Limited significance of repeated long-term radiological and hormonal examination in nonfunctioning adrenal incidentalomas

ABSTRACT Purpose: The purposes of the present study were to evaluate growth rate of nonfunctioning adrenal incidentalomas (AIs) and their development to hormonal hypersecretion on follow-up. Materials and methods: A retrospective study was conducted from the electronic medical records. A total of 314 patients were diagnosed with adrenal tumors between 2000 and 2016. After excluding patients who had overt adrenal endocrine disorders or whose adrenal tumors were clinically diagnosed as metastatic malignancies, we investigated 108 patients with nonfunctioning AIs including characteristics, the treatment, the way of follow-up and pathology. Results: Fifteen patients received immediate adrenalectomy because of the initial tumor size or patient's preference. Pathological examination revealed malignancy in 2 patients. In the remaining 93 patients, radiological examinations were performed periodically. Tumor enlargement of ≥ 1.0cm was observed in 8.6% of the patients who were followed up as nonfunctioning AIs with a median follow-up period of 61.5 months (range: 4-192). Eleven patients underwent adrenalectomy. On the pathological examinations, all of the tumors, which showed a size increase, were diagnosed as benign tumors. Regarding the followed up patients without adrenalectomy, only 2.4% of the patients had tumor enlargement during the prolonged follow-up. Furthermore, none of the patients developed hormonal hypersecretion or clinical signs such as obesity, glucose intolerance or poorly controlled hypertension. Conclusions: Tumor enlargement of AIs did not correlate with malignancy. The value of repeat radiological and hormonal examinations may be limited in the long-term follow-up of patients whose AIs are not enlarged.

Effect of intravenous dexmedetomidine infusion on some proinflammatory cytokines, stress hormones and recovery profile in major abdominal surgery

This study was designed to evaluate the effect of intravenous dexmedetomidine infusion in patients undergoing major abdominal surgery on stress response markers as plasma interleukin-6, cortisol and blood glucose level. It also assessed its effect on recovery profile and postoperative pain. Thirty adult ASA I-III patients admitted to the surgery department of the Alexandria Main University Hospital scheduled for elective major abdominal surgery under general anaesthesia were included. They were randomly classified into two equal groups of 15 patients each, dexmedetomidine group [Group D] received intravenous dexmedetomidine infusion and placebo group [Group P] received intravenous infusion of normal saline. Haemodynamic parameters were recorded intra- and postoperatively. Interleukin-6, cortisol and blood glucose levels were measured. Recovery profile, postoperative pain score and analgesic requirement postoperatively were assessed. Heart rate and mean arterial pressure were significantly lower in group D relative to group P during most of the intra- and postoperative periods. Postoperatively, the levels of interleukin-6, cortisol and blood glucose were significantly lower in group D relative to group P. Recovery time was longer in group D than group P but with no significant difference. Postoperative pain score was significantly less in group D relative to group P during the early postoperative period with smaller amount of analgesic requirements in group D. Dexmedetomidine is safe and effective in blunting the postoperative rise of the proinflammatory cytokine interleukin-6 and resulted in lower levels of markers of stress response to surgery as cortisol and blood glucose. Dexmedetomidine also reduces the postoperative pain score without delaying recovery from anaesthesia

Adrenocortical reserve and morphology in tuberculosis.

