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1.
Autops. Case Rep ; 12: e2021347, 2022. graf
Article in English | LILACS | ID: biblio-1355724

ABSTRACT

Fetus in fetu (FIF) is a rare entity in which a malformed vertebrate fetus is incorporated within its twin. This entity should be differentiated from a teratoma, which has more malignant potential. We describe a neonate with a heterogeneous calcified suprarenal mass. The aspiration cytology revealed a heterogeneous cell population with spindle cells and small round blue cells. Operative and histopathologic examination showed features consistent with a fetus in fetu. This case report describes a rare entity and discusses its clinical presentation, cytological features on fine-needle aspiration, and the difficulties posed in its differentiation from a teratoma.


Subject(s)
Humans , Female , Infant, Newborn , Teratoma/complications , Adrenal Glands , Biopsy, Fine-Needle , Fetus/abnormalities , Congenital Abnormalities/pathology
2.
Autops. Case Rep ; 11: e2021259, 2021. tab, graf
Article in English | LILACS | ID: biblio-1249015

ABSTRACT

Androgen secreting adrenocortical carcinoma (ACC) is a very rare disease with a poor prognosis. Approximately 80% of tumors are functional, most commonly secreting glucocorticoids. We herewith report a case of a huge functional ACC of the right adrenal gland in a 33-year-old female who presented with complaints of hirsutism, amenorrhea and an abdominal lump. On abdominal examination a large lump was palpable in the right hypochondrium reaching up to the umbilicus. Contrast-enhance computed tomography (CECT) revealed a mass in the right suprarenal region. The tumor measured 29 cm × 20 cm × 12 cm and weighed 7.8 kg, the largest reported case of ACC in the world to the best of our knowledge.


Subject(s)
Humans , Female , Adult , Adrenal Glands/pathology , Adrenocortical Carcinoma/pathology , Adrenal Cortex Neoplasms/pathology , Rare Diseases
3.
MedUNAB ; 24(2): 155-168, 20210820.
Article in Spanish | LILACS | ID: biblio-1291973

ABSTRACT

Introducción. Las masas encontradas en la glándula suprarrenal pueden clasificarse de acuerdo con su origen, comportamiento, localización, función y forma de diagnóstico. En Colombia no existen datos suficientes que describan la frecuencia y las principales características histopatológicas de dichas lesiones. El objetivo del presente manuscrito es describir los principales hallazgos histopatológicos y la malignidad de las masas suprarrenales en un centro médico especializado en patología de Bucaramanga, Santander. Metodología. Estudio descriptivo y retrospectivo. Se revisaron patologías de pacientes de todas las edades con alteraciones histopatológicas en la glándula suprarrenal, en un centro médico de Bucaramanga, Santander. Resultados. Se revisaron 79 patologías suprarrenales de las cuales 39 presentaron lesión a nivel de la glándula suprarrenal, la lesión más frecuente encontrada fue la metástasis (28.2%), y la localización de lesión más frecuente se evidenció en la glándula derecha (62.1%). Conclusión. Es fundamental que se realicen estudios prospectivos que permitan obtener datos epidemiológicos con el fin de generar datos locales.


Introduction. Masses found in the adrenal gland can be classified according to their origin, behavior, location, function and manner of diagnosis. In Colombia there are insufficient data describing the frequency and main histopathological characteristics of these lesions. The aim of this manuscript is to describe the main histopathological findings and malignancy of adrenal masses in a medical center specialized in pathology in Bucaramanga, Santander. Methodology. Descriptive and retrospective study. Pathologies of patients of all ages with histopathologic alterations in the adrenal gland were reviewed in a medical center in Bucaramanga, Santander. Results. Seventy-nine adrenal pathologies were reviewed, of which 39 showed adrenal gland lesions. The most frequent lesion found was metastasis (28.2 %), and the most frequent location of the lesion was in the right gland (62.1 %). Conclusion. It is essential that prospective studies be carried out to obtain epidemiological data in order to generate local data


Introdução. As massas encontradas na glândula adrenal podem ser classificadas de acordo com a sua origem, comportamento, localização, função e forma de diagnóstico. Na Colômbia, não há dados suficientes que descrevam a frequência e as principais características histopatológicas dessas lesões. O objetivo deste artigo é descrever os principais achados histopatológicos e a malignidade das massas adrenais em um centro médico especializado em patologia em Bucaramanga, Santander. Metodologia. Estudo descritivo e retrospectivo. Foram analisadas patologias de pacientes de todas as idades com alterações histopatológicas na glândula adrenal, em um centro médico em Bucaramanga, Santander. Resultados. Foram revisadas 79 patologias adrenais, das quais 39 apresentavam lesão em glândula adrenal, a lesão mais frequente encontrada foi metástase (28.2%), e o local mais frequente de lesão foi evidenciado na glândula direita (62.1%). Conclusão. É imprescindível a realização de estudos prospectivos para obtenção de dados epidemiológicos a fim de gerar dados locais.


