Subject(s)
Funnel Chest/diagnostic imaging , Tomography, X-Ray Computed , Adolescent , Adult , Funnel Chest/surgery , Humans , MaleABSTRACT
In the last 7 years 64 patients (48 women, 16 men, aged 25-75 yrs) with incidentally found asymptomatic adrenal tumours have been observed in the Department of Endocrinology. In 11 patients a routine clinical investigations revealed metastatic tumours at the adrenal glands. In the remaining 53 patients the diameter of the adrenal tumours was < or = 3 cm. Only two of them were treated surgically; the rest has been observed regularly and ultrasonographic examinations have been repeated every 3 to 6 months. Twenty three patients with adrenal tumours < 3 cm of diameter were treated by surgery. The macroscopical examination revealed adrenal cortical adenoma in 11 cases, adrenocortical carcinoma in seven, and pheochromocytoma in 5 patients. The investigation of the pituitary-adrenal system (urinary excretion of 17-OHCS before and during dexamethasone administration, 17-KS, "free" corticosteroids, plasma ACTH, cortisol and S-DHA levels) did not reveal any abnormality except that in 10 patients the plasma ACTH concentration was low, especially in the morning. These values were significantly lower as compared with the remaining patients and with control group. One of the possible interpretations is a pituitary suppression by only periodically increased concentrations of the corticosteroids.
Subject(s)
Adrenal Gland Neoplasms/physiopathology , Pituitary-Adrenal System/physiopathology , Adrenal Gland Neoplasms/diagnosis , Adrenocorticotropic Hormone/blood , Adult , Aged , Female , Humans , Male , Middle Aged , Pituitary-Adrenal Function TestsABSTRACT
Localization tests including TC-scans, scintigraphy with 131I-radiolabelled metaiodobenzylguanidine and ultrasound have been performed in 68 patients with diagnosed pheochromocytoma. Diagnosis was based on clinical symptoms and increased catecholamines and/or their metabolites excretion with the urine. Proper diagnosis with CT-scans was 97%, scintigraphy--92%, and ultrasound--93%; false negative results in scintigraphy amounted to 8% (3 patients) and 5% (3 patients) in case of ultrasound. CT-scans were free of such errors. False positive diagnosis was made in 2 (3%) patients with CT-scans and in 1 (2%) patient tested with ultrasound. These results suggest that pheochromocytoma may be precisely localized with non-invasive techniques, especially CT-scans.
Subject(s)
Adrenal Gland Neoplasms/diagnosis , Pheochromocytoma/diagnosis , Adolescent , Adult , Aged , Diagnostic Imaging/methods , Humans , Middle Aged , Predictive Value of TestsABSTRACT
The paper sums up the experience of the clinic in diagnosing and therapy of the Cushing syndrome due to multiple autonomous adrenal cortical adenomas. The observation was carried out in a group of 5 women between 15-44 years of age (31.7 on an average). In the clinical material including 225 cases of the Cushing syndrome, they amounted to 2.2 per cent. All the five patients had typical somatic symptoms, myasthenia, ++amenorrhea. In hormonal examinations the content of 17-OHCS in the 24-hour urine was only periodically increased, 17-KS was within the normal range. There was no inhibiting action of dexamethasone on the excretion of cortisol, even when the initial values of corticosteroids++ were normal. The concentration of ACTH in the blood (determined in 3 cases) was around low normal range. Three patients underwent computer tomography; in one case adrenal glands were of normal size, in the second case--the two glands were enlarged, in the third case--the right gland was much larger than the left one. Microscopic examinations showed the atrophy of adrenal cortex beyond the adenomas. In case of multiple adenomas of the left gland surgery was confined to unilateral adrenalectomy. Among the remaining 4 patients, 3 underwent simultaneous resection of the two glands. All the patients showed the regression of symptoms of the disease, except for the changes in bones. One patient did not turn up for further therapy after unilateral adrenalectomy because of partial improvement.
Subject(s)
Adenoma/diagnosis , Adrenal Cortex Neoplasms/diagnosis , Cushing Syndrome/diagnosis , Neoplasms, Multiple Primary/diagnosis , Adenoma/metabolism , Adolescent , Adrenal Cortex Neoplasms/metabolism , Adult , Cushing Syndrome/physiopathology , Diagnosis, Differential , Female , Humans , Neoplasms, Multiple Primary/metabolismABSTRACT
107 patients presenting Raynaud's phenomenon attacks were studied. It has been demonstrated by means of arteriographies that in pallid phase of Raynaud's phenomenon attacks not only the digital but also the radial ulnar and interosseous arteries are in spasm. In the cyanotic phase of Raynaud's phenomenon the natural arteriovenous anastomoses are widely open bringing about peripheral skin ischemia. On the assumption that the opening of arteriovenous anastomoses in Raynaud's phenomenon attacks is due to injury of that part of the peripheral nerve which lies in contact with the cervical vertebral column all 107 studied patients were submitted to detailed cervical vertebral column X-ray examinations. In 103 patients i.e. in 96.3% characteristic degenerative changes of cervical vertebrae were recognised. In 100 controls who never had neither Raynaud's phenomenon attacks nor cervico-brachial neuritis the same type of degenerative changes were found in 10% only. The authors presume that the Raynaud's phenomenon attacks are due to peripheral mixed nerve or their roots injury. The blue phase of Raynaud's phenomenon attacks is due to opening of arteriovenous anastomoses.
