Analysis of contrast-enhanced ultrasound performance of adrenal cortical adenoma and cortical hyperplasia nodules / 上海交通大学学报（医学版）

Objective · To explore the features of contrast-enhanced ultrasound (CEUS) image of adrenal cortical adenoma and cortical hyperplasia nodules (size greater than 10 mm) and its diagnostic value. Methods · Fifty cases of adrenal cortical adenoma and 22 cases of cortical hyperplasia nodules which were confirmed by pathology were retrospectively analyzed. The conventional ultrasound and CEUS features were recorded, including the size, border, arrival time, peak time, wash-out time, enhancement degree [hypo, hyper (iso-) ], enhancement pattern (peripheral to central, overall, and nonspecific), etc. Results · There was no significant differences between two groups among conventional ultrasonic features. Multi-parameters of CEUS images analysis results showed that the wash-out time of cortical adenomas were significantly longer than the cortical hyperplasia nodules (P=0.002), the under area of the receiver operating characteristic (ROC) curve was 0.694, had the 75.7％ sensitivity and 53.3％ specificity with the cutoff of 42 s.Conclusion · There is no significant difference between the adrenal cortical adenoma and cortex hyperplasia nodules in CEUS pattern, but it still can provide certain information for differentiation.

Analysis of contrast-enhanced ultrasound performance of adrenal cortical adenoma and cortical hyperplasia nodules / 上海交通大学学报（医学版）

Objective • To explore the features of contrast-enhanced ultrasound (CEUS) image of adrenal cortical adenoma and cortical hyperplasia nodules (size greater than 10 mm) and its diagnostic value. Methods • Fifty cases of adrenal cortical adenoma and 22 cases of cortical hyperplasia nodules which were confirmed by pathology were retrospectively analyzed. The conventional ultrasound and CEUS features were recorded, including the size, border, arrival time, peak time, wash-out time, enhancement degree [hypo, hyper (iso-)], enhancement pattern (peripheral to central, overall, and nonspecific), etc. Results • There was no significant differences between two groups among conventional ultrasonic features. Multi-parameters of CEUS images analysis results showed that the wash-out time of cortical adenomas were significantly longer than the cortical hyperplasia nodules (P=0.002), the under area of the receiver operating characteristic (ROC) curve was 0.694, had the 75.7% sensitivity and 53.3% specificity with the cutoff of 42 s. Conclusion • There is no significant difference between the adrenal cortical adenoma and cortex hyperplasia nodules in CEUS pattern, but it still can provide certain information for differentiation.

An Adrenal Cortical Adenoma with Adrenal Medullary Hyperplasia / 대한내과학회지

The relationship between the adrenal cortex and medulla has been studied since the 1960s. Rarely, a patient with an adrenal cortical adenoma presents with the findings of pheochromocytoma. However, there has been no report of a case with the clinical features of pheochromocytoma showing the pathological features of an adrenal cortical adenoma with medullary hyperplasia on histological examination. We report a 59-year-old-man who was shown to have an adrenal cortical adenoma, with medullary hyperplasia, during a diagnostic work up for pheochromocytoma.

Adrenal Medullary Hyperplasia with Coexisting Adrenal Cortical Adenoma / 대한내분비외과학회지

Adrenal medullary hyperplasia is an increase in the mass of the adrenal medullary cells. We report a case of a 38-year-old man presenting with pheochromocytoma-like symptoms who was preoperatively misdiagnosed with pheochromocytoma. Hypertension was associated with an intracranial hemorrhage evident in a brain computed tomography scan, in which no obvious pituitary gland enlargement was detected. An abdominopelvic CT revealed a solitary tumor in the right adrenal gland with no obvious enlargement of the contralateral adrenal gland or sympathetic chains. Lab results showed increased levels of urinary metanephrines. Based on clinical data, the patient underwent a laparoscopic right adrenalectomy bases on a diagnosis of pheochromocytoma. The patient was finally diagnosed with adrenal medullary hyperplasia with coexisting ipsilateral non-functioning adrenal cortical adenoma. Postoperatively, blood pressure and lab results were maintained in the normal range and the patient was symptomatically free during the follow-up period.