Subject(s)
Pathology , Adrenal Glands , Neoplasm Metastasis , Neoplasms
4.
Article in English, Portuguese | LILACS | ID: biblio-1369475

ABSTRACT

Introdução: O schwanoma é um tumor pouco frequente que se origina das células de Schwann que recobrem os prolongamentos nervosos. A malignidade desses tumores é ainda mais rara, correspondendo a 5-10% de todos os sarcomas. O prognóstico é reservado, mesmo após completa ressecção cirúrgica. Relato do caso: Paciente do sexo masculino, 79 anos, apresentou-se com lesão crostosa em perna esquerda com dois meses de evolução. A biópsia da lesão inicialmente revelou sarcoma pleomórfico, mas seu padrão imuno-histoquímico confirmou tumor maligno da bainha do nervo periférico. O tumor desenvolveu metástase linfonodal, pulmonar e adrenal dentro de poucos anos após o diagnóstico inicial. A ressecção do tumor adrenal não foi possível. O paciente desenvolveu síndrome paraneoplásica e teve piora do estado clínico, evoluindo a óbito. Conclusão: Tendo em vista a forma inespecífica do aparecimento do tumor e sua agressividade, é importante ressaltar o papel da ressecção cirúrgica ampla no seu tratamento. Além disso, fica evidente a necessidade de novos relatos desse tipo de neoplasia para melhor definição de uma conduta mais apropriada, principalmente em casos de recorrência ou disseminação metastática


Introduction: Schwannoma is a rare type of tumor which grows from Schwann cells, that protect nerve extensions. The malignancy of these tumors is even rarer, corresponding to 5-10% of all sarcomas. The prognosis is dismal, even after complete surgical resection. Case report: A 79-year-old male patient presented with a crusted lesion in his left leg with two months of evolution. Initially, the biopsy of the lesion revealed pleomorphic sarcoma, but its immunohistochemical pattern was peripheral nerve sheath malignant tumor. The tumor developed lymph node, lung, and adrenal metastasis within a few years after the first diagnosis. Adrenal tumor resection was not possible. The patient developed paraneoplastic syndrome and his clinical status worsened, progressing to death. Conclusion: In view of the nonspecific form of tumor appearance and its aggressiveness, it is important to highlight the role of wide surgical resection in its treatment. In addition, it is clear that new case reports of this type of neoplasia are necessary for better definition of more appropriate conducts, especially in recurrence or metastatic cases


Introducción: El schwannoma es un poco común, el cual se origina en las células de Schwann, que cubren las extensiones nerviosas. La malignidad de estos tumores es aún más rara, y representa 5-10% de todos los sarcomas. El pronóstico es reservado, incluso después de una resección quirúrgica completa. Relato del caso: Varón de 79 años que presenta una lesión costrosa en la pierna izquierda a los dos meses de evolución. La biopsia de la lesión reveló inicialmente un sarcoma pleomórfico, pero su patrón inmunohistoquímico era un tumor maligno de la vaina del nervio periférico. El tumor desarrolló metástasis en los ganglios linfáticos, pulmones y suprarrenales pocos años después del diagnóstico. La resección del tumor suprarrenal no fue posible. El paciente desarrolló síndrome paraneoplásico y empeoró el estado clínico, progresando hasta la muerte. Conclusión: Dada la forma inespecífica de aparición del tumor y su agresividad, es importante destacar el papel de la resección quirúrgica amplia en su tratamiento. Además, existe una clara necesidad de nuevos informes de este tipo de neoplasias para definir mejor un abordaje más adecuado, especialmente en casos de recurrencia o diseminación metastásica


Subject(s)
Humans , Male , Aged , Peripheral Nervous System Neoplasms , Neurofibrosarcoma , Adrenal Glands , Lung , Neoplasm Metastasis , Neurilemmoma
5.
Braz. J. Pharm. Sci. (Online) ; 57: e19139, 2021. graf
Article in English | LILACS | ID: biblio-1350244

ABSTRACT

Dehydroepiandrosterone (DHEA) is a steroid hormone secreted by the adrenal glands, gonads and brain. It is a precursor to sex hormones and also is known to have immune modulatory activity. However, little is known about the relationship between DHEA and neutrophils and thus our study evaluates the influence of DHEA in the effector functions of neutrophils. Human neutrophils were treated in vitro with DHEA and further infected with Salmonella enterica serovar Typhimurium. The treatment of neutrophils with 0.01 µM of DHEA increased the phagocytosis of Salmonella independent of TLR4 as the treatment did not modulate the TLR4 expression. Additionally, DHEA caused a decrease in ROS (reactive oxygen species) production and did not influence the formation of the neutrophil extracellular trap (NET). Steroid treated neutrophils, infected or stimulated with LPS (lipopolysaccharide), showed reduced production of IL-8, compared to untreated cells. Also, the protein levels of p-NFκB were decreased in neutrophils treated with DHEA, and this reduction could explain the reduced levels of IL-8. These results led us to conclude that the steroid hormone DHEA has important modulatory functions in neutrophils


Subject(s)
Humans , Male , Adult , In Vitro Techniques , Dehydroepiandrosterone/analysis , Neutrophils/metabolism , Phagocytosis/genetics , Gonadal Steroid Hormones/pharmacology , Adrenal Glands/metabolism , Salmonella enterica/classification
6.
Int. j. morphol ; 38(5): 1271-1280, oct. 2020. tab, graf
Article in English | LILACS | ID: biblio-1134436

