Adrenalectomía laparoscópica en Adenoma virilizante a propósito de un caso / Laparoscopy adrenalectomy in virilizant adenoma: a case report

Presentar un caso clínico. Paciente femenina de 40 años de edad IIIG IIIP enfermedad actual en 2007 con amenorrea, signos de virilización, fascie cushinoide, por lo cual acude a facultativo. Estudia con un perfil hormonal reportando en abril de 2009: prolactina 7,83, T3, T4, TSH sin alteraciones, estradiol elevado 280, progesterona en 0,4, FSH 9,7 LH 6,5, ultrasonido abdominopélvico reportando quiste de ovario izquierdo simple de 36 mm x 33 mm x 28 mm, volumen de 17,5 cm³, TAC abdomino-pélvica reporta imagen heterogénea capta contraste, contornos definidos en fosa suprarrenal derecha 4,8 cm de diámetro, sugestiva de adenoma suprarrenal, se aprecian aumento de volumen uterino sugestivo de fibromatosis y quiste de ovario derecho simple, catecolaminas urinarias y ácido vanidilmandélico normales, se decide tomar conducta quirúrgica definitiva, por lo que se solicita pre operatorio y el 17-02-10 fue llevada a adrenalectomía laparoscópica, con diagnóstico de adenoma suprarrenal virilizante. La biopsia definitiva reportó tumor epitelial benigno de células corticales adrenales (Adenoma adrenal cortical), sin invasión capsular necrosis ni pleomorfismos sin indicios de malignidad. La paciente fue dada de alta a las 24 horas, con posoperatorio inmediato satisfactorio, Presentando sangrado menstrual 1 mes posterior a la cirugía y reversión posquirúrgico de los signos de virilización. Los adenomas suprarrenales virilizantes son una patología rara pero cuando se presenta la clínica es inequívoca, se recomienda el abordaje laparoscópica de estas lesiones en pacientes bien seleccionados ya que el beneficio es indiscutible

Present a clinical case. Feminine of 40 years old IIIG IIIP initial start disease in 2007 with amenorrhoea, virilization signs, cushin fascies. Goes to facultative that studies with hormonal profile reporting in April of 2009: Prolactin 7.83, T3 T4 TSH without alterations, estradiol 280, progesterone in 0,4, FSH 9.7 LH 6.5, pelvic and abdominal ultrasound reporting cyst simple left ovary of 36 mm x33 mm x 28 mm and volume of 17.5 cm³, abdominal and pelvic TAC that reports heterogeneous image that catches contrast, contours defined in right adrenal grave 4.8 cm of diameter, suggestive of adrenal adenoma, also increase uterine volume of fibromatosis and cyst of straight simple ovary, urinary catecholamines and normal vanidilmandelic acid are appraised, reason by which it is decided to take definitive surgical treatment, reason why asks for pre operating studies and the 02-17-10 was taken to laparoscopic adrenectomy, with diagnosis of virilizant adrenal adenoma. The definitive biopsy report benign epithelial tumor of adrenal cortical cells (cortical adrenal adenoma), without capsular invasion necrosis non pleomorphic, without malignant suspicious items. The patient egresses to the 24 hours after surgery, with an immediate satisfactory post-operative, Presenting/displaying menstrual bleeding 1 month subsequent to the surgery and postsurgical reversion of the signs of virilization. The virilizant adrenal adenomas are a rare pathology but when the clinic appears is unequivocal, laparoscopic boarding of these injuries in selected patients is good recommended since the benefit is unquestionable

Chromaffin cells in the adrenal medulla of the mouse: a morphological study of their innervation

