Critical size of residual adrenal tissue and recovery from impaired early postoperative adrenocortical function after subtotal bilateral adrenalectomy

Surgery ◽  
2003 ◽  
Vol 134 (6) ◽  
pp. 1020-1027 ◽  
Author(s):  
M Brauckhoff
Keyword(s):  
Critical Size ◽  
Bilateral Adrenalectomy ◽  
Adrenocortical Function ◽  
Adrenal Tissue

Ovarian carcinoma in a 14-year-old with classical salt-wasting congenital adrenal hyperplasia and bilateral adrenalectomy

2015 ◽  
Vol 28 (5-6) ◽  
Author(s):  
Christian Pina ◽  
Ahmed Khattab ◽  
Philip Katzman ◽  
Lauren Bruckner ◽  
Jeffrey Andolina ◽  
...  
Keyword(s):  
Congenital Adrenal Hyperplasia ◽  
Ovarian Carcinoma ◽  
Left Ovary ◽  
Bilateral Adrenalectomy ◽  
Ca 125 ◽  
Adrenal Hyperplasia ◽  
Serous Adenocarcinoma ◽  
Adrenal Tissue ◽  
Ovarian Serous Adenocarcinoma ◽  
21 Hydroxylase Deficiency

AbstractA 14-year-old female with classical congenital adrenal hyperplasia because of 21-hydroxylase deficiency underwent bilateral adrenalectomy at 6 years of age as a result of poor hormonal control. Because the patient was adrenalectomized, extra adrenal androgen production was suspected. Imaging studies including pelvic ultrasound and pelvic magnetic resonance imaging (MRI) were obtained to evaluate for adrenal rest tumors of the ovaries. Abdominal MRI was obtained to evaluate for residual adrenal tissue. A cystic lesion arising from her right ovary suspicious for ovarian neoplasm was noted on pelvic MRI. Right salpingo-oophorectomy was performed and histopathological examination revealed ovarian serous adenocarcinoma, low-grade, and well-differentiated. Tumor marker CA-125 was elevated and additional ovarian cancer staging workup confirmed stage IIIC due to one lymph node positive for carcinoma. The patient then developed a large left ovarian cyst, which led to a complete total abdominal hysterectomy and removal of the left ovary and fallopian tube. Pathology confirmed ovarian serous adenocarcinoma with microscopic focus of carcinoma in the left ovary. After numerous complications, the patient responded well to chemotherapy, CA-125 levels fell and no evidence of carcinoma was observed on subsequent imaging. To our knowledge, this is the first reported case of an ovarian serous adenocarcinoma in a patient with CAH. Although rare, we propose that the ovaries were the origin of androgen production and not residual adrenal tissue. The relationship between CAH and ovarian carcinomas has yet to be established, but further evaluation is needed given the poor survival rate of high-grade serous ovarian carcinoma.

Pituitary-adrenal function after transplantation in rats: dependence on age of the adrenal graft

1986 ◽  
Vol 250 (1) ◽  
pp. E87-E93
Author(s):  
W. C. Engeland
Keyword(s):  
Plasma Corticosterone ◽  
Adrenal Function ◽  
Adrenocortical Function ◽  
Elevated Plasma ◽  
Plasma Acth ◽  
Adult Rats ◽  
Adrenal Cells ◽  
Adrenal Tissue ◽  
Corticosterone Response

Comparisons of resting plasma adrenocorticotropin (ACTH) and corticosterone in the morning and afternoon were made among adult rats bearing regenerated adult adrenal grafts, neonatal (day 1) adrenal grafts, adult adrenal capsule grafts, or intact adrenals. In the morning plasma ACTH and corticosterone were similar in all rats. In the afternoon, plasma ACTH was elevated in rats bearing neonatal adrenal grafts or adult adrenal capsule grafts, but not in rats bearing whole adult adrenal grafts. There was no difference in afternoon plasma corticosterone among rats bearing transplanted adrenals, although afternoon plasma corticosterone was decreased in rats bearing transplants compared with rats with intact adrenals. Thus the increased plasma ACTH after adrenal transplantation cannot be explained entirely by decreases in resting plasma corticosterone. Adrenal responsiveness to ACTH was tested at 5 wk after transplantation in the afternoon by measuring the plasma corticosterone response to submaximal doses of ACTH. The responsiveness was decreased in rats bearing transplants. In addition, responsiveness was inversely related to the age of the grafted adrenal tissue. Adrenals regenerated from adult adrenals were more responsive than adrenals regenerated either from neonatal adrenals or from adult adrenal capsules. The findings suggest that following adrenal transplantation reestablishment of normal pituitary-adrenocortical function does not occur in rats bearing adrenals regenerated from immature adrenal cells. In addition, comparable alterations occur after regeneration of adrenal tissue from neonatal adrenal cells and adult adrenal capsular cells. Elevated plasma ACTH associated with adequate plasma corticosterone in rats bearing adrenals regenerated from immature adrenal cells may result from chronic alteration in responsiveness to steroid feedback.(ABSTRACT TRUNCATED AT 250 WORDS)

IN VITRO RESPONSES OF FOCAL HYPERPLASTIC TISSUE OF THE HUMAN ADRENAL ZONA FASCICULATA TO ACTH

1977 ◽  
Vol 86 (2) ◽  
pp. 363-368 ◽  
Author(s):  
Kenneth V. Honn ◽  
Walter Chavin ◽  
Amnuay Singhakowinta
Keyword(s):  
Adrenocortical Function ◽  
Zona Fasciculata ◽  
Adrenal Tissue ◽  
Basal Cortisol ◽  
Aldosterone Production ◽  
Hyperplastic Tissue ◽  
Normal Human ◽  
Adrenal Zona Fasciculata ◽  
Normal Adrenal Tissue

ABSTRACT The temporal cAMP, cortisol and aldosterone responses to ACTH of focal hyperplasia of the zona fasciculata and of normal human adrenocortical tissue were investigated. ACTH significantly increased cAMP levels (1 min) and cortisol output (2 min) in normal adrenal tissue but not in hyperplastic tissue. However, following ACTH treatment cortisol and aldosterone production were depressed in the abnormal adrenal tissue below the untreated or the ACTH stimulated normal adrenal tissue. In addition, basal cortisol and aldosterone production of the hyperplastic adrenal tissue was elevated above that of the normal adrenal tissue. These findings suggest that the cAMP second messenger concept may be only one of several mechanisms in the modulation of human adrenocortical function.

RESIDUAL ADRENOCORTICAL FUNCTION AFTER BILATERAL ADRENALECTOMY

The Lancet ◽  
1982 ◽  
Vol 319 (8265) ◽  
pp. 219-220
Author(s):  
Janos Szücs ◽  
Eva Kollin ◽  
Julia Rádó ◽  
Istvan Holló ◽  
Bruno Ambrosi ◽  
...  
Keyword(s):  
Bilateral Adrenalectomy ◽  
Adrenocortical Function

scholarly journals High Prevalence of Adrenal Remnant Tissue in Patients Undergoing Bilateral Adrenalectomy for Cushing’s Disease

2020 ◽  
Author(s):  
Julian B. Wilson ◽  
Mohan Zopey ◽  
Jaimie Augustine ◽  
Randolph Schaffer ◽  
Manfred Chiang ◽  
...  
Keyword(s):  
Cushing’S Disease ◽  
Signs And Symptoms ◽  
Pituitary Surgery ◽  
Serum Cortisol ◽  
Bilateral Adrenalectomy ◽  
Cushing's Disease ◽  
Adrenal Tissue ◽  
Number Of Patients ◽  
Free Cortisol ◽  
Endogenous Cortisol

AbstractBilateral adrenalectomy (BLA) is a treatment option for patients with Cushing’s Disease (CD) if transsphenoidal pituitary surgery fails or is not a therapeutic option. For most patients, BLA eliminates endogenous glucocorticoid and mineralocorticoid production, but for a small number of patients, endogenous secretion of adrenal hormones from adrenal tissue continues or recurs, leading to signs and symptoms of hypercortisolism. If adrenal tissue is confined to the adrenal bed, it is considered adrenal remnant tissue, while if it is outside the adrenal bed, it is considered adrenal rest tissue. We retrospectively evaluated morning serum cortisol, nighttime serum cortisol, nighttime salivary cortisol, and 24-h urine free cortisol on at least three occasions in 10 patients suspected of having endogenous cortisol production. Imaging of adrenal remnant tissue was also reviewed. Ten of 51 patients who underwent BLA during this time period had adrenal remnant/rest tissue marked by detectable endogenous glucocorticoid production; 9 of the 10 patients had signs and symptoms of hypercortisolism. Localization and treatment proved difficult. We conclude that the incidence of adrenal remnant/rest tissue in those undergoing BLA following unsuccessful pituitary surgery was 12% although there may have been a selection bias affecting this prevalence. The first indication of remnant tissue occurrence is a reduction in glucocorticoid replacement with symptoms of hypercortisolism. If this occurs, endogenous cortisol production should be tested for by cortisol measurements using a highly specific cortisol assay while the patient is taking dexamethasone or no glucocorticoid replacement. Endocrinologists need to monitor the development of both adrenal remnant tissue and Nelson’s syndrome following BLA.

Adrenal Scintigraphy with 131I-Adosterol

1976 ◽  
Vol 15 (06) ◽  
pp. 297-299
Author(s):  
O. A. Chomicki ◽  
W. Hartwig ◽  
A. Mikołajków ◽  
H. Siwicki ◽  
A. Kasperlik-Zaluska
Keyword(s):  
Bilateral Adrenalectomy ◽  
Adrenal Tumour ◽  
Adrenal Scintigraphy ◽  
Female Patients ◽  
Adrenal Tissue

SummaryA new adrenal scanning agent, Adosterol (131I-6β-iodomethyl-19-norcholest-5(10)-en-3β-ol) has been evaluated in three female patients with hypercortic-ism. In one case, characterised by recurrent adrenocortical hyperactivity after bilateral adrenalectomy, a remnant of adrenal tissue was detected. In two other cases, the presence of an adrenal tumour could be excluded. The scan made on the 6th day after the administration of Adosterol was found to be superior in quality to that made on the 13th day.

Experimental Study on Adrenal Autografts in Rats to Preserve Normal Adrenocortical Function after Bilateral Adrenalectomy

1992 ◽  
Vol 24 (2) ◽  
pp. 112-118 ◽  
Author(s):  
T. Okamoto ◽  
Y. Fujimoto ◽  
T. Obara ◽  
Y. Ito ◽  
T. Kodama
Keyword(s):  
Experimental Study ◽  
Bilateral Adrenalectomy ◽  
Adrenocortical Function

NUCLEAR SHAPE VARIATIONS IN THE FASCICULAR ZONE OF THE RAT ADRENAL GLAND

1968 ◽  
Vol 59 (4) ◽  
pp. 652-659 ◽  
Author(s):  
Chr. Åhrén ◽  
G. Hansson ◽  
P. Hedner
Keyword(s):  
Adrenal Gland ◽  
Nuclear Volume ◽  
Nuclear Shape ◽  
Adrenocortical Function ◽  
Cellular Activity ◽  
Adrenal Tissue ◽  
Initial Stage ◽  
Transient Elevation ◽  
Free Plasma

ABSTRACT Variations in nuclear volume and shape from one to 24 hours after exogenous corticotrophin (ACTH) administration have been studied in the fascicular zone of the rat adrenal gland. It appeared that ACTH gave rise to a transient rounding of the normally ovoid nucleus. The change in nuclear eccentricity was maximal at 6 hours and returned to normal within 9 hours. This variation in shape was concomitant with the initial stage of a more prolonged increase in nuclear volume as well as with a more transient elevation of the free plasma and adrenal tissue corticosteroid levels. Nuclear shape variations presumably constitute a morphological indication of increased cellular activity. It is pointed out that karyometric determination of nuclear shape variations might serve as a supplementary parameter in studies of adrenocortical function.

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