ABSTRACT

SUMMARY: The Viperidae venoms are composed of a mixture of constituents with enzymatic and non-enzymatic actions, which act on ultrastructural components of cells and tissues. Here, the number of mitochondria, mitochondrial area and the number of mitochondrial cristae from adrenal glands cortex treated with snake venoms were tested after 3, 6 and 24 hours of venom injections. The mitochondria quantitative changes showed a statistically significant decrease, in the number of mitochondria past 3, 6 and 24 h. There was an increase in the mitochondrial area after 6 h, where Crotalus vegrandis venom did not present significant differences with Crotalus pifanorum or Bothrops venezuelensis venoms. After 24 h, there was an escalation of mitochondrial area in all tested venoms. The number of mitochondrial cristae after 3 h did not present important differences with the control treatment. After 6 h, the number of mitochondrial cristae initiated to decrease under the activities of the 3 venoms action, until 24 h of observation. In the qualitative observations it was possible to witness an intense damage of the mitochondria, with loss and swelling of membranes, disappearance of cristae and the appearance of myelin figures, which started at 3 h after the Crotalus and Bothrops venoms injections. These damages probably were due to cytotoxic effects of phospholipases, metalloproteases and/or other proteolytic activities present in Viperidae snake venoms, being more evident in Crotalus venoms. As far as we know, these results define a novel finding that suggest that Viperidae snake venoms are extremely toxic to mammalian mitochondria.


RESUMEN: Los venenos de Viperidae tienen acciones enzimáticas y no enzimáticas, que actúan sobre la estructura celular. Aquí se probaron, a las 3, 6 y 24 horas de la inyección del veneno, el número de mitocondrias, el área mitocondrial y el número de crestas mitocondriales de la corteza de las glándulas adrenales. Los cambios cuantitativos de las mitocondrias mostraron una disminución en el número de mitocondrias a las 3, 6 y 24 h. Hubo un aumento en el área mitocondrial a las 6 h, donde el veneno de la serpiente Crotalus vegrandis no presentó diferencias significativas con los venenos de Crotalus pifanorum o Bothrops venezuelensis. Después de 24 h, hubo un aumento del área mitocondrial en todos los venenos. El número de crestas mitocondriales a las 3 h no presentó alteraciones o diferencias importantes con el tratamiento de control. Después de 6 h, el número de crestas mitocondriales comenzó a disminuir bajo la acción de los 3 venenos, hasta las 24 h de observación. En las observaciones cualitativas se observó un daño intenso de las mitocondrias, con pérdida y edema de las membranas, desaparición de las cristae y aparición de figuras mielínicas, que comenzó a las 3 h después de las inyecciones de veneno de Crotalus y Bothrops. Estos daños se debieron factiblemente a los efectos citotóxicos de componentes proteolíticos de los venenos. Creemos que estos resultados definen un nuevo y original hallazgo, que sugiere que los venenos de serpiente Viperidae son extremadamente tóxicos para las mitocondrias de mamíferos.


Subject(s)
Animals , Mice , Viper Venoms/toxicity , Viperidae/physiology , Adrenal Glands/drug effects , Mitochondria/drug effects , Adrenal Glands/ultrastructure , Crotalus , Bothrops , Mitochondria/ultrastructure
7.
Arch. argent. pediatr ; 118(4): e414-e417, agosto 2020. tab, ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1118595

ABSTRACT

La hemorragia de las glándulas suprarrenales en el período neonatal se produce secundariamente a traumatismos del parto y a modificaciones de la presión venosa. La ictericia neonatal tiene como causa infrecuente la presencia de un hematoma suprarrenal. Los casos sintomáticos son poco frecuentes y, si se manifiestan, suele ser como ictericia prolongada.Se presenta el caso de un neonato que ingresó a las 20 horas de vida por ictericia isoinmune anti-A. Por aumento de bilirrubina directa, se solicitó una ecografía abdominal a los 10 días de vida, que mostró una masa suprarrenal derecha no vascularizada, de 50 x 21 mm, con imágenes quísticas en su interior, compatible con hemorragia de glándula suprarrenal derecha. La ecografía seriada mostró una resolución progresiva hasta desaparecer, y el paciente se mantuvo asintomático y sin ictericia. Cuando persiste una ictericia en el período neonatal, hay que evaluar la posibilidad de una hemorragia suprarrenal significativ


Hemorrhage of the adrenal glands in the neonatal period happens secondarily to birth trauma and to changes in venous pressure. Neonatal jaundice has as an infrequent etiology the presence of an adrenal gland hematoma. Symptomatic cases are rare, and if they manifest, it is usually as prolonged jaundice.We present the case of a neonate who was admitted at 20 hours of life due to isoimmune jaundice. Due to an increase in conjugated bilirubin, an abdominal ultrasound was requested at 10 days of life, which showed a non-vascularized right adrenal mass, 50 x 21 mm, with cystic images inside, compatible with bleeding of the right adrenal gland. Serial ultrasound showed a progressive resolution until its disappearance, keeping the baby asymptomatic and without jaundice. In cases of prolonged jaundice in the neonatal period, the possibility of significant adrenal hemorrhage must be assessed.