Ninety seven patients (63 males, mean age 31.8 years, SD 2.3) with various forms of tuberculosis were studied. All of them were HIV negative. Thirty normal control subjects (16 males, mean age 36.4 years, SD 1.8) were also studied. Fifty-eight of the 97 patients (59.8%) were malnourished (BMI < 18 kg/m2). The mean basal serum cortisol was lower in the TB group (n = 91) (351 nmol/1; SD 150) as compared to the normal control group (n = 8) (402 nmol/1; SD 93) but this difference did not attain statistical significance. Following administration of synthetic ACTH (cosyntropin), the 30 and 60 minutes mean serum cortisol values in the TB group were significantly lower as compared to the normal control group (p < 0.05). Forty five of the 91 patients (49.5%) who underwent the ACTH stimulation test had compromised adrenal reserve. Fourteen of the 86 patients (16.3%) in whom adrenal morphology was studied revealed adrenal gland enlargement on abdominal CT scan. ACTH stimulation was done in 12 of these 14 patients and eight of them had compromised adrenal reserve. Repeat ACTH stimulation done six months to one year after treatment in 13 patients revealed significantly increased 30 minutes (p < 0.05) and 60 minutes (p < 0.05) serum cortisol values. While nine of these 13 patients were negative responders before treatment, only three of them had evidence of compromised adrenal reserve after one year of antituberculosis treatment, (p < 0.05). Serum cortisol values in patients with drug-sensitive and drug-resistant tuberculosis did not differ significantly. Patients with drug-resistant tuberculosis had a higher prevalence of adrenal gland enlargement (7 of the 30) as compared to those with drug-sensitive tuberculosis (7 of the 56) (p = NS). Subclinical adrenal insufficiency is prevalent in a significant number of patients with both drug-sensitive and drug-resistant tuberculosis, and in some of these it is associated with adrenal gland enlargement. The compromised adrenal reserve and enlargement seem to reverse with therapy.

Effect of electrolytic lesion of the median raphe nucleus on behavioral and physiological measures of stress

The effect of electrolytic lesion of the median raphe nucleus was measured on behavioral and physiological parameters related to stress 24 h after the lesion. In of the elevated plus-maze the lesion decreased the percentage of open arm entries and tended to shorten the time spent on the open arms indicating as increase in anxiety. In contrast, the lesion markedly increased the time spent in the bright (aversive) compartment of the light-dark box and decrease in attempts to cross from the dark toward the bright compartment, an anxiolyic effect. With the exception of plasma prolactin level, which was lowered by the lesion, the physiological measures used in the present study indicate that the lesioned animals are under stress. Thus, death rate and weight loss after the surgery were higher in lesioned than in control animals. In addition, lesioned animals showed higher plasma corticoster- one levels, a high incidence of gastric ulcers in the fundus and a depressed immune response to the mitogen concavaline A. These results highlight the importance of the median raphe nucleus in the regulation of stress and anxiety. They also show that behavioral and physiological measures of stress may be dissociated.

Efectos de la terapéutica corticoidea sobre los leucocitos / Effects of corticoids therapeutic overleukocytes

Se estudiaron 60 pacientes de 18 meses a 70 años, en que la administración terapéutica de Corticoides provocó en el 63 por ciento leucocitosis neutrófila, lo cual está totalmente de acuerdo con la literatura internacional revisada

Effects of prolonged administration and abrupt withdrawal of nifedipine on some endocrine and metabolic parameters in normal rabbits

The effect of prolonged oral administration of nifedipine [four weeks] in three dose levels 1, 3 and 10 mg/kg/day] as well as the effect as measured on the third day following abrupt withdrawal of the drug on plasma levels of adenocorticotrophic hormone [ACTH] and serum levels of cortisoly triiodothyromine [T3] thyroxine [T4], insulin, glucose and free fatty acids [FFAs] was studied in normal rabbits. Nifedipine decreased plasma ACTH serum insulin and FFAs levels at the three doses used. A decrease of serum T[3] level occurred at the 1 mg/kg dose. Meanwhile it increased serum cortisol at 10 and 3 mg/kg doses and serum glucose at the 10 mg/kg dose. Withdrawal of nifedipine still showed an increase in serum cortisol at the 10 mg/kg dose as a result of persistence of its pharmacodynamie effect. Also it increased serum FFAs at the 10 and 3 mg/kg doses; while a decrease of serum T[3] was noted at the 10 and 3 mg/kg doses. A decrease of serum insulin at the three doses used occurred on the third day after abrupt cessation of the drug

Funçäo da córtex adrenal em pacientes com paracoccidioidomicose: estudo através da dosagem radioimunológica do ACTH plasmático / Function of the adrenal cortex in patients with paracoccidioidomycosis: study by radioimmune assay of plasma ACTH

