical approaches to the adrenal gland were transperitoneal in 16 cases and extraperitoneal in 5 cases. Operative complications occurred in 11 cases. The incidence, however, of complications related to the operative approach was not significant except in 2 cases of postoperative ileus.