A functioning adrenal adenoma and pheochromocytoma in the same adrenal gland: two discrete adrenal incidentalomas

No abstract available.

A case of primary aldosteronism presenting as non-ST elevation myocardial infarction

No abstract available.

Persistent hypokalaemia in a jamaican hypertensive patient / Hipocalemia persistente en un paciente hipertenso jamaicano

We report the case of a 48-year old man with uncontrolled hypertension and persistent hypokalaemia from an aldosterone producing adrenal adenoma treated by laparoscopic adrenalectomy. Clinicians' identification of primary hyperaldosteronism is critical as the correct treatment results in improved blood pressure control and reduced risk of complications.

Reportamos el caso de un hombre de 48 años de edad con hipertensión descontrolada e hipocalemia persistente a partir de un adenoma suprarrenal productor de aldosterona, tratado mediante adena-lectomía laparoscópica. La identificación de hiperaldosteronismo primario por parte de los clínicos es fundamental, ya que el tratamiento correcto trae como resultado un mejor control de la presión sanguínea a la par que reduce el riesgo de complicaciones.

Unusual presentation of the Conn's syndrome: a case report

A 26 -year- old woman presented with rhabdomyolysis secondary to severe hypokalemia. Hypertension and metabolic alkalosis could lead to the suspicion of primary aldosteronism, which was confirmed by a decreased plasma rennin, elevated plasma aldosterone levels and high aldosterone/rennin ratio additionally. Additionally adrenal computed tomography showed an adrenal tumour. Blood pressure and hypokalemia returned to the normal level after adrenaiectomy was performed. This case report highlights the need to be alert to the possibility of primary aldosteronism incidence in a patient presenting with rhabdomyolysis and hypertension caused by severe hypokalemia

Predictors of Resolution of Hypertension after Adrenalectomy in Patients with Aldosterone-producing Adenoma

Primary aldosteronism (PA) is a frequent cause of secondary hypertension and is amenable to surgical intervention when it is caused by aldosterone-producing adenoma (APA). Many patients, however, continue to require antihypertensive medications to control their blood pressure after adrenalectomy. The aim of this study was to determine the preoperative factors that predict clinical outcomes after adrenalectomy in patients with APA. We studied 27 patients (mean age 45+/-4 yr) who had APA and underwent unilateral adrenalectomy between December 1995 and September 2008 at our institution. Clinical and biochemical data were evaluated at baseline and after a mean follow-up of 51.8+/-47.0 months (range, 6-159). At the end of the follow-up, 16 patients (59.3%) were considered to experience "complete resolution" without postoperative medications, whereas 7 patients (25.9%) "improved" with medications and 4 patients (14.8%) were "uncontrolled." Three factors (< or =2 antihypertensive medications [P=0.007], duration of hypertension <6 yr [P=0.002], and serum aldosterone <350 pg/mL [P<0.001]) were the predictive for complete resolution in univariate analysis. Multivariate regression analysis showed that serum aldosterone level (<350 pg/mL) was the single most important factor that predicted complete resolution after surgery (P<0.001). The best preoperative clinical factor that predicted resolution of postoperative hypertension after adrenalectomy is serum aldosterone level (<350 pg/mL).

Symptomatic Hypocalcemia in Primary Hyperaldosteronism: A Case Report

The metabolic alterations caused by hyperaldosteronism are being increasingly recognized and have generated considerable interest among the medical fraternity. Hyperaldosteronism is suspected to have a pivotal role in the patho-physiology of congestive cardiac failure where it has been studied extensively. But its effects on calcium metabolism, parathyroid metabolism and renal handling of calcium are less well described. Recent experimental models have shed light into the roles played by previously unknown mechanisms in causing these metabolic alterations. We hereby report a case of primary hyperaldosteronism due to adrenal adenoma (Conn's syndrome) who presented with a myriad of clinical features including symptomatic hypocalcemia, significant weight loss along with uncontrolled hypertension for a prolonged period before eventually detected to have primary hyperaldosteronism. Surgical removal of the causative tumor resulted in prompt disappearance of all the symptoms and signs and regain of lost weight.

