ABSTRACT
ABSTRACT Objective: We aimed to identify metabolic dysfunction in non-functioning adrenal adenomas (NFAAs) and Visceral Adiposity Index (VAI) predictability in the practical estimation of metabolic syndrome (MetS) in NFAAs. Subjects and methods: 134 NFAA patients and 68 control subjects matched for age, sex, and body mass index (BMI) were included in the study. After physical, biochemical, and endocrine evaluation, IDF and NCEP ATP III criteria were used to determine MetS. HOMA-IR and VAI were calculated for both study group subjects. Results: MetS was significantly higher in the NFAA patients. The incidence of MetS by IDF and NCEP criteria was 52.9%,48.5% in the NFAI and 32.3%,30.8% in the control group (p < 0.01, p = 0.02). The risk of MetS was increased in NFAA (75.6 vs. 24.4%, p = 0.017, OR = 1.34, 95% CI = 1.06-1.68). Glucose, HOMA IR, hypertension, and VAI were significantly increased in NFAA patients. The risk of MetS was independently associated with high VAI (79.2 vs. 20.8%, p = 0.001, OR = 2.22; 95% CI = 1.70-2.91). Conclusion: MetS, insulin resistance, and VAI are more prevalant in NFAA patients than in healthy individuals. VAI can be used with high specificity to estimate MetS in NFAA patients.
ABSTRACT
【Objective】 To effectively differentiate adrenal adenoma (AA) and small diameter pheochromocytoma (PCC) by establishing a clinical-radiomic nomogram model before surgery. 【Methods】 A total of 132 pathologically confirmed patients (45 PCC cases, 87 AA cases) were enrolled. After the features of enhanced CT were assessed, the radiomic features and related clinical indicators were extracted. Based on multiple Logistic regression, a clinical-radiomic nomogram with radiomic features and independent clinical predictors was developed. The area under the receiver operating characteristic (ROC) curve (AUC) was used for internal evaluation to compare the diagnostic effectiveness of the three models. The clinical effectiveness of the nomogram was verified with decision curve analysis (DCA). 【Results】 One of the 108 candidate features was used to construct the radiological feature score. Individualized clinical-radiomic nomogram included independent clinical factors (24 h urinary vanmandelic acid/renin/angiotensin I) and original first-order median radiological feature scores. Internal evaluation of the prediction model showed that the AUC was 0.945 (95%CI:0.906-0.984), superior to the single clinical model or radiological model in precise differentiation. DCA showed that the nomogram had the best clinical use. 【Conclusion】 The clinical-radiomic nomogram model can effectively differentiate adrenal adenoma from small diameter pheochromocytoma, which can improve the preoperative differential diagnosis and preparation.
ABSTRACT
@#Oncocytic adrenocortical tumours (OATs) or oncocytomas are extremely rare and are usually benign and nonfunctional. We report the case of a 4-year-old male with a right-sided, functional oncocytic adrenocortical adenoma, who presented with precocious puberty and Cushing’s syndrome. After work-up, the patient underwent laparoscopic adrenalectomy. The excised adrenal mass weighed 21 g and measured 3.5 cm in maximum dimension. Histological examination demonstrated no features suggestive of aggressive biological behaviour. The patient had no features of recurrent or metastatic disease and had prepubertal testosterone levels with suppressed hypothalamic-pituitary-adrenal axis twelve months after the surgery. A discussion of this case and a review of the literature on functional OATs in the pediatric population are presented.
ABSTRACT
Adrenocortical carticnoma (ACC) is an uncommon tumor with an incidence of 1-2 cases/million/year. It has two peak incidences; the first one in the first decade and the second one in the fourth decade. Most patients present with features of steroid hormone excess or abdominal mass effects, but about 15% of ACC are diagnosed incidentally. It is hormonally functional in 80 - 100% patients and the predisposing lesions include congenital adrenal hyperplasia and adenoma. ACC has significant syndromic and genetic association. Surgery offers the best chance of cure, especially in localized disease. Here, we present the case of virilization in a young female child secondary to a functioning ACC. The child had classical hormonal and imaging features of functioning ACC and underwent resection of the tumor (Adrenalectomy) with good outcome.
