The Adrenal Glands

2011 ◽  
Author(s):  
Richard J. Auchus ◽  
Keith L. Parker
Keyword(s):  
Steroid Hormones ◽  
Chronic Stress ◽  
Adrenal Glands ◽  
Visceral Obesity ◽  
Basic Function ◽  
Sodium Reabsorption ◽  
Body Fluid Volume ◽  
Life Threatening ◽  
Clinically Significant ◽  
Obesity Hypertension

The basic function of the adrenal glands is to protect the organism against acute and chronic stress, a concept popularized as the fight-or-flight response for the medulla and as the alarm reaction for the cortex. The steroid hormones of the cortex and the catecholamines of the medulla probably developed as protection against immediate stress or injury and more prolonged deprivation of food and water. In acute stress, catecholamines mobilize glucose and fatty acids for energy and prepare the heart, lungs, and muscles for action, while glucocorticoids protect against overreactions from the body’s responses to stress. In the more chronic stress of food and fluid deprivation, adrenocortical steroid hormones stimulate gluconeogenesis to maintain the supply of glucose and increase sodium reabsorption to maintain body fluid volume. Based on the widespread effects of its secreted products in multiple tissues, adrenal dysfunction is associated with protean manifestations. Diseases associated with adrenocortical hypofunction are relatively rare, while those associated with adrenocortical hyperfunction are slightly more common. However, both of these conditions are life threatening if untreated, and a high index of suspicion must therefore be maintained. Subtle increases in cortisol secretion or tissue sensitivity to glucocorticoids may be involved in many of the devastating effects of chronic stress, including visceral obesity, hypertension, diabetes mellitus, dyslipidemia, infertility, and depression. Moreover, exogenous glucocorticoids are widely used to treat numerous diseases and, when used in supraphysiological doses, can induce all of the manifestations of glucocorticoid excess. Perhaps because the adrenal medulla accounts for only 10 % of total sympathetic nervous activation, we can live quite well without it, and syndromes due to hypofunction are not clinically significant. However, conditions of excess catecholamine output due to tumors called pheochromocytomas are a rare but potentially life-threatening cause of secondary hypertension.

A Serological Storm

1970 ◽  
Vol 9 (2) ◽  
Author(s):  
Bertha Wong MD ◽  
Maria Bagovich MD ◽  
Ivan Blasutig PhD ◽  
Simon Carette MD MPhil
Keyword(s):  
Differential Diagnosis ◽  
Hepatitis C Virus ◽  
Immune System ◽  
Hepatitis C ◽  
Hcv Infection ◽  
Clinical Context ◽  
Autoantibody Profile ◽  
Life Threatening ◽  
Clinically Significant ◽  
Sensory Polyneuropathy

This article describes a patient presenting with a sensory polyneuropathy and multiple autoantibodies, leading to the diagnosis of hepatitis C virus (HCV) infection. His widely positive autoantibody profile in the absence of clinically significant rheumatic disease illustrates the importance of interpreting autoimmune serology in the appropriate clinical context and the concept of HCV being a non-specific activator of the immune system. In addition, it highlights the importance of considering untreated HCV infection in the differential diagnosis of rheumatic complaints, particularly if the workup reveals multiple autoantibodies, as HCV is a potentially severe and life-threatening disease, which can be appropriately managed with effective antiviral therapy.

scholarly journals Feline abdominal ultrasonography: what’s normal? what’s abnormal? The adrenal glands

2021 ◽  
Vol 23 (1) ◽  
pp. 33-49 ◽  
Author(s):  
Sally Griffin
Keyword(s):  
Adrenal Glands ◽  
Ultrasound Examination ◽  
Abdominal Ultrasound ◽  
Evidence Base ◽  
Vital Role ◽  
Abdominal Ultrasonography ◽  
Operator Experience ◽  
High Resolution Images ◽  
Clinically Significant ◽  
Diagnostic Work