Síndrome de cushing ACTH-independente por adenoma de supra-renal: relato de caso / Cushing syndrome ACTH-independent for adenoma of supra-renal: case report

JUSTIFICATIVA E OBJETIVOS: Relatar um caso de sín­drome de Cushing causado por adenoma de supra-renal, com acompanhamento das condutas diagnósticas e terapêuticas. RELATO DO CASO: Paciente do sexo feminino, 19 anos, que aos 17 anos iniciou com manifestações clínicas sugestivas de síndrome de Cushing e abortamento espontâneo aos 18 anos. Na avaliação laboratorial constatou-se hipercortisolismo, o qual diminuiu após o teste de Liddle 2, porém não chegou a suprimir o cortisol (8,73 miu.1g/dL), com ACTH em 1 pg/dL, in­dicando ser ACTH-independente. A tomografia de abdômen demonstrou imagem em adrenal esquerda compatível com adenoma. A paciente foi submetida a adrenelectomia esquer­da e posteriormente foi realizado estudo anatomopatológico confirmando adenoma de supra-renal, definindo a etiologia da síndrome de Cushing. CONCLUSÃO: O adenoma de supra-renal representa uma etiologia rara de síndrome de Cushing, constituindo um desafio diagnóstico para o clínico. Apesar do diagnóstico ser difícil, o tratamento pode ser facilitado por uma anamnese rigorosa, exame físico minucioso e exames complementares apropriados, favore­cendo a boa evolução da maioria dos casos existentes relatados

A Case of Cushing's Syndrome Presenting as Endometrial Hyperplasia

We describe here the case of a 39-year-old woman with a cortisol-producing adrenal adenoma and she presented with endometrial hyperplasia and hypertension without the specific characteristics of Cushing's syndrome. The patient had consulted a gynecologist for menometrorrhagia 2 years prior to her referral and she was diagnosed with endometrial hyperplasia and hypertension. Her blood pressure and the endometrial lesion were refractory despite taking multiple antihypertensives and repetitive dilation and curettage and progestin treatment. On admission, the clinical examination revealed mild central obesity (a body mass index of 22.9 kg/m2, a waist circumference of 85 cm and a hip circumference of 94cm), but there was no hirsutism and myopathy. She showed impaired glucose tolerance on an oral glucose tolerance test. The biochemical hypercortisolemia together with the prolactin and androgen levels were evaluated to explore the cause of her anovulation. Adrenal Cushing's syndrome was confirmed on the basis of the elevated urinary free cortisol (454 microgram/24h, normal range: 20-70) with a suppressed ACTH level (2.0 pg/mL, normal range: 6.0-76.0) and the loss of circadian cortisol secretion. A CT scan revealed a 3.1 cm, hyperechoic, well-marginated mass in the left adrenal gland. Ten months post-adrenalectomy, the patient had unintentionally lost 9 kg of body weight, had regained a regular menstrual cycle and had normal thickness of her endometrium.

Síndrome de Cushing subclínica em populações de risco: [revisão] / Subclinical Cushing's syndrome in populations at risk: [review]

Os incidentalomas de adrenais (IA) são tumores freqüentes em humanos. A síndrome de Cushing (SC) endógena é rara e os adenomas de adrenais são responsáveis por 10 por cento dos casos de SC. A SC subclínica ocorre em IA com dinâmica do cortisol anormal e ausência de fenótipo característico de hipercortisolismo. A prevalência média de SC subclínica em IA é de 9 por cento. Dados de pequenas séries indicam que 20 por cento dos IA desenvolvem alterações bioquímicas quando acompanhados por 10 anos. A evolução da SC subclínica parece ser benigna, raramente ocorrendo aumento da massa e evolução para a SC clinicamente manifesta. Os incidentalomas e a SC subclínica têm sido correlacionados aos componentes da síndrome metabólica, especialmente ao diabetes mellitus do tipo 2. Embora o número de pacientes avaliados ainda seja pequeno, os estudos disponíveis demonstram que o tratamento do hipercortisolismo resulta em melhor controle metabólico e da pressão arterial. Esses achados levaram alguns autores a pesquisar a presença de SC subclínica em pacientes com diagnóstico prévio de diabetes mellitus. Os estudos realizados utilizando diferentes abordagens diagnósticas mostraram que nesse grupo de pacientes a incidência de SC subclínica é maior do que na população geral.