ABSTRACT
Cushing′s syndrome during pregnancy is a very rare clinical condition, but can be seriously detrimental to mothers and fetuses. The gestation could lead to an increase of endogenous adrenal cortisol which could mimick the symptoms of Cushing′s syndrome and also cause difficulty in biochemical diagnosis. Moreover, the therapy of Cushing′s syndrome need to be optimized based on the classification of the pathogenesis, the timing of terminating pregnancy should be considered prudently and comprehensively in this condition. This article mainly reviews the diagnosis and therapies of Cushing′s syndrome concomitant with pregnancy and provides possible suggestions for the management of this condition.
ABSTRACT
Abstract Introduction: Secondary hypertension corresponds to 15 % of the causes of arterial hypertension, and among them, primary hyperaldosteronism presents a variable incidence of about 3 % in hypertensive patients. It has a slightly higher prevalence in women, between 30 and 60 years, and is usually unilateral. Case presentation: The authors describe the clinical case of a patient, followed by a severe hypertension medicated with four antihypertensive drugs for tension stabilization, maintaining systolic arterial tensions superior to 170 mmHg. In the aetiological study of hypertension, analytical alterations suggested hyperaldosteronism and a nodular lesion was detected in the left adrenal gland. The patient was submitted to surgery and excision of the lesion was done with histological confirmation of the diagnosis of corticomedullary adenoma of the adrenal gland. The patient presented improvement of the tension profile, with need to suspend two of the four antihypertensive drugs and to reduce the dose of the remaining ones. Conclusion: A tumor of the adrenal cortex producing aldosterone is the main cause of primary hyperaldosteronism and should always be excluded when the presence of difficult to control, severe hypertension is detected, since the standard treatment is surgical, leading to a stabilization of the tension pattern after a few months.
Resumen Introducción: la hipertensión secundaria corresponde al 15 % de las causas de hipertensión arterial, y entre ellas, el hiperaldosteronismo primario presenta una incidencia variable de sobre 3 % en pacientes hipertensos. Tiene una prevalencia ligeramente mayor en mujeres, entre 30 y 60 años, y generalmente es unilateral. Presentación del caso: los autores describen el caso clínico de un paciente, seguido por una hipertensión resistente medicada con cuatro fármacos antihipertensivos para la estabilización de la tensión, con mantenimiento de las tensiones arteriales sistólicas superiores a 170 mmHg. Las alteraciones analíticas en el estudio etiológico de la hipertensión sugirieron hiperaldosteronismo y una lesión nodular en la glándula suprarrenal izquierda. El paciente fue sometido a cirugía y se realizó la escisión de la lesión con confirmación histológica del diagnóstico de adenoma corticomedular de la glándula suprarrenal. El paciente presentó una mejora en el perfil de tensión, con la necesidad de suspender dos de los cuatro fármacos antihipertensivos y reducir la dosis de los restantes. Discusión: un tumor de la corteza suprarrenal que produce la aldosterona es la principal causa de hiperaldosteronismo primario y siempre debe excluirse cuando se presenta hipertensión grave, difícil de controlar, ya que el tratamiento estándar es quirúrgico y conduce a una estabilización del patrón de tensión después de unos meses.
Resumo Introdução: a hipertensão secundária corresponde ao 15 % das causas de hipertensão arterial, e entre elas, o hiperaldosteronismo primário apresenta uma incidência variável de sobre 3 % em pacientes hipertensos. Tem uma prevalência ligeiramente maior em mulheres, entre 30-60 anos, e geralmente é unilateral. Apresentação do caso: os autores descrevem o caso clínico de um paciente, seguido por uma hipertensão resistente medicada com quatro fármacos anti-hipertensivos para a estabilização da tensão, com manutenção das tensões arteriais sistólicas a 170 mmHg. As alterações analíticas no estudo etiológico da hipertensão sugeriram hiperaldosteronismo e uma lesão nodular na glândula suprarrenal esquerda. O paciente foi submetido a cirurgia e se realizou a incisão da lesão com confirmação histológica do diagnóstico de adenoma córtico-medular da glândula suprarrenal. O paciente apresentou uma melhora no perfil de tensão, com a necessidade de suspender dois dos quatro fármacos anti-hipertensivos e reduzir a dose dos restantes. Discussão: um tumor do córtex suprarrenal que produz a aldosterona é a principal causa de hiperaldosteronismo primário e sempre deve excluir-se quando se apresenta hipertensão grave, difícil de controlar, pois o tratamento standard é cirúrgico e conduz a uma estabilização do patrão de tensão depois de uns meses.