Subject(s)
Humans , Male , Infant, Newborn , Adrenal Glands , Hemorrhage/diagnostic imaging , Jaundice, Neonatal , Bilirubin
8.
Saude e pesqui. (Impr.) ; 13(1): 53-61, jan/mar 2020. ilus
Article in Portuguese | LILACS | ID: biblio-1052901

ABSTRACT

Estresse é a resposta aos diferentes estímulos que o organismo sofre em busca de adaptação à homeostasia. Devido à sua alta incidência, diversos modelos experimentais estão sendo desenvolvidos para a melhor compreensão de sua inter-relação com outros órgãos. Neste contexto, o objetivo deste estudo foi avaliar os efeitos em longo prazo do estresse físico e psicológico juvenil agudo sobre as glândulas suprarrenais de ratos, no que se refere aos aspectos morfológicos, pois tais glândulas apresentam relação direta com situações de estresse. Para tanto, as glândulas suprarrenais destes animais foram processadas e análises morfológicas da medula e do córtex foram realizadas por meio de morfometria e quantificação por planimetria. Os resultados obtidos demonstraram que o estresse tanto físico quanto psicológico não provocaram alterações significativas em relação à área de superfície e espessura das suprarrenais, indicando adaptação dos animais aos fatores estressantes aqui estudados.


Stress is a response to different stimuli experienced by the organism for its adaption to homeostasis. Due to its high occurrence, several experimental models are being developed to understand better the interrelationships between these organs. Current paper evaluates long-term effects of juvenile physical and psychological stress on the suprarenal glands of rats with regard to morphological aspects. In fact, these glands have a direct relationship with stress conditions. Rats´ suprarenal glands were processed and their medulla and cortex were morphologically investigated through planimetry. Results show that physical and psychological stress failed to cause significant changes on the surface area and thickness of the glands. This fact showed adaptation of animals to the type of stress under analysis.


Subject(s)
Animals , Mice , Stress, Mechanical , Stress, Psychological , Adrenal Glands , Cell Nucleus Shape
9.
Chinese Journal of Traumatology ; (6): 149-151, 2020.
Article in English | WPRIM | ID: wpr-827841

ABSTRACT

Adrenal gland trauma is a rare phenomenon, due to the small size and retroperitoneal location of the organ. The majority of adrenal gland trauma is due to blunt force injury and is only rarely encountered due to the penetrating mechanisms. A 20-year-old male sustained a gunshot wound to the left abdomen. Upon exploration, he was found to have a through and through injury to the left adrenal gland, among other injuries. Injury to the adrenal gland due to penetrating trauma is exceptionally rare. The principles of management are to control bleeding from the gland with debridement and hemostasis rather than attempt to resect the entire organ. The management of a penetrating injury to the adrenal gland is straightforward and should not be a contributor to a patient's morbidity or mortality.


Subject(s)
Adrenal Glands , Diagnostic Imaging , Wounds and Injuries , Adult , Debridement , Hemorrhage , Therapeutics , Hemostasis, Surgical , Humans , Laparotomy , Male , Multiple Trauma , Therapeutics , Organ Sparing Treatments , Methods , Tomography, X-Ray Computed , Treatment Outcome , Wounds, Gunshot , Diagnostic Imaging , Therapeutics , Young Adult
10.
Int. j. morphol ; 37(3): 1023-1032, Sept. 2019. tab, graf
Article in English | LILACS | ID: biblio-1012391

ABSTRACT

The suprarenal glands are bilaterally supplied by three suprarenal arteries and drained by a single suprarenal vein. Variable vascular origins of the fetal suprarenal gland have been documented in different population groups viz. Indian, Polish and Argentinian. However, there is lack of a detailed description regarding the course, relations, number of branches and vertebral levels of the origins of the vasculature of the suprarenal glands in fetuses. This study aimed to identify and document the vascular supply of the suprarenal glands in fetuses in a South African setting. Fifty fetal specimens (26 males; 24 females) with a gestational age ranging between 12 and 20 weeks, were bilaterally micro-dissected (n=100) using a Zeiss Stemi DV4 microscope. Data was recorded and the frequencies of the origin, course, relations, number of branches and vertebral levels of the suprarenal vascular supply were determined. Arterial supply: Origin: (i) The superior suprarenal artery (SSA) bilaterally arose from the inferior phrenic arteries in 98 % of the fetuses; (ii) the middle suprarenal artery (MSA) frequently arose from the renal artery (RA) on the right side (46 %) and the abdominal aorta on the left side (34 %); while (iii) the inferior suprarenal artery (ISA) predominantly arose from the RA in 91 % of the specimens, bilaterally. Course and relations: The suprarenal arteries followed a superior, inferior, lateral, supero-lateral and infero-lateral course to the gland. These arteries were closely related to the crura of the diaphragm, the inferior vena cava, the left inferior phrenic vein and the pancreas. Number of branches: The branches ranged from one to seven for the SSA, one to four for the MSA and one to three for the ISA. Vertebral levels: The SSA predominantly arose from the first lumbar (L1) vertebral body (32 %), the MSA arose from the middle third of the intervertebral disc between the L1 and the second lumbar (L2) vertebrae (19 %) and the ISA arose from the L2 vertebral body (28 %). Venous drainage: In 1 % of the specimens, an additional right suprarenal vein (ARSV) was observed. This ARSV followed a superomedial course into the inferior vena cava, just below the entrance of the main right suprarenal vein. The arteries supplying the suprarenal gland presented varying origins and number of branches, corroborating with the reviewed literature and standard anatomical textbooks. The findings of this study may aid pediatric surgeons in understanding the vascular morphology (and the variations thereof) of the suprarenal gland, when performing adrenelectomy surgery in neonates.