Practical relevance: Abdominal ultrasound plays a vital role in the diagnostic work-up of many cats presenting to general and specialist practitioners. Ultrasound examination of the adrenal glands can provide important information pertaining to several conditions including hyperaldosteronism and hyperadrenocorticism. Clinical challenges: Despite ultrasonography being a commonly used modality, many practitioners are not comfortable performing an ultrasound examination or interpreting the resulting images. Even for the experienced ultrasonographer, differentiating between incidental findings, such as adrenal mineralisation, and clinically significant pathological changes can be challenging. Aim: This review, part of an occasional series on feline abdominal ultrasonography, discusses the ultrasonographic examination of the normal and diseased adrenal glands. Aimed at general practitioners who wish to improve their knowledge of and confidence in feline abdominal ultrasound, this review is accompanied by high-resolution images and videos available online as supplementary material. Equipment: Ultrasound facilities are readily available to most practitioners, although the use of ultrasonography as a diagnostic tool is highly dependent on operator experience. Evidence base: Information provided in this article is drawn from the published literature and the author’s own clinical experience.

scholarly journals The bowel and beyond: extracolonic findings from CT colonography

2021 ◽  
Author(s):  
Gerard Lambe ◽  
Peter Hughes ◽  
Louise Rice ◽  
Caoimhe McDonnell ◽  
Mark Murphy ◽  
...  
Keyword(s):  
Ct Colonography ◽  
Surgical Intervention ◽  
Potential Significance ◽  
Age And Gender ◽  
Abdominal Aortic ◽  
Life Threatening ◽  
Extracolonic Findings ◽  
The Difference ◽  
Clinically Significant ◽  
And Gender

AbstractCT colonography has emerged as the investigation of choice for suspected colorectal cancer in patients when a colonoscopy in incomplete, is deemed high risk or is declined because of patient preference. Unlike a traditional colonoscopy, it frequently reveals extracolonic as well as colonic findings. Our study aimed to determine the prevalence, characteristics and potential significance of extracolonic findings on CT colonography within our own institution. A retrospective review was performed of 502 patients who underwent CT colonography in our institution between January 1, 2010 and January 4, 2015. Of 502 patients, 60.63% had at least one extracolonic finding. This was close to other similar-sized studies (Kumar et al. Radiology 236(2):519–526, 2005). However, our rate of E4 findings was significantly higher than that reported in larger studies at 5.3%(Pooler et al. AJR 206:313–318, 2016). The difference may be explained by our combination of symptomatic/screening patients or by the age and gender distribution of our population. Our study lends support to the hypothesis that CT colonography may be particularly useful in identifying clinically significant extracolonic findings in symptomatic patients. CT colonography may allow early identification of extracolonic malignancies and life-threatening conditions such as an abdominal aortic aneurysm at a preclinical stage when they are amenable to medical or surgical intervention. However, extracolonic findings may also result in unnecessary investigations for subsequently benign findings.

UTILIZATION OF [26-14C]CHOLESTEROL BY HUMAN FOETAL ADRENAL GLANDS IN VITRO

1978 ◽  
Vol 79 (3) ◽  
pp. 393-394 ◽  
Author(s):  
R. GUNASEGARAM ◽  
K. L. PEH ◽  
P. C. T. CHEW ◽  
S. M. M. KARIM ◽  
S. S. RATNAM
Keyword(s):  
Adrenal Gland ◽  
Steroid Hormones ◽  
Adrenal Glands ◽  
De Novo ◽  
Obstetrics And Gynaecology ◽  
Perfusion Studies

Department of Obstetrics and Gynaecology, University of Singapore, Kandang Kerbau Hospitalfor Women, Singapore 8, Republic of Singapore (Received 3 May 1978) From the previous studies of Bloch & Benirschke (1959, 1962) and Plotz, Kabara, Davis, LeRoy & Gould (1968) it appears that at mid-term, human foetal adrenal glands are capable of synthesizing C21- and C19-steroids de novo from acetate and cholesterol. Villee, Engel, Loring & Villee (1961), however, incubated slices and homogenates of foetal adrenal gland with [2-14C]acetate or [4-14C]cholesterol and could not demonstrate the incorporation of radioactivity into these steroids. Moreover, perfusion studies by three groups of investigators indicated only minute conversions of the same radioactive substrates into neutral steroids in the foetal adrenal glands (Solomon, Bird, Ling, Iwamiya & Young, 1967; Telegdy, Weeks, Archer, Wiqvist & Diczfalusy, 1970a; Telegdy, Weeks, Lerner, Stakemann & Diczfalusy, 1970b). It is widely believed that steroid hormones are normally synthesized from acetate via

scholarly journals Fetomaternal interactions and influences during equine pregnancy