Subject(s)
Humans , Male , Middle Aged , Hypertension , Case Reports , Adrenal Cortex Diseases , HyperaldosteronismABSTRACT
Objective To investigate the clinical characteristics in patients with bilateral macronodular adrenal hyperplasia ( BMAH). Methods We enrolled 357 patients with adrenal tumors including 42 BMAH, 167 cortisol-producing adrenal adenoma (CPA), and 148 non-functional adenomas (NFA). The clinical manifestations, hormonal explorations and complications were compared among groups. Results (1) Age at diagnosis of BMAH group was significantly higher than that of CPA group [(53.7±8.3 vs 41.1±13.1)years], female proportion of BMAH group was lower that that of CPA group(54.8%vs 88.0%, P＜0.01). Both were similar to NFA group. (2) Compared to NFA group, metabolic abnormalities were severer in BMAH and CPA groups. Prevalence of hypertension, diabetes mellitus, and hypokalemia were the highest in BMAH group. ( 3) BMAH patients had lower midnight serum cortisol, 24 hour urine free cortisol, and adrenocorticotrophic hormone levels than CPA patients (P＝0.008, 0.010, and P＝0.001, respectively). The suppression rate of serum cortisol after low-dose dexamethasone suppression test was significantly higher in BMAH group ( P＝ 0. 005). Conclusion BMAH patients were at higher age at diagnosis. Although hypercortisolism in BMAH patients is relatively slight, metabolic abnormalities are more severe. Besides functional diagnosis, physicians should pay more attention to the assessment of complications related to hypercortisolism.
ABSTRACT
Objective To investigate the feasibility of using CT texture analysis to differentiate among lipid-poor adrenal adenoma,pheochromocytoma and adrenal metastases.Methods 66 lipid-poor adrenal adenoma,98 pheochromocytoma and 101 adrenal metastases lesions were analyzed retrospectively.All the patients had abdominal non-enhanced CT and adrenal enhanced CT scans.We used TexRAD software to analyze the textural features of CT images and compared the differences in each texture parameter among three adrenal lesions.Results On non-enhanced CT images,there were significant differences in Mean and Kurtosis at all the texture scales(SSF 0-6) among the three types of adrenal lesions (P<0.05),as well as SD at fine and coarse texture scale (SSF 2,6)(P<0.05).Entropy (SSF 0-3, 5-6) and MPP (SSF 0-2, 4-6) were significantly lower in lipid-poor adrenal adenoma and adrenal metastases than that in pheochromocytoma (P<0.05).There were significant differences in Skewness (SSF 0-3) among three types of lesions, which was lowest in pheochromocytoma and highest in adrenal metastases.On enhanced CT images, Mean, SD, Entrophy and MPP showed significantly differences among the three types of adrenal lesions at all the texture scales (SSF 0-6) (P<0.05), which were all highest in pheochromocytoma and lowest in adrenal metastases.Skewness (SSF 0) and Kurtosis (SSF 0, 2) were significantly lower in adrenal metastases than that in lipid-poor adrenal adenoma and pheochromocytoma (P<0.05).Conclusion There are significant differences in CT texture analysis parameters among lipid-poor adrenal adenoma,pheochromocytoma and adrenal metastases.CT texture analysis has potential clinical application values in differentiating these three adrenal lesions.