Las glándulas suprarrenales son irrigadas bilateralmente por tres arterias suprarrenales y drenadas por una sola vena suprarrenal. Los orígenes vasculares variables de la glándula suprarrenal fetal se han documentado en diferentes grupos de población: indios, polacos y argentinos. Sin embargo, no existe una descripción detallada del curso, las relaciones, el número de ramas y los niveles vertebrales de los orígenes de la vasculatura de las glándulas suprarrenales en los fetos. Este estudio tuvo como objetivo identificar y documentar el suministro vascular de las glándulas suprarrenales en fetos en una población sudafricana. Cincuenta especímenes fetales (26 hombres; 24 mujeres) con una edad gestacional que oscila entre las 12 y las 20 semanas, fueron micro-diseccionados bilateralmente (n = 100) utilizando un microscopio Zeiss Stemi DV4. Se registraron los datos y se determinaron las frecuencias de origen, curso, relaciones, número de ramas y niveles vertebrales del suministro vascular suprarrenal. Suministro arterial: Origen: (i) La arteria suprarrenal superior (SSA) surgió bilateralmente de las arterias frénicas inferiores en el 98 % de los fetos; (ii) la arteria suprarrenal media (MSA) surgió frecuentemente de la arteria renal (AR) en el lado derecho (46 %) y en la parte abdominal de la aorta en el lado izquierdo (34 %); mientras que (iii) la arteria suprarrenal inferior (AIS) surgió predominantemente de la AR en el 91 % de los especímenes, bilateralmente. Curso y relaciones: las arterias suprarrenales seguían un curso superior, inferior, lateral, superolateral e inferolateral hacia la glándula. Estas arterias estaban estrechamente relacionadas con la crura del diafragma, la vena cava inferior, la vena frénica inferior izquierda y el páncreas. Número de ramas: Las ramas variaron de una a siete para la SSA, de una a cuatro para la MSA y de una a tres para la ISA. Niveles vertebrales: la SSA surgió predominantemente del primer cuerpo vertebral lumbar (L1) (32 %), la MSA surgió del tercio medio del disco intervertebral entre la L1 y la segunda vértebra lumbar (L2) (19 %) y la ISA surgió del cuerpo vertebral L2 (28 %). Drenaje venoso: en el 1 % de las muestras, se observó una vena suprarrenal derecha (ARSV) adicional. Este ARSV siguió un curso superomedial hacia la vena cava inferior, justo debajo de la entrada de la vena suprarrenal derecha principal. Las arterias que irrigaban la glándula suprarrenal presentaban diversos orígenes y número de ramas, lo que corrobora la literatura revisada y los libros de texto anatómicos estándar. Los hallazgos de este estudio pueden ayudar a los cirujanos pediátricos a comprender la morfología vascular (y sus variaciones) de la glándula suprarrenal, al realizar una cirugía de adrenelectomía en neonatos.


Subject(s)
Humans , Male , Female , Arteries/anatomy & histology , Veins/anatomy & histology , Adrenal Glands/blood supply , Fetus/anatomy & histology , South Africa , Anatomic Variation
12.
Int. braz. j. urol ; 45(4): 747-753, July-Aug. 2019. tab
Article in English | LILACS | ID: biblio-1019872

ABSTRACT

ABSTRACT Purpose This study aimed to compare perioperative and postoperative results of right and left laparoscopic adrenalectomy (LA), and to evaluate the impact of challenging factors on these outcomes. Materials and Methods A total of 272 patient's medical records that underwent single side LA between October 2006 and September 2017 were retrospectively reviewed. The patients were divided into 2 groups according to operation side. Moreover, pheochromocytoma, metastatic masses and adrenal lesions >5cm in size were considered to be difficult adrenalectomy cases and the outcomes of these cases were compared between two groups. Results 135 patients (49.6%) underwent right LA and 137 patients (50.4%) underwent left LA. Operation time, estimated blood loss (EBL) and hospitalization time were similar between the groups (p=0.415, p=0.242, p=0.741, respectively). Although EBL was higher on the right side than the left (p=0.038) in the first 20 cases, after this learning period has been completed, there was no significant difference between the groups. In patients with pheochromocytoma, metastatic mass and a mass >5cm in size, despite bleeding complications were clinically higher on the right side, this difference was not statistically significant. Conclusions During the learning period of LA, EBL is higher on the right side. Due to the greater risk of bleeding complications on the right side even on the hands of experienced surgeons, extra care and preoperative planning are required in patients with pheochromocytoma, metastatic masses and masses >5cm in size.


Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Young Adult , Laparoscopy/adverse effects , Laparoscopy/methods , Adrenalectomy/adverse effects , Adrenalectomy/methods , Postoperative Period , Reference Values , Retrospective Studies , Risk Factors , Blood Loss, Surgical , Treatment Outcome , Adrenal Gland Neoplasms/surgery , Adrenal Gland Neoplasms/pathology , Adrenal Glands/surgery , Adrenal Glands/pathology , Statistics, Nonparametric , Risk Assessment , Tumor Burden , Perioperative Period , Operative Time , Length of Stay , Middle Aged
13.
Rev. colomb. psiquiatr ; 48(1): 35-43, ene.-mar. 2019. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1013958

ABSTRACT

RESUMEN La prescripción de carbonato de litio es común en la actividad psiquiátrica cotidiana. El objetivo es identificar las alteraciones endocrinas secundarias y sus bases fisiopatológicas. La revisión de la literatura se realizó en Psycinfo, EMBASE, PubMed y Scopus. Se efectuó una búsqueda computarizada de información utilizando la estrategia PICO. Las alteraciones más comunes están en riñones, tiroides, paratiroides, páncreas y vías neuroendocrinas. Los mecanismos fisiopatológicos subyacentes son diversos, y destacan la inhibición de la adenilato ciclasa tiroidea sensible a tirotropina como causa de hipotiroidismo, la expresión reducida de acuaporina 2 como causa de diabetes insípida nefrogénica, la pérdida del equilibrio iónico del calcio y la presencia de hiperparatiroidismo e hipercalcemia. En el eje hipotálamo-hipófiso-adrenal, se documenta una disminución en la producción de catecolaminas. Finalmente, se documenta la desregulación en el control de la glucemia al aumentar la resistencia a la insulina. Es necesario conocer estas eventualidades e identificarlas tempranamente a través de evaluaciones periódicas. Se propone un esquema de evaluación integral, sin que implique un algoritmo de tratamiento.


ABSTRACT The prescribing of Lithium is common in psychiatric clinical practice. The aim of this study was to identify the most common endocrine side effects associated with this drug and to clarify the pathophysiological basis. A systematic review was conducted in Psycinfo, Embase, PubMed, and Scopus. A computerised search for information was performed using a PICO (patient, intervention, comparative, outcomes) strategy. The main neuroendocrine alterations were reported in kidneys, thyroid and parathyroid glands, pancreas, and the communication pathways between the pituitary and adrenal glands. The pathophysiological mechanisms are diverse, and include the inhibition of the thyroid adenylate cyclase sensitive to the thyroid stimulant hormone (TSH) sensitive adenylate cyclase, which causes hypothyroidism. It also reduces the expression of aquaporin type 2, which is associated with nephrogenic diabetes insipidus, and the loss of the ionic balance of calcium that induces hyperparathyroidism and hypercalcaemia. Other considerations are related to alterations in the hypothalamic-pituitary-adrenal axis and a decrease in the production of catecholamines. Finally, another side-effect is the glycaemic dysregulation caused by the insulin resistance. Periodical clinical and para-clinical evaluations are necessary. The author proposes an evaluation scheme.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Lithium Carbonate , Kidney , Lithium , Parathyroid Glands , Thyroid Gland , Adrenal Glands , Diabetes Insipidus, Nephrogenic
14.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(1): 20-26, Jan.-Mar. 2019. tab
Article in Portuguese | LILACS | ID: biblio-985132

ABSTRACT

RESUMO Objetivo: Analisar as características clínicas, laboratoriais e histopatológicas e o percurso até o estabelecimento do diagnóstico e do tratamento de pacientes com carcinoma de suprarrenal (CSR). Métodos: Estudo retrospectivo com 13 pacientes tratados no serviço de oncologia pediátrica do Hospital das Clínicas da Universidade Federal de Minas Gerais (HC-UFMG) entre 2004 e 2015. Resultados: A idade ao diagnóstico variou de 1,0 a 14,8 anos (mediana: 2,0 anos). As manifestações de hipercortisolismo foram identificadas em todos os casos, e as de virilização, em todas as meninas. Todos os pacientes preencheram os critérios de Weiss para diagnóstico histopatológico de CSR. A imuno-histoquímica foi realizada em 61,5% dos casos. A maioria dos pacientes apresentou doença em estádio I (76,9%). Todos foram submetidos à ressecção tumoral total. Dois pacientes (estádios III e IV) receberam quimioterapia associada ao mitotano. O único óbito observado foi do paciente com doença em estádio IV. A probabilidade de sobrevida global para todo o grupo aos 5,0 anos foi de 92,3±7,4%. A mediana de tempo entre o início dos sintomas e o diagnóstico foi de 9,5 meses, e de 6,0 meses entre a primeira consulta e o início do tratamento. Conclusões: A baixa idade ao diagnóstico, o predomínio de casos com doença localizada e a ressecção tumoral completa - com apenas um caso de ruptura de cápsula tumoral - são possivelmente a explicação para a evolução favorável da população estudada. O longo percurso entre o início dos sintomas e o diagnóstico sugere a importância da capacitação dos pediatras para o reconhecimento precoce dos sinais e dos sintomas do CSR.