Foram estudados 15 pacientes com paracoccidioidomicose (PMC), dos quais 14 com a forma disseminada e um com a forma pulmonar progressiva, sendo 10 virgens de tratamento e cinco com recidiva da micose. O diagnóstico micológico foi feito através da evidenciaçäo etiológica em espécimes obtidos das lesöes: exame direto (KOH), histopatológico e/ou cultura. A funçäo adrenocortical foi estudada através das dosagens hormonais basais (cortisol plasmático-ritmo circadiano, ACTH plasmático e 17 OHCS na urina de 24 horas) e pós-teste de estímulo pelo ACTH exógeno (Cortrosina), empregando-se kits comerciais para essas dosagens. O trabalho visou a detecçäo da elevaçäo dos níveis plasmáticos de ACTH, a descoberta de pequenas reservas adrenocorticais e a evidenciaçäo de graus menores de falência adrenal (insuficiência corticoadrenal primária) por meio da dosagem do ACTH plasmático (método radioimunoensaio) em paracoccidioidomicóticos. Os resultados demonstram a presença de três grupos de pacientes: 1) ACTH plasmático < 20pg/ml; 2) ACTH plasmático entre 20 e 50pg/ml; e 3) ACTH plasmático > 58pg/ml. Feita a correlaçäo ACTH-cortisol pós-teste de estímulo pelo ACTH exógeno, oito pacientes situaram-se no grupo 1, sendo que dois deles apresentaram queda menor que duas vezes o basal, enquanto que nos quatro pacientes do grupo 3 ficou bem evidenciada a elevaçäo do ACTH plasmático em níveis superiores ao normal, dos quais dois mostraram resposta nula pós-estímulo, junto a sintomas e sinais de doença de Addison, satisfazendo critérios de insuficiência supra-renal primária. Na correlaçäo ACTH-17 OHCS pós-teste de estímulo pelo ACTH, oito pacientes situaram-se no grupo 1, sendo que sete apresentaram níveis de 17 OHCS menores que duas vezes o basal. Em três dos quatro pacientes do grupo 3, ficou comprovada insuficiência supra-renal primária, ao passo que o quarto paciente do grupo mostrou resposta aos 17 OHCS superior a três vezes o basal

Measurement of immune function in surgical patients: their relationship to post-operative infection

A wide spectrum of laboratory tests was applied to a 20 patients, before and after surgery, to assess their susceptibility to infection. Four developed intra-abdominal sepsis and live suffered from minor 5 common antigers were variable and did not relate to the development of infection. Phytohaemagglutin [PHA] induced lymphocyte transformation did not show any marked change and again failed to predict infection in individual patients. The number of polymorphs in the blood rose and the number of lymphocytes fell in the immediate postoperative period. The latter was apparently related to the precipitious rise in serum cortisol found immediately after operation. The levels of immunoglobulins g, A and M and comlement components C1 q, C3, C4 and B showed some significant changes but there was no evidence of a deficit in a single immune mechanism after surgery. two striking findings were a doubling, on the seventh post-operative day, of the lymphocyte response to PHA stimulation in medium supplemented with autologous serum and on the same day, an increased number of lymphocytes DNA without mitogenic stimulation

Regulación hormonal del metabolismo de glucosa en islotes de langerhans / Hormonal regulation of glucose metabolism in island of Langerhans

Se ha estudiado simultáneamente la secreción de insulina y el metabolismo de glucosa en islotes aislados, obtenidos de ratas normales, ratas con diversas insuficiencias endocrinas (adrenalectomizadas, ovariectomizadas y radioyodotiroidectomizadas), como así también grupos de animales con deprivación hormonal seguida de hormonoterapia sustitutiva. Los islotes provenientes de todos los grupos de animales con déficit endocrino mostraron alteraciones concordantes en ambos parámetros y la correlación entre los cambios en la secreción de insulina y el metabolismo de glucosa fue altamente significativa. Todos los cambios observados en estos animales hormono-deficientes fueron corregidos mediante la terapia sustitutiva específica. Estos resultados sugieren que probablemente las diversas hormonas estudiadas podrían alterar la secreción de insulina a través de una modificación en la capacidad de los islotes para metabolizar la glucosa