ABSTRACT
Objective To investigate the differential diagnostic value of CT scan minimum attenuation values (minAVsCT) in adrenal adenomas and non-adenomas.Methods CT scan data of 89 cases of clinical and pathologically confirmed adrenal adenomas were subjected to retrospective analysis and compared with data of 46 cases involving 50 non-adenomas (25 metastases,20 pheochromocytomas,3 lymphomas,and 2 cortical carcinomas).The distributions of mean attenuation values (meanAVs) ￥ 10 Hu and minAVs ￥0 Hu and CT histogram analysis with ≥ 10％ negative pixels were observed in adrenal adenomas and non-adenomas,and the diagnostic sensitivity and specificity of these 3 methods for adenomas were calculated.Results The distributions of unenhanced meanAVs ￥ 10 Hu,minAVs ￥0 Hu,and CT histogram analysis with ≥ 10％ negative pixels among cases of adenoma and non-adenoma were 62.9％ (56/89) and 0％ (0/50) (x2=52.687,P=0.000),84.3％ (75/89) and 2％ (1/50) （x2=83.917,P=0.000),and 77.5％ (69/89) and 0％ (0/50) (x2=83.917,P=0.000),respectively.The respective diagnostic sensitivities,specificities,false negative rate (FNR),false positive rate (FPR),positive pre dictive value (PPV),negative predictive value (NPV) and accuracy of these 3 methods for adenomas were 62.9％vs 84.3％ vs 77.5％,100％ vs 98.0％ vs 100％,37.1％ vs 15.7％ vs 22.5％,0 vs 2％ vs 0,100％ vs 98.7％ vs 100％,60.2％ vs 77.8％ vs 71.4％,and 76.3％ vs 89.2％ vs 85.6％.Conclusion Although the specificity and PPV of minAVs≤0Hu is slightly less than meanAVs≤10Hu and CT histogram analysis with ≥ 10％ negative pixels,it exhibits the best sensitivity and accuracy with a simple operation,and is thus suitable for clinical application.
ABSTRACT
Objective To compare effects between the laparoscopic surgery and open surgery for the bigger adrenal adenoma(＞4cm) patients in Qinghai.Methods Altogether 57 cases of bigger adrenal adenoma patients(＞4cm)in the affiliated hospital of Qinghai university and Qinghai People's Hospital from 2012 to 2016 were selected and divided into two groups (A and B) according to surgical programs difference.Group A (23 cases)wcre givcn laparoscopic surgcry and Group B (34 cases)were given open surgery (And 2 cases in group A turned into open surgery were out of statistics).The operative time,blood loss,hospital stay and drainage tube removal time were compared.Results The operative time,blood loss,hospital stay and draiuage tube removal time in Group A were significantly better than those in Group B,with statistical significance (P ＜ 0.05).Conclusion The use of laparoscopic surgery for the bigger adrenal adenoma(＞4cm) patients is safer and more effective than open surgery.
ABSTRACT
Objective To investigate the features of CT perfusion (CTP) parameters of adrenal adenoma (AA) using wide detector CT.Methods The wide detector CT scanning data of 21 patients with pathologically confirmed AA were retrospectively analyzed.CT perfusion (CTP) imaging was performed with the axis mode covering by 16 cm detector and ASiR-V50％.The image acquisition of CTP was performed after 6 s of injection of contrast media.Totally 26 consecutive volume acquisitions were contained.The arterial,venous and delayed phase images were obtained at the time of 22 s,51 s and 153 s after the injection,respectively.The blood flow (BF),blood volume (BV),mean transit time (MTT),time to peak (TP) and permeability of surface (PS) values of AA (group A) and contralateral normal adrenal gland (group B) were measured.All parameters between the two groups were compared,and the radiation dose was assessed.ROC curves were used to assess the diagnostic efficiency of CT perfusion parameters for AA.Results BV,MTT and PS values of group A were statistically lower than those of group B (all P＜0.05).There was no statistical difference of BF and TP values between the two groups (both P＞0.05).The area under the ROC curve (AUC) of BV,MTT and PS was 0.780,0.762 and 0.831,respectively.The sensitivity and specificity of diagnosis of AA was 95.2％ and 81.0％,respectively,when the threshold of PS was 1.37 ml/(100g · min).The effective dose (ED) of CT plain and CTP (including three-phase enhanced scan) were (3.20 ± 0.57) mSv and (19.98 ± 1.95) mSv.Conclusion Wide detector CT perfusion imaging can provide high-quality conventional three-phase enhanced images for diagnosis of AA,and provide effective quantitative perfusion data at the same time.PS value shows strong capability for diagnosis of AA.