ABSTRACT Objective: To analyze clinical, laboratory and histopathological features and the path to diagnosis establishment and treatment of patients with adrenal carcinoma (AC). Methods: Retrospective study with 13 patients assisted at the pediatric oncology service of Hospital das Clínicas, Universidade Federal de Minas Gerais, Brazil, between 2004 and 2015. Results: Age at diagnosis ranged from 1.0 to 14.8 years (median: 2.0 years). Manifestations of hypercortisolism were identified in all cases and virilization in all girls. All patients met the Weiss criteria to AC histopathological diagnosis. Immunohistochemistry was performed in 61.5% of the cases. Most patients had stage I disease (76.9%). All subjects were submitted to total tumor resection. Two patients (stages III and IV disease) received chemotherapy associated to mitotane. The only death case was that of a patient with stage IV disease. The probability of overall survival for the entire group up to 5.0 years was 92.3±7.4%. The median time between the onset of symptoms and diagnosis was 9.5 months, and 6.0 months between first visit and start of treatment. Conclusions: Low age at diagnosis, predominance of cases with localized disease and complete tumor resection - with only one case of tumor capsule rupture - can possibly explain the favorable evolution of the studied population. The long period between onset of symptoms and diagnosis highlights the importance of training pediatricians for early recognition of AC signs and symptoms.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Antineoplastic Agents/therapeutic use , Outcome and Process Assessment, Health Care , Brazil/epidemiology , Carcinoma/mortality , Carcinoma/pathology , Carcinoma/therapy , Retrospective Studies , Adrenal Gland Neoplasms/mortality , Adrenal Gland Neoplasms/pathology , Adrenal Gland Neoplasms/therapy , Adrenal Glands/pathology , Adrenalectomy/methods , Adrenalectomy/statistics & numerical data , Cushing Syndrome/diagnosis , Cushing Syndrome/etiology , Early Detection of Cancer , Time-to-Treatment/statistics & numerical data , Neoplasm Staging
15.
Article in English | WPRIM | ID: wpr-760331

ABSTRACT

PURPOSE: To examine the perioperative surgical and long-term outcomes of laparoscopic partial adrenalectomy (LPA) by comparing the results of laparoscopic total adrenalectomy (LTA). MATERIALS AND METHODS: A total of 132 transperitoneal laparoscopic adrenalectomies were performed for adrenal gland tumor between May 2006 and April 2019. All surgeries were performed by a single surgeon. Seventy patients underwent LTAs and 54 underwent LPAs. The data were collected retrospectively through review of the medical charts. We compared the perioperative and long-term outcomes between the 2 surgical methods. RESULTS: A total of 70 patients, including 4 patients with bilateral tumors, underwent LTA. In contrast, 54 patients, including 4 patients with bilateral masses, underwent LPA. There were no differences between the 2 groups with regard to mean age at presentation, mean tumor size, or postoperative stay. However, the mean operating time was significantly shorter in the LPA group than that of the LTA group. The mean estimated blood loss in the LPA group was significantly higher than that in the LTA group. However, none of the LPA patients required blood transfusion. The biochemical markers and laboratory values normalized postoperatively in all patients with functional adrenal tumors. There was no local recurrence during the follow-up period. CONCLUSIONS: Our data demonstrate that the surgical outcomes and perioperative complications in LPA group are similar to those of LTA. When LPA is performed for small adrenal lesions, most patients remain steroid independent, as well as recurrence-free at long-term follow-up.


Subject(s)
Adrenal Glands , Adrenalectomy , Biomarkers , Blood Transfusion , Follow-Up Studies , Humans , Laparoscopy , Recurrence , Retrospective Studies
16.
Article in English | WPRIM | ID: wpr-760171

ABSTRACT

Although pheochromocytoma usually presents as a solid tumor, it can also present as a cystic lesion in the adrenal glands. Cystic lesions in the adrenal glands, along with hypertension, need attention to exclude pheochromocytoma. If ignored, they may lead to a hypertensive crisis with multi-organ failure. Proper preoperative preparation is important to prevent a hypertensive crisis during and after surgery. We report a case of pheochromocytoma with cystic degeneration that presented as a hypertensive crisis caused by endoscopic ultrasound-guided tissue sampling.


Subject(s)
Adrenal Glands , Biopsy, Fine-Needle , Endosonography , Hypertension , Pheochromocytoma
17.
Article in English | WPRIM | ID: wpr-759833

ABSTRACT

BACKGROUND: Korean Americans constitute the fifth largest subgroup in the Asian American population. Despite their increasing population, research and guidelines regarding their health status assessment and disease screening are lacking. This study aimed to compare the prevalence of diseases in Korean Americans and native Koreans to determine the risk factors and guidelines for disease screening. METHODS: Patients who visited the Gangnam Severance Hospital from February 2010 to May 2015 for a health checkup were enrolled in this study. Baseline characteristics, laboratory data, and the organs (stomach, colon, thyroid, brain, prostate, lung, liver, kidney, pancreas, adrenal gland, and heart) of patients were examined. Data regarding patients' dietary patterns were also obtained. Overall, 1,514 Korean Americans (group 1) and 1,514 native Koreans (group 2) were enrolled. RESULTS: The following diseases were more prevalent in group 1 than in group 2: reflux esophagitis (12.9% vs. 10%), gastric ulcer (3.0% vs. 5.5%), colorectal polyp (37.7% vs. 28.7%), hemorrhoids (32.2% vs. 29.9%), and benign prostatic hyperplasia (30.2% vs. 14.3%). Although not statistically significant, coronary artery disease has a high prevalence rate of >20% in both groups. Dietary patterns were not significant between the two groups. CONCLUSION: This study showed that the prevalence of several diseases in Korean Americans differed from that observed in native Koreans. Therefore, a foundation for setting up new guidelines for disease screening among Korean Americans is established.


