scholarly journals SUN-910 High Enhancement Washout by CT Imaging Does Not Exclude Pheochromocytoma/Paraganglioma: Review of Two Cases

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Feyza Erenler ◽  
Ronald M Lechan
Keyword(s):  
Adrenal Gland ◽  
Laparoscopic Adrenalectomy ◽  
Ct Imaging ◽  
Cardiac Resynchronization ◽  
Vanillylmandelic Acid ◽  
Mibg Imaging ◽  
Left Adrenal Gland ◽  
Urinary Catecholamines ◽  
The Right ◽  
Adrenal Nodule

Abstract Background: It is well known that delayed images from contrast-enhanced CT are useful in distinguishing adrenal adenomas from non-adenomas, with an absolute washout that exceeds 60% being most consistent with a lipid rich adenoma. We present two cases of an adrenal mass that met the criteria for a lipid rich adenoma by CT imaging, but found to be a pheochromocytoma (PCC) and paraganglioma (PGL). Clinical Case Case#1 An 82 yo woman presenting with tachycardia was found to have a 2.4 cm heterogeneously attenuating, left adrenal nodule with an absolute washout of 61% and a relative washout of 45%. The right adrenal was normal. Urinary catecholamine levels were elevated with an epinephrine (E) 38 mcg (2–24), norepinephrine (NE) 388 mcg (15–100), dopamine (DOPA) 175 mcg (52–480), metanephrine (MN) mcg 620 (90–315), normetanephrine (NMN) 1553 mcg (122–676) and vanillylmandelic acid 12.5 mg (< 6) on a 24h collection. Due to a cardiac resynchronization therapy device, an MRI could not be obtained. MIBG imaging was obtained and showed increased uptake in left adrenal gland, corresponding to the lesion identified on CT. The patient underwent laparoscopic adrenalectomy and the pathology confirmed a PCC. Case#2: A 74 yo man was found to have an incidental right adrenal nodule on CT imaging measuring 2.4 cm. Absolute washout was 83% and relative washout 68%. The left adrenal gland was normal. A follow up MRI obtained showed slight increase in T2 weighted images and no drop out on out of phase imaging, raising concern for a PCC. Urinary catecholamines were elevated including E 12 mcg (2–24), NE 280 mcg (15–100), DOPA 246 mcg (52–480), MN 175 mcg (90–315) and NMN 1298 mcg (122–676) on a 24-hr. collection. MIBG imaging further confirmed the diagnosis with increased uptake in the right adrenal gland. The patient underwent laparoscopic adrenalectomy then, converted to open right adrenalectomy through an anterior approach due to adherence of the tumor to the renal vein. The pathology revealed a PGL. Conclusion: PCC/PGL are rare but life-threatening neuroendocrine tumors that require early detection to reduce associated morbidities and mortality and improve surgical outcomes. CT is commonly used to characterize adrenal lesions and an absolute washout of >60% is most