ABSTRACT
PURPOSE: To examine and compare the perioperative outcomes of laparoscopic adrenalectomy (LA) and to determine its efficacy in patients with nonfunctioning adrenal adenomas (NFA) and subclinical Cushing syndrome (SCS). MATERIALS AND METHODS: We retrospectively analyzed the clinical data obtained from 79 consecutive patients who underwent LA for the treatment of either NFA (n=35) or SCS (n=44) between 2011 and 2016. All patients had undergone computed tomography, as well as endocrinological tests to confirm the diagnosis prior to the adrenalectomy. The primary endpoint was improved metabolic parameters relating to diabetes, hypertension, dyslipidemia, and obesity. RESULTS: Patients with SCS compared to those with NFA showed a higher occurrence of diabetes (29.5% vs. 11.4%), hypertension (59.1% vs. 34.3%), and dyslipidemia (43.2% vs. 14.3%). Patients with SCS showed a smaller median tumor size compared to those with NFA (2.5 cm vs. 5 cm). No significant perioperative complications ≥ Clavien-Dindo classification grade III were observed in any patient (SCS or NFA group). In terms of their metabolic profile, patients with SCS showed a significant postoperative improvement in hypertension (50.0%), diabetes (53.9%), dyslipidemia (31.6%), and obesity (29.2%). However, patients with NFA showed a postoperative improvement only in dyslipidemia (40.0%) and obesity (4.8%). CONCLUSIONS: Owing to absence of significant perioperative complications and the marked postoperative improvement in metabolic impairment, LA is a useful treatment strategy in patients diagnosed with SCS. In contrast, LA was not observed to show beneficial effects in correcting/improving the metabolic profile in patients presenting with NFA.
Subject(s)
Humans , Adenoma , Adrenalectomy , Classification , Cushing Syndrome , Diagnosis , Dyslipidemias , Hypertension , Metabolome , Obesity , Retrospective StudiesABSTRACT
La hormona luteinizante (LH) y la gonadotropina coriónica humana (hCG) puede inducir esteroidogénesis, hiperplasia y tumorigénesis adrenal a través del estímulo sobre el receptor constitutivo de la LH (R-LHCG) en la corteza adrenal. Los mecanismos fisiopatológicos del síndrome de Cushing adrenal dependiente de LH (SCa-LH) no se han establecido plenamente, pero es reconocida la relación ontogénica adrenal-gonadal con mutua participación de diversos genes, factores de transcripción y enzimas esteroidogénicas como posible causa. El SCa-LH fue descrito en mujeres durante la gestación por el estímulo de hCG y en la posmenopausia ante el aumento de LH, así como en hurones luego de la gonadectomía quirúrgica.
Luteinising hormone (LH) and human chorionic gonadotropin (hCG) can induce steroidogenesis, hyperplasia, and adrenal tumorigenesis through the stimulus of the constitutive LH receptor (R-LHCG) within the adrenal cortex. The pathophysiological mechanisms of luteinising hormone-dependent Cushing's syndrome are not completely understood, but the ontogenic relationship between the adrenal cortex and the gonads, with mutual participation of different genes, transcription factors and steroidogenic enzymes cited as a possible cause, is well-recognised. SCa-LH has been described in pregnant women, as a result of hCG stimulus, and in post-menopausal women, due to increased levels of LH, as well as in ferrets after gonadectomy.
ABSTRACT
Minimally invasive approach has been the gold standard therapy for adrenal tumor since 1992. The improvements of endo-crine test and radiographic options that are used to evaluate adrenal lesion relevance ratio have promoted the diagnosis and treat-ment. Future research may focus on secondary hypertension screening, subclinical situation of functional adrenal tumor, and differen-tial diagnosis through imaging tests and other methods. Subclinical hypercortisolism and the relationship between incidentaloma and metabolism should be given particular importance. Laparoscopic adrenalectomy has become the gold standard approach for adrenal benign tumor treatment. The indication for usage of this approach has extended and included adrenal carcinoma (tumor size ranging within 6-10 cm) and pheochromocytoma larger than 6 cm. Partial adrenalectomy mainly depends on surgeon's experience. In addi-tion, the perioperative period of minimally invasive surgery need further research. This paper reviews related studies.