Subject(s)
Adrenal Glands , Asian Americans , Brain , Colon , Coronary Artery Disease , Esophagitis, Peptic , Hemorrhoids , Humans , Kidney , Liver , Lung , Mass Screening , Pancreas , Polyps , Prevalence , Prostate , Prostatic Hyperplasia , Risk Factors , Stomach Ulcer , Thyroid Gland
18.
Article in Korean | WPRIM | ID: wpr-764192

ABSTRACT

PURPOSE: Adrenal gland injuries in trauma are rare and usually misdiagnosed or underestimated in an emergency setting because they are asymptomatic and associated with severe abdominal injuries. This paper reviews the clinical characteristics of adrenal injuries. METHODS: A retrospective analysis of trauma patients who visited the authors' emergency center was performed from March, 2010 to December, 2017. The patient demographic data, injury mechanism & associated injuries, injury severity score, hospital stay, and mortality were retrieved and analyzed. RESULTS: Adrenal gland injuries were found in 52 patients: 73.1% (n=38) were males and the mean age was 43.6 years. Of the patients, 84.6% (n=44) had ISS ≥15. Right adrenal gland injuries occurred in 82.7% (n=43). The mechanism of injury was falls in 30.8% (n=16), motor vehicle accidents in 25.0% (n=13), and pedestrian accidents in 23.1% (n=12). Associated injures were liver injury (58.5%), rib fracture (52.8%), kidney injury (24.5%), pelvic bone fracture (20.8%), spine fracture (28.3%), and spleen injury (13.2%). The mean hospital stay was 34.2 days, and the intensive care unit stay was 9 days. The mortality rate was 3.8% (n=2). CONCLUSION: Adrenal gland injuries are common in males and frequent in the right side. Falls are the leading cause of injury. Most injuries have an associated injury at the abdominal or thoracic region. Adrenal injury is accompanied by high injury severity but showed a good prognosis.


Subject(s)
Abdominal Injuries , Accidental Falls , Adrenal Glands , Emergencies , Humans , Injury Severity Score , Intensive Care Units , Kidney , Length of Stay , Liver , Male , Mortality , Motor Vehicles , Pelvic Bones , Prognosis , Retrospective Studies , Rib Fractures , Spine , Spleen
19.
Article in English | WPRIM | ID: wpr-762560

ABSTRACT

BACKGROUND: Dehydroepiandrosterone sulfate (DHEAS) is an endogenous steroid hormone produced by the adrenal gland. DHEAS has been suggested to play a protective role against psychosocial stress. The aim of this study was to investigate the association between job-related stress and blood concentrations of DHEAS according to occupational stress factors among female nurses. METHODS: A cross-sectional study was conducted among 118 premenopausal nurses from 4 departments (operating room, emergency room [ER], intensive care unit, and ward) of a university hospital. Participants were all rotating night shift workers who have worked for over a year and mean age of 33.5 ± 4.8 years. Data from structured questionnaires including the Korean Occupational Stress Score, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Pittsburgh Sleep Quality Index (PSQI) were used. RESULTS: In the high job-related stressor group, scores of BDI, BAI, and PSQI were significantly higher than low-stressor group. ER nurses had relatively more work-burden related stressors, but they had significantly lower levels of anxiety and depression than other groups. And, ER nurses showed higher levels of DHEAS than the other department nurses. The differences were significant (p = 0.003). Additionally, there was a statistically significant difference even after adjusting for factors that could affect level of DHEAS, such as age, body mass index, drinking, and physical activity (p = 0.039). CONCLUSIONS: This result suggests the possibility that DHEAS may play a role as a marker of proper stress management. The capacity to secrete DHEAS is not simply due to workload or job stressor but could be determined depending on how individuals and groups deal with and resolve stress. Proper resolution of stress may affect positive hormone secretion.


Subject(s)
Adrenal Glands , Anxiety , Body Mass Index , Cross-Sectional Studies , Dehydroepiandrosterone Sulfate , Dehydroepiandrosterone , Depression , Drinking , Emergency Service, Hospital , Female , Humans , Intensive Care Units , Motor Activity
20.
Article in English | WPRIM | ID: wpr-762607

ABSTRACT

Over the last decades, the onset of puberty in girls has occurred earlier, but the tempo of pubertal progression has been relatively slower, resulting in a younger age at puberty onset without a change in age at menarche. Sufficient energy availability and adiposity contribute to early pubertal development, and environmental factors, such as endocrine-disrupting chemicals (EDCs), may affect not only the control of energy balance, but also puberty and reproduction. EDCs are hormonally active substances that can perturb puberty by acting both peripherally on target organs, such as adipose tissue or adrenal glands, and/or centrally on the hypothalamic-pituitary-gonadal (HPG) axis. Depending on whether the exposure takes place earlier during fetal and neonatal life or later during early childhood, EDCs can lead to different outcomes through different mechanisms. Evidence of associations between exposures to EDCs and altered pubertal timing makes it reasonable to support their relationship. However, human epidemiologic data are limited or inconsistent and cannot provide sufficient evidence for a causal relationship between EDC exposure and changes in pubertal timing. Further investigation is warranted to determine the overall or different effects of EDCs exposure during prenatal or childhood windows on pubertal milestones and to reveal the underlying mechanisms, including epigenetic marks, whereby early-life exposure to EDCs affect the HPG-peripheral tissue axis.


Subject(s)
Adipose Tissue , Adiposity , Adolescent , Adrenal Glands , Endocrine Disruptors , Epigenomics , Female , Humans , Menarche , Puberty , Reproduction
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