Reproduction ◽  
2001 ◽  
pp. 513-527 ◽  
Author(s):  
WR Allen
Keyword(s):  
Steroid Hormones ◽  
Adrenal Glands ◽  
Maternal Serum ◽  
Trophoblast Cells ◽  
Maternal Circulation ◽  
Invasive Phenotype ◽  
Uterine Lumen ◽  
Non Invasive ◽  
Unusual Phenomenon ◽  
Near Term

The equine embryo takes 6 days to traverse the oviduct and, when it finally enters the uterus, it remains spherical in shape and moves continually throughout the uterine lumen until day 17 after ovulation to deliver its maternal recognition of pregnancy signal to the entire endometrium. Between day 25 and day 35 after ovulation, the trophoblast cells of a discrete annulate portion of the chorion multiply rapidly and acquire an invasive phenotype and, between day 36 and day 38, migrate deeply into the maternal endometrium to form the equine-unique endometrial protuberances known as endometrial cups. These cups secrete large quantities of a gonadotrophic hormone (eCG) into the maternal circulation which, in conjunction with pituitary FSH, stimulates the development of accessory luteal structures in the maternal ovaries to supplement the supply of progesterone to maintain the pregnancy until the placenta can assume this role at about day 100. The non-invasive allantochorion extends slowly to fill the uterus by days 80-85 and its microcotyledonary architecture, which provides both haemotrophic and histotrophic nutrition for the growing fetus, is not fully established until days 120-140. The fetoplacental unit synthesizes large quantities of steroid hormones during the second half of pregnancy, using fetal C-19 precursors secreted by the enlarged fetal gonads for the production of oestrogens and maternal C-21 precursors for the synthesis of progesterone and large quantities of 5alpha-reduced progestagens. Near term, additional pregnenelone is secreted by the fetal adrenal glands so that the mare exhibits the unusual phenomenon of foaling while maternal serum progestagen concentrations are increasing and oestrogen concentrations are decreasing.

scholarly journals Ketogenic Diet-Induced Severe Ketoacidosis in a Lactating Woman: A Case Report and Review of the Literature

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Benedicta Nneoma Nnodum ◽  
Eziafa Oduah ◽  
David Albert ◽  
Mark Pettus
Keyword(s):  
Ketogenic Diet ◽  
Case Reports ◽  
High Fat ◽  
Carbohydrate Diet ◽  
Low Carbohydrate Diet ◽  
Lactating Mothers ◽  
Low Carbohydrate ◽  
Life Threatening ◽  
Clinically Significant ◽  
Prompt Diagnosis

The ketogenic diet (KD) is a high-fat, adequate-protein, and low-carbohydrate diet that leads to nutritional ketosis and weight loss. It is known to induce ketosis but is not an established cause of clinically significant ketoacidosis. Lactation ketoacidosis is well established in bovine literature but remains a rare phenomenon in humans. Here we present a life-threatening case of severe ketoacidosis in a nondiabetic lactating mother on a strict ketogenic diet. We review the available case reports of lactation ketoacidosis in humans and the mechanisms thereof. Although ketogenic diet has been shown to be safe in nonpregnant individuals, the safety of this diet in lactating mothers is not known. Health professionals and mothers should be made aware of the potential risk associated with a strict ketogenic diet when combined with lactation. Prompt diagnosis and immediate treatment cannot be overemphasized. To our knowledge, this is the first reported case of life-threatening lactation ketoacidosis associated with ketogenic diet while consuming an adequate number of calories per day.

Randomized Comparison of ABVD and MOPP/ABV Hybrid for the Treatment of Advanced Hodgkin’s Disease: Report of an Intergroup Trial

2003 ◽  
Vol 21 (4) ◽  
pp. 607-614 ◽  
Author(s):  
David B. Duggan ◽  
Gina R. Petroni ◽  
Jeffrey L. Johnson ◽  
John H. Glick ◽  
Richard I. Fisher ◽  
...  
Keyword(s):  
Overall Survival ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Hematologic Toxicity ◽  
Standard Regimen ◽  
Life Threatening ◽  
P 16 ◽  
Clinically Significant ◽  
Advanced Hodgkin’S Disease