A Case of Bilateral Adrenal Cortical Adenomas Causing Cushing's Syndrome and Primary Aldosteronism

A 38-year old female was admitted to our hospital for further evaluation of an incidentally found cardiac murmur. She had been in a hypertensive state for 5 years but had taken antihypertensive drugs intermittently on her own. Her history revealed that she had become amenorrheic for 7 months and had, had headaches for a few months. Physical examination revealed central obesity and a moon face, but no hirsuitism. When she first visited our hospital, her blood pressure was 260/170 mmHg and grade 2 systolic murmur was audible along the left sternal border. Laboratory studies revealed high levels of 24-hour urine-free cortisol and plasma aldosterone, but a very low level of plasma adrenocorticotropic hormone and plasma renin activity. A low-dose and a high-dose dexamethasone suppression tests, adrenal venous sampling, inferior petrosal sinus sampling, and a renin stimulation test were performed. Bilateral adrenal masses were found on computerized tomographic scanning and magnetic resonance imaging but there was no abnormality of the pituitary gland. The uncontrollable blood pressure and the elevated 24-hour urine-free cortisol and plasma aldosterone levels were corrected by a right-total and left-subtotal adrenalectomy. Pathologic findings were bilateral adrenal cortical adenomas of different cell types. These findings indicate that the adrenal cortical adenomas were tumors that functioned differently, causing Cushing's syndrome and primary aldosteronism in the same patient. A review of, the literature published in English showed that this is the first reported case, of bilateral adrenal adenomas functioning differently.

A Case of Multiple Endocrine Neoplasia Type 1

In 1903 Erdheim reported multiple endocrine neoplasia type 1 (MEN 1) by autopsy, and in 1954 Wermer reported a familial occurrence of multiple tumors which were associated with neoplastic transformation of parathyroid, pituitary and pancreatic islet cells. This complex association of abnormalities is inherited as an autosomal dominant trait and related to tumor suppressor gene on chromosome 11. In a 38-year-old woman with epigastric discomfort, general weakness and mental change, a pituitary gland tumor was diagnosed with sella magnetic resonance imaging and combined pituitary stimulation test. a pancreas insulinoma, an adrenal gland cortical adenoma and a thyroid adenoma were confirmed by pathology and they were diagnosed with biochemical test, CT scan, percutaneous transhepatic portal vein catheterization with insulin sampling, thyroid sonogram and scintigram. The blood glucose level was normalized after operation. In the 6 months follow up study, she has not presented any symptoms of hypoglycemia so far. Authors present this case briefly with a review of literature.

A Case of Multiple Endocrine Neoplasia Type 1 / 대한내분비학회지

Multiple endocrine neoplasia type 1 (MEN 1) is the association of neoplastic transformation of parathyroid, pituitary, and pancreatic islet cells. This syndrome is inherited as an autosomal dominant trait. A 38-year-old woman presented with general weakness and mental changes. She had experienced same symptoms 7 years ago, after then her weight gradually increased. Insulinoma was suspected by markedly decreased blood glucose level (20mg/dL) and the increased insulin/glucose ratio (0.43) that sampled in emergency room at the time of mental change. Unusually large pancreatic tail mass and Lt, adrenal gland mass were detected by abdominal CT. Percutaneous transhepatic portal vein catheterization with insulin sampling showed sudden step up of insulin/glucose ratio at the middle portion of pancreas. Measuring of basal pituitary hormones as a screening procedure of MEN showed increased basal prolactin level. Combined pituitary stimulation test showed blunted response of prolactin to TRH and sellar magnetic resonance imaging showed intrasellar mass. Thyroid nodule was palpated on her anterior neck. Thyroid scintigram showed cold nodule, and there was no lymphadenopathy around the nodule by the thyroid sonogram. Fine needle aspiration cytology showed benign hyperplastic follicular cells only. Serum ionized calcium and parathyroid hormone level were normal. Under the impression of MEN type I, the distal pancreatectomy, splenectomy, Lt. thyroid lobectomy and Lt. adrenalectomy was performed at the same time. Histologic examination of the surgically removed tissues revealed pancreas islet cell tumor, adrenal cortical adenoma and thyroid adenoma. Transient hyperglycemia was developed after surgical intervention, but thereafter she never felt any symptoms of hypoglycemia till now and her blood glucose showed completely normal level with oral glucose tolerance tests. We present this case with a review of literature.

Treatment of primary aldosteronism / 대한비뇨기과학회지

Eight patients with primary aldosteronism treated in Kyungpook University Hospital were evaluated by clinical studies. All the patients had unilateral adrenal adenomas and location of adenomas were left in 4 and right in 4. Patient age ranged from 25 to 44 years (mean 35.6 years) and sex ratio of male to female waF 4 to 4. These patients had had a history of hypertension between 2 months and 20 years and showed hypokalemia and kaliuresis. The diagnosis of primary aldosteronism was made by clinical and laboratory testing which demonstrated elevated plasma and urinary aldosterone levels in conjunction with suppressed plasma renin activity and no response of captopril tests which were checked in 5 patients and all adenomas were accurately located by computed tomography. Surgical removal of adenoma were performed by extra-peritoneally in 5 patients and by transperitoneally in 3. There was no troublesome operative complication. All the patients noted normalized biochemical levels in postoperative laboratory testing and resolved hypertensions. The surgical specimens of adrenal gland histopathologically confirmed to adrenal cortical adenoma with clear cytoplasm in all cases.