ABSTRACT
Objective To evaluate the feasibility , safety, therapeutic effects and adverse reactions of CT-guided radiofrequency ablation (RFA)for adrenocortical adenoma with Cushing's syndrome.Methods From Jan.2009 to Dec.2013, 24 patients with 24 tumors diagnosed as adrenocortical adenoma with Cushing's syn-drome received CT-guided percutaneous RFA.The average tumor size was(2.1 ±0.7)cm(ranging from 1.1 to 3.9 cm) .RFA was performed under real-time computed tomography guidance .Technical success was defined as disappearance of tumor enhancement on contrast CT imaging 1 week after RFA .Clinical success was defined as improvement in serum cortisol, adreno-cortico-tropic-hormone(ACTH)and symptoms within the follow-up.Patho-logical diagnosis was acquired through the needle biopsy after RFA procedure .Results RFA was technically successful in all the 24 patients.No conversion occured.During operation, patients suffered blood pressure fluc-tuation but no one experienced a hypertensive crisis .Mild postoperative lumbar pain occurred in 6 patients . Tumor enhancement disappeared in CT scan .The mean follow-up was 18 months, ranging from 3 to 36 months. Both serum cortisol and ACTH basically returned to normal levels , and the symptoms related to Cushing's syn-drome gradually disappeared .No severe complications occurred during this procedure .Histopathology results showed all were adrenal cortical adenomas .No serious complication occurred to any patient during RFA .Conclu-sion CT-guided RFA for adrenocortical adenoma with Cushing's syndrome is a feasible , safe, effective and mini-mally invasive treatment with few complications .
ABSTRACT
A substantial proportion of adrenal incidentalomas demonstrates subtle hormonal hypersecretion; however, adenomas that cosecrete aldosterone and cortisol are rare. We here report a case of an adrenal mass that was incidentally detected on a computed tomography scan in a 57-year-old man. The patient had a 10-year history of diabetes mellitus and a 5-year history of hypertension. Evaluation revealed hyperaldosteronemia with an elevated plasma aldosterone-to-renin ratio, hypokalemia, unsuppressed cortisol after dexamethasone administration, and elevated urinary free cortisol concentration. The appearance of the right adrenalectomy specimen indicated adrenal adenoma. Postoperatively, the blood glucose and blood pressure control improved and the urinary cortisol and aldosterone-to-renin ratio normalized. A complete endocrine evaluation in patients with incidentally discovered adrenal masses should be performed, even if the patient has a long-standing history of hypertension and diabetes, to avoid any postoperative adrenal crises.
Subject(s)
Humans , Middle Aged , Adenoma , Adrenalectomy , Adrenocortical Adenoma , Aldosterone , Blood Glucose , Blood Pressure , Dexamethasone , Diabetes Mellitus , Hydrocortisone , Hyperaldosteronism , Hypertension , Hypokalemia , PlasmaABSTRACT
La hipertensión arterial secundaria es más común en individuos menores de 30 años, la mayor parte son de causa renovascular; la etiología endocrina es excepcional, el hiperaldosteronismo primariosólo ocupa de 5-15%, el síndrome de Conn corresponde a 0.05-2.2% de la población de hipertensos y es una de las pocas causas potencialmente curables de hipertensión, por lo que consideramos este caso digno de ser revisado. Se presenta un hombre de 63 años de edad con hipertensión arterialdiagnosticada hace 25 años, en tratamiento con múltiples antihipertensivos, incluido el minoxidil sin control de cifras tensionales, que consulta a endocrinología por aparición de vello facial. Se consideró hipertensión arterial secundaria y se halló hipokalemia. La relación de aldosterona y renina elevada, sugería la presencia de hiperaldosteronismo, que se localizó con venografía de suprarrenales. La extirpación quirúrgica de la lesión confirmó el diagnóstico de adenoma adrenocortical. Después de la cirugía mejoró el control de la tensión arterial y tras suspender el minoxidil, la hipertricosis desaparece. (Acta Med Colomb 2014; 39: 191-195).
