ABSTRACT
PURPOSE: Adrenal cortical adenomas (ACAs) represent one of the most common endocrine neoplasms. Recently, a genetic syndrome, characterized by tumor-suppressor ARMC5-gene mutations and causing primary macronodular bilateral adrenal hyperplasia with concomitant meningiomas of the central nervous system, has been described. Apart from this rare disorder and despite the well-known influence of steroid hormones on meningiomas, no data are available about the association between ACAs and meningiomas. METHODS: We investigated the prevalence of ACAs in a group of patients with cerebral meningioma undergoing unenhanced chest CT scans before attending surgical treatment. Patients with meningioma were age- and sex-matched in a 1:3 ratio with hospitalized patients for COVID-19. RESULTS: Fifty-six patients with meningioma were included and matched with 168 control patients with COVID-19. One-hundred forty-four (66.1%) were female and the median age was 63 years. Twenty ACAs were detected in the overall population (8.9% of the subjects): 10 in patients with meningioma (18%) and the remaining 10 (6%) in the control group (p = 0.007). Multivariate analysis showed that age and presence of meningioma were statistically associated with the presence of ACAs (p = 0.01, p = 0.008). CONCLUSION: We report, for the first time, a higher prevalence of ACAs in patients with meningioma as compared to age- and sex-matched controls. Larger studies are needed to confirm our data and to clarify the characteristics of the ACAs in patients with meningioma. Whether the detection of ACAs should prompt a neuroimaging evaluation to exclude the presence of meningiomas needs also to be considered.
ABSTRACT
A 74-year-old man, dyslipidemic, underwent cardiac surgery for DIA about 30 years ago, who had been carrying biventricular AICD for about 5 years when he was performing negative coronary angiography for significant stenosis. Replacement of the AICD 2 years ago due to premature battery depletion due to high threshold of the left catheter. He is hospitalized for incessant VT refractory to AICD electrical therapy and pharmacologically regressed upon entry into the ward with IV cordarone bolus and IV MG SO4 infusion. Several times subjected to a negative covid 19 swab. Coronary angiography examination performed with coronary arteries angiographically free from significant stenosis and only slightly atheromatous. Stabilized from an electrical point of view with metoprolol therapy 100 mg x 2/day. Subjected in the following days to replacement of AICD for end of life. The patient is sent to a catheter ablation center to verify the functioning of the device with induction tests, left and right pace-mapping and ablation of the shock-refractory ventricular hyperkinetic arrhythmia. Subjected to ablation of right VT in two foci: inferior septal basal and peritricuspid. Inserted in arrhythmological follow up and device control in therapy with beta-blockers and cordarone. The case in question opens the discussion on the advantage represented by integrated procedures on this type of patients. The shock- refractory arrhythmic form was effectively treated by catheter ablation at a level III electrophysiology center with which it is in close collaboration. The patient therefore receives clinically triple protection: AICD, Ablation and drug therapy, against the possible onset of severe arrhythmic forms, in a prognostic key. The patient returns to the hospital after a few days for atrial flutter with an average ventricular rate of 140 b/m ', movement of the Trop I with high sensitivity and primary modifications (deepening of T waves on BBS) post tachycardia, following omission of dose of metoprolol 100 mg. Subjected to coronary angiography and FFr which resulted in 95, therefore the mild non-stenosing atheroma of the previous coronary angiography is confirmed. He is discharged in conditions of clinical stability. (Figure Presented).