Based on autopsy studies, adrenal masses are among the most common tumors in humans. Endogenous Cushing's syndrome (CS) is unusual and adrenal adenomas account for 10 percent of all cases of CS. Patients with subclinical CS (SCS) present abnormal cortisol dynamics without obvious manifestations. The prevalence of hypercortisolism in clinically inapparent adrenal masses has been reported as 9 percent. Data from several small series of patients indicate that fewer than 20 percent develop hormone overproduction when followed for up to 10 years. Follow-up of patients with subclinical CS suggests that rarely masses increase in size or progress to overt CS. Adrenal incidentalomas and subclinical CS are related to metabolic disorders, in special to type-2 diabetes. The scarce available data suggest that treatment of hypercortisolism correct the metabolic abnormalities and blood pressure. Some studies evaluating the prevalence of subclinical CS in overweight type-2 diabetes patients suggest that it is considerably higher in populations at risk than in the general population.

Subclinical Cushing's syndrome: [review]

Subclinical Cushing's syndrome (CS) is attracting increasing interest since the serendipitous discovery of an adrenal mass has become a rather frequent event owing to the routine use of sophisticated radiologic techniques. Cortical adenoma is the most frequent type of adrenal incidentaloma accounting for approximately 50 percent of cases in surgical series and even greater shares in medical series. Incidentally discovered adrenal adenomas may secrete cortisol in an autonomous manner that is not fully restrained by pituitary feedback, in 5 to 20 percent of cases depending on study protocols and diagnostic criteria. The criteria for qualifying subclinical cortisol excess are controversial and presently there is no consensus on a gold standard for the diagnosis of this condition. An increased frequency of hypertension, central obesity, impaired glucose tolerance, diabetes and hyperlipemia has been described in patients with subclinical CS; however, there is still no clear demonstration of the long-term complications of this condition whose management remains largely empirical. Either adrenalectomy or careful observation associated with treatment of the metabolic syndrome have been suggested as treatment options.

A síndrome de Cushing subclínica (SCS) tem atraído interesse cada vez maior desde que a descoberta casual de uma massa adrenal se tornou um evento freqüente devido ao emprego rotineiro de técnicas sofisticadas de imagem. O adenoma cortical é o tipo mais freqüente de incidentaloma adrenal, correspondendo a cerca de 50 por cento dos casos em séries cirúrgicas e até mais do que isso em séries médicas. Adenomas adrenais descobertos incidentalmente podem secretar cortisol de maneira autônoma ou não controlada totalmente pelo feedback hipofisário, em 5 a 20 por cento dos casos, dependendo do protocolo de estudo e dos critérios diagnósticos. Os critérios para qualificar um excesso subclínico de cortisol são controversos e atualmente não existe consenso a respeito de "padrão ouro" para o diagnóstico dessa condição. Em pacientes com SCS, tem sido descrita uma freqüência elevada de hipertensão, obesidade central, intolerância à glicose, diabetes e hiperlipemia; entretanto, ainda não existe uma evidente demonstração de complicações a longo prazo dessa condição, cujo manejo permanece amplamente empírico. Tanto a adrenalectomia como a observação cuidadosa, associada com o tratamento da síndrome metabólica, têm sido sugeridos como opções terapêuticas.

Hiperaldosteronismo primário causado por aldosteronoma: problemas no diagnóstico etiológico / Primary aldosteronism caused by aldosteronoma: problems in the etiologic diagnosis

O hiperaldosteronismo primário (HAP) representa importante causa de hipertensão arterial secundária, potencialmente curável, que tem recebido atenção recente em função do aumento de sua prevalência desde a introdução do rastreamento pelo uso da relação aldosterona/atividade plasmática de renina. Apresentamos caso de HAP causado por provável aldosteronoma, coexistente com adenoma adrenal não-funcionante contra-lateral, o que dificultou o diagnóstico etiológico. Discutimos as formas mais apropriadas de rastrear, confirmar o diagnóstico de HAP e diferenciar as suas diversas etiologias, com destaque para o papel do cateterismo de adrenais no diagnóstico diferencial definitivo entre aldosteronoma e hiperaldosteronismo idiopático, com implicações no sucesso terapêutico.

Primary aldosteronism (PA) represents an important cause of secondary hypertension, potentially curable, and it has been receiving particular attention due to its increasing prevalence, after the beginning of the use of plasma aldosterone concentration to plasma renin activity ratio as a screening method. We present a case of PA caused by an aldosteronoma associated with a contralateral nonfunctioning adrenal adenoma, which resulted in difficulties in the final diagnosis. We discuss the most appropriated tests to screen, confirm the diagnosis of PA and define the etiology of the disorder, especially the adrenal veins sampling to distinguish the aldosteronoma and idiopathic hyperaldosteronism and to guide successful treatment.