Secondary Hypertension is more common in individuals under 30; most have renovascular etiology; endocrine etiology is exceptional; primary hyperaldosteronism is only responsible for 5-15%, Conn syndrome corresponds to 0.05-2.2 % of the hypertensive population and is one of the few potentially curable causes of hypertension, so we consider this case worthy to be revised. A 63 year old man diagnosed with hypertension 25 years ago and treated with multiple antihypertensives including minoxidil, with uncontrolled blood pressure readings, which consults to endocrinology for appearance of facial hair, is presented. Secondary hypertension was considered, and hypokalemia was found. The ratio of aldosterone and high renin, suggested the presence of hyperaldosteronism which was localized by adrenal venography. Surgical removal of the lesion confirmed the diagnosis of adrenocortical adenoma. After surgery, control of blood pressure improved and after discontinuation of minoxidil, hypertrichosis disappears. (Acta Med Colomb 2014; 39: 191-195).
Subject(s)
Humans , Male , Middle Aged , Adrenocortical Adenoma , Blood Pressure , Renin , Aldosterone , Hyperaldosteronism , HypertensionABSTRACT
Objective To compare the advantages and disadvantages of retroperitoneal laparoscopic sur -gery and open surgery in treatment of adrenal adenoma , in order to provide the clinical evidence for the selection of surgical treatment of adrenal adenoma .Methods 120 cases undergoing surgical treatment from Jan .2005 to Dec.2010 were randomly divided into laparoscopic group and open surgery group .Operation indicators , postop-erative recovery indicators , postoperative clinical manifestations , success of operation , complications and follow-up data were evaluated and compared between the 2 groups.Results 3 cases in laparoscopic group and 4 cases in open surgery group withdrew.The operation time, intraoperative blood loss, and blood transfusion cases were (89.6 ±18.4)min vs (124.2 ±27.3)min, (70.2 ±17.2)ml vs (205.7 ±51.9)ml, and 8 cases vs 20 cases in laparo-scopic group and open surgery group .Extubation time, starting feeding time, time of getting out of bed, and length of hospital stay were (2.8 ±1.3)d vs (4.2 ±2.0)d, (1.7 ±1.1)d vs (2.9 ±1.4)d, (2.6 ±1.2)d vs (5.1 ± 3.1)d and (6.2 ±3.1)d vs (13.5 ±5.4)d in laparoscopic group and open surgery group .Postoperative analge-sic using cases and drainage volume were 11 cases vs 43 cases, and(15.4 ±4.2)ml vs(45.1 ±12.7)ml in lapa-roscopic group and open surgery group .The difference had statistical significance (P＜0.01).The cost was simi-lar between the 2 groups(P>0.05).The open surgery group had no death or relapse within 1 year, while 5 cases in laparoscopic group converted to laparotomy , with 1 case of death and 2 cases of relapse within 1 year.The complications incidence was 3.51%(2/57)in laparoscopic group, obviously lower than 16.07%(9/56)in open surgery group(P＜0.01).Conclusions Compared to the traditional open surgery, retroperitoneal laparoscopic sur-gery has advantages of less trauma, fewer complications, and faster postoperative recovery in treatment of adrenal ade-noma.Experience and skills of surgeon need to be improved to reduce the possibility of failure or recurrence .
ABSTRACT
Objective To assess the safety and feasibility of CT-guided percutaneous argon-helium cryoablation in the treatment of adrenal tumors.Methods 1 7 patients with adrenal tumors were treated with CT-guided percutaneous argon-helium cryoablation. Three of these patients were retreated second cryoablation three months later due to the lager tumor diameters.Percutaneous tran-scatheter arterial embolization was performed in four patients because of rich blood supply before cryoablation.Continuous arterial blood pressure monitoring was performed in eight pheochromocytoma patients.Results Technical success was achieved in all pa-tients.There were no serious complications.Eight pheochromocytoma patients experienced a significant increase in systolic blood pressure and diastolic pressure when compared with the basic values (P <0.05).There were no enhancement on enhanced CT and/or up-take on FDG PET-CT in the ablated zones during the follow-up period (3-24months).Conclusion It is safety and efficacy of CT-guided percutaneous argon-helium cryoablation for adrenal tumor.It might be initial treatment of choice for the patients who were not suitable for resection.
ABSTRACT
No abstract available.