To study the synaptic nerve endings on the adrenaline [A], noradrenaline [NA] and small granular Chromaffin [SGC] cells of the mouse before and after puberty and the possible functional relationship between these cells. Male albino mice bred at the animal house-Jordan University, which aged 5, 10 and 12 days and 5 weeks were used. After sacrifice, the adrenal glands were removed from the animals and processed for examination with a Philips 300 electron microscope. The percentage of SGC cells and the number of synaptic endings on A and NA cells were calculated. All the nerve endings observed are typical in appearance with the cholinergic-type synaptic endings. No evidence of an adrenergic innervation of Chromaffin tissue of the adrenal medulla has been obtained during the present work, though the elongated processes of small granular Chromaffin cell could readily be misinterpreted as adrenergic nerve fibres. The processes of these cells come close to other Chromaffin cells, both A, NA cell and form synapses. Frequent exocytotic figures related to these cells were observed. The present findings suggest that the SGS cells form an intrinsic system that regulates the activity of other chromaffin cells, particularly in the early postnatal period when the extrinsic innervation of the chromaffin cells is not yet fully developed

Feocromocitoma suprarrenal derecho: reporte de un caso y revisión de la literatura / Right adrenal pheochromocytoma: a case report and literature review

Presentar el caso clínico de una patología poco frecuente su manejo y su resolución quirúrgica, tratado en el Servico de Cirugía General IAHULA Mérida-Venezuela. Revisión de la literatura y descripción del caso clínico. El feocromocitoma es una enfermedad inusual y es causa de hipertensión arterial secundaria. Se presenta más frecuentemente como un tumor adrenal unilateral y en los mayores de 60 años. Las manifestaciones clínicas más comunes son cefalea paroxística, palpitaciones, diaforesis e hipertensión arterial paroxística o persistente. El diagnóstico se apoya en la clínica y en la determinación bioquímica, siendo el métdodo de elección la cuantificación de metanefrinas plasmáticas. Planteado el diagnósticio, es fundamental conocer la localización del tumor, lo que debe ser realizado mediante tomografía axial computada o resonancia nuclear magnética. El tratamiento consiste en el empleo de drogas antihipertensivas y la resección quirúrgica del tumor. Las drogas de elección son los antagonistas de los receptores alfa 2 adrenérgicos y/o bloqueadores de los canales de calcio, la resección puede ser realizada por laparotomía clásica como lo fue nuestro caso.

Altered gonodal hormone level and constant light-induced stress interfere with the response of the adrenal medulla to oxytocin

The effect of oxytocin (0.25 IU/100 g per day) on the adrenal medulla was examined in intact, intact estrogen-treated, castrated and castrated testosterone-treated adult male Wistar rats. Stereological analysis of the gland (N = 5 rats per group) revealed that in intact animals the number of chromaffin cells (x10(3)) was significantly increased after 3-day (saline: 467.6 +/- 27.4; oxytocin: 567.6 +/- 28.9) or 7-day (saline: 486.2 +/- 39.1; oxytocin: 618.7 +/- 36.8) oxytocin administration. During 7 days of recovery after the 7-day treatment, the chromaffin cell number returned to the control level (saline: 491.4 +/- 12.6; oxytocin: 554.4 +/- 28.7). The effect of oxytocin on chromaffin cell number was also observed in rats simultaneously injected with estradiol (0.3 microg/100 g per day) for 10 days (estradiol: 454.3 +/- 32.8; estradiol + oxytocin: 576.1 +/- 25.0), as well as in 10-day castrated rats (saline: 594.7 +/- 22.7; oxytocin: 765.3 +/- 33.1). Testosterone replacement (0.6 mg/100 g per day) abolished the medullary response to oxytocin (testosterone + saline: 528.5 +/- 24.7; testosterone + oxytocin: 620.8 +/- 56.0). There was a 20 percent rise in adrenal dopamine content (from 0.236 +/- 0.015 to 0.283 +/- 0.015 microg per pair of glands; N = 9-12) in intact rats injected with oxytocin for 3 days. Oxytocin had no effect on any of the catecholamine levels in adrenal glands of rats exposed to stress induced by constant lighting. The present data indicate that the proliferative response of chromaffin tissue to oxytocin depends on the gonadal hormone level and the basal activity of the adrenal medulla.