Adrenalectomía laparoscópica / Laparoscopic adrenalectomy

Se presenta un caso clínico de una paciente portadora de un tumor funcionante de la corteza suprarrenal secretor de aldosterona. Se analiza el diagnóstico, los exámenes paraclínicos y en particular la modalidad de tratamiento por cirugía laparoscópica. El diagnóstico se planteó por la clínica y los exámenes de laboratorio (hipopotasemia e hiperaldosteronismo). Se confirmó la topografía del tumor con los exámenes imagenológicos (TAC, RMN y Centellograma), localizándose a nivel de la glándula suprarrenal izquierda. Se realizó el abordaje por cirugía laparoscópica, procediéndose a su resección. La evolución de la paciente del punto de vista quirúrgico fue excelente, normalizándose las cifras de hipertensión arterial, potasemia y aldosterona.

Adenoma de Conn: uma causa de hipertensão e hipocalemia / Conn's adenoma: a cause of hypertension and hypokalemia

Hipertensão secundária corresponde aproximadamente a 5 a 10% das causas de hipertensão arterial e, entre elas, o hiperaldosteronismo primário apresenta uma incidência variável de 0,05 a 2% em hipertensos, com quadro característico de hipocalemia, produção aumentada de aldosterona, redução ou supressão da renina, relação aldosterona/renina elevada e alcalose metabólica. Descrevemos um caso de paciente com hipertensão arterial primária controlada, que apresentou na sua evolução um adenoma de supra-renal com piora dos níveis tensionais.

A Case of Cushing's Syndrome in Pregnancy Secondary to an Adrenal Cortical Adenoma

Cushing's syndrome in pregnant women is rare and difficult to be diagnosed because of the syndrome's association with oligomenorrhea or amenorrhea and the changes in cortisol metabolism during normal pregnancy. Cushing syndrome in pregnancy is usually confused with complicated pregnancy, such as preeclampsia or gestational diabetes, and its rarity leads to a low degree of clinical suspicion, often delaying diagnosis. We experienced a case of Cushing's syndrome in pregnancy, which had been considered as the severe preeclampsia and gestational diabetes due to uncontrolled hypertension and hyperglycemia. The pregnancy was terminated with an emergency cesarean operation at 30 weeks of gestation because of severe preeclampsia. In consequence of the evaluation about the Cushing's syndrome after delivery, the adrenal cortical adenoma of right adrenal gland was diagnosed and laparoscopic adrenalectomy was performed.

Cirugía de las glándulas suprarrenales en Arica / Adrenal gland surgery in Arica

Se presentan cuatro pacientes sometidos a cirugía por enfermedades quirúrgicas de las suprarrenales ente 1992 y 1997. Estos casos correspondieron a un quiste, dos metástasis solitarias de adenocarcinoma renal y un adenoma con síndrome de Cushing. Se analizan las indicaciones, métodos diagnósticos, tipos de abordaje, comparando con la experiencia nacional publicada

Selective testosterone secreting adrenocortical carcinoma in an infant.

Adrenocortical carcinoma in children is a rare tumor of adrenal gland. An infant presented with signs of virilization due to selective testosterone hypersecretion. Diagnosis was established with the help of the computerized tomographic scan and histopathological examination. Following adrenalectomy patient made uneventful recovery and six months later does not have any clinical or laboratory evidence of recurrence or metastasis.

Adrenalectomía a incisión mínima lumbar video asistida / Adrenalectomy at lumbar minimal incision assisted by video

Se presenta una nueva técnica de adrenalectomía a incisión mínima video asistida, que permite efectuar una intervención quirúrgica muy precisa, segura y no traumática. Se destaca la buena tolerancia, disminución del dolor y la rápida deambulación y alta. Este método mixto auna las ventajas de la cirugía abierta y de los métodos endoscópicos percutáneos que utilizan óptimas y cámaras videoscópicas

Congenital hemihypertrophy with adrenocortical adenoma.

A rare case of adrenocortical adenoma in a 7-month-old female infant with congenital hemihypertrophy of left leg is described. Only 7 similar cases including the present one, are on record. The patients ranged in age from 7 weeks to 45 years. The male:female ratio was 3:4. The adrenal tumors were often detected after CH had become evident. Large functional tumors often produced symptoms of hirsutism, virilization, and precocious puberty. CT and ultrasound are necessary for early detection and prompt treatment.