Purpose: In a series of trials, doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) and mechlorethamine, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, and vinblastine (MOPP/ABV) have been identified as effective treatments for Hodgkin’s disease. We compared these regimens as initial chemotherapy for Hodgkin’s disease. Patients and Methods: Adult patients (N = 856) with advanced Hodgkin’s disease were randomly assigned to treatment with ABVD or MOPP/ABV. The major end points were failure-free and overall survival, life-threatening acute toxicities, and serious long-term toxicities, including cardiomyopathy, pulmonary toxicity, myelodysplastic syndromes (MDS), and secondary malignancies. Results: The rates of complete remission (76% v 80%, P = .16), failure-free survival at 5 years (63% v 66%, P = .42), and overall survival at 5 years (82% v 81%, P = .82) were similar for ABVD and MOPP/ABV, respectively. Clinically significant acute pulmonary and hematologic toxicity were more common with MOPP/ABV (P = .060 and .001, respectively). There was no difference in cardiac toxicity. There were 24 deaths attributed to initial treatment: nine with ABVD and 15 with MOPP/ABV (P = .057). There have been 18 second malignancies associated with ABVD and 28 associated with MOPP/ABV (P = .13). Thirteen patients have developed MDS or acute leukemia: 11 were initially treated with MOPP/ABV, and two were initially treated with ABVD but subsequently received MOPP-containing regimens and radiotherapy before developing leukemia (P = .011). Conclusion: ABVD and the MOPP/ABV hybrid are effective therapies for Hodgkin’s disease. MOPP/ABV is associated with a greater incidence of acute toxicity, MDS, and leukemia. ABVD should be considered the standard regimen for treatment of advanced Hodgkin’s disease.

scholarly journals Significant Bradycardia in Critically Ill Patients Receiving Dexmedetomidine and Fentanyl

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Channing Hui ◽  
Maria Cardinale ◽  
Balaji Yegneswaran
Keyword(s):  
Risk Factors ◽  
Heart Rate ◽  
Critically Ill Patients ◽  
Infusion Rate ◽  
Case Series ◽  
Life Threatening ◽  
Sedation And Analgesia ◽  
Clinically Significant ◽  
Dexmedetomidine Infusion ◽  
Community Teaching

Purpose. To report a case series of three patients who developed significant bradycardia while receiving the combination of dexmedetomidine and fentanyl for sedation and analgesia. Materials and Methods. This is a case series of patients obtained from a mixed medical, surgical, and cardiac ICU in a community teaching hospital. Three intubated patients receiving fentanyl and dexmedetomidine infusion developed sudden bradycardia requiring intervention. In all three cases, adjustments to therapy were required. Results. All three patients experienced significant bradycardia, with a heart rate less than 50 bpm, and one patient briefly developed asystole. In Case  1, the fentanyl infusion rate was reduced by 67% and the dexmedetomidine infusion rate was reduced by 25%. In Case  2, the sedation was changed to midazolam, and in Case  3, both fentanyl and dexmedetomidine were discontinued. In all three cases, there were no further incidences of significant bradycardia following intervention. Conclusions. Fentanyl used in combination with dexmedetomidine can result in clinically significant bradycardia. Further study is warranted to identify risk factors and elucidate the mechanisms that result in life-threatening bradycardia.

Safety evaluation of percutaneous ultrasound-guided thrombin injection into pseudoaneurysms

2019 ◽  
Vol 91 (2) ◽  
pp. 20-24 ◽  
Author(s):  
Marta Pająk ◽  
Robert Hasiura ◽  
Tomasz Stępień
Keyword(s):  
Blood Supply ◽  
Safety Evaluation ◽  
Channel Length ◽  
Thrombin Injection ◽  
Ultrasound Guided ◽  
Aneurysm Neck ◽  
Mean Width ◽  
Life Threatening ◽  
Clinically Significant ◽  
Common Application

Summary Introduction: common application of endovascular procedures is frequently connected with increasing risk of pseudoaneurysm at the site of the artery puncture. The most frequent method of treatment of aneurysms is percutaneus ultrasound-guided thrombin injection. The aim of this research was safety evaluation of treatment of pseudoaneurysm by thrombin injection based on own experience . Methods and materials: 70 people (53% women, 43% men, average age 67.9 ±10.5) with pseudoaneurysm and under ultrasound-guided thrombin injection treatment carried out between 2007 and 2018 in the Department of General and Vascular Surgery of Pirogow Hospital in Lodz were analysed. Patients were qualified to treatment based on aneurysm and channel morphology in ultrasound examination. Before application of medicine blood supply to the limb was clinically assessed and examined using sonography. The tip of the needle was imaged into the lumen of the aneurysm. Results: in the research group, average aneurysm diameter was 29.9mm (± 17.2) within a range from 10mm to 96mm. Multi-chamber aneurysm was detected in 21% of patients. Mean channel length was 12mm (±7.7), mean width 3.5mm (±1.4), mean thrombin injected 1.7ml (±0.7) within range from 0.5 to 4ml. The treatment was successful in 94% of cases. Complications after thrombin injection occurred in 7% of cases (1 patient suffered from shock, 1 from thrombus in the saphenous vein, 3 from thrombus moving from aneurysm neck to femoral artery). No deterioration of blood supply in a limb was detected after obliteration of aneurysm. No relevant differences in aneurysm and channel dimensions were detected between groups with and without complications (p > 0.05). Conclusions: obliteration of the pseudoaneurysm by percutaneous ultrasound-guided thrombin injection is a highly effective method. This method is considered as safe, however, it requires experience. Its application may cause complications of which some are clinically significant and may lead to health and life threatening situations. In some specific cases surgical treatment of choice should be considered.

Leptomeningeal disease after surgical resection and radiosurgery for brain metastases and neurologic death: A multi-institutional analysis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2524-2524
Author(s):  
Roshan Sudhir Prabhu ◽  
Brandon E Turner ◽  
Anthony L Asher ◽  
Samuel Marcrom ◽  
John B. Fiveash ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Tertiary Care ◽  
Whole Brain Radiotherapy ◽  
Leptomeningeal Disease ◽  
Study Cohort ◽  
Brain Radiotherapy ◽  
Life Threatening ◽  
Clinically Significant ◽  
Systemic Symptoms ◽  
Tertiary Care Centers

2524 Background: Postoperative radiosurgery (SRS) has been associated with up to 30% risk of subsequent leptomeningeal disease (LMD). We previously demonstrated that radiographic pattern of LMD (classical “sugarcoating” [cLMD] vs. nodular [nLMD]) in this setting is prognostic. The association between radiographic pattern of LMD, type of salvage treatment (tx), and neurologic death (ND) has not been well described. Methods: The records of patients (pts) with brain metastases (BM), of which 1 was resected and treated with adjunctive SRS, and who subsequently developed LMD were combined from 7 tertiary care centers. Pts with classically radiosensitive tumors or prior or planned whole brain radiotherapy (WBRT) were excluded. ND was defined as symptomatic CNS progression around the time of death without life threatening systemic symptoms or progression. Salvage radiotherapy (RT) for LMD was categorized according to use of WBRT vs. focal cranial RT. Results: The study cohort consisted of 147 pts, of which 125 had died with known cause, 107 also received LMD salvage tx, and 82 also had cranial MRI follow-up. The ND rate in the 125 pts who died with known cause was 79%; the rate in pts who underwent LMD salvage tx (n = 107) was 76%. Univariate logistic regression demonstrated radiographic pattern of LMD (cLMD vs. nLMD, odds ratio [OR] 2.9, p = 0.04) and 2nd LMD failure after salvage tx (OR 3.9, p = 0.02) as significantly associated with ND. The ND rate was 86% for cLMD vs. 68% for nLMD pattern. WBRT was used in 95% of pts with cLMD vs. 52% of pts with nLMD. In the nLMD cohort (n = 58), there was no difference in ND rate based on type of salvage RT (WBRT: 67% vs. focal cranial RT: 68%, p = 0.92). Second LMD failure (vs. not) was associated with higher ND in the nLMD cohort (77% vs. 52%, p = 0.02). Of the 26 pts with nLMD who experienced 2nd LMD failure, 7 had classical 2nd LMD, of which 100% experienced ND, and 19 had nodular 2nd LMD, of which 68% experienced ND (p = 0.09). Conclusions: LMD after surgery and SRS for brain metastases is a clinically significant event with high rates of neurologic death. Classical LMD pattern (vs. nodular) and 2nd LMD failure after salvage tx were significantly associated with higher risk of neurologic death. In the nodular LMD cohort, radiographic pattern of 2nd LMD may be associated with risk of subsequent neurologic death. Pts with nodular LMD treated with salvage focal cranial RT or WBRT had similar risk of neurologic death. Methods to decrease LMD and the subsequent high risk of neurologic death in this setting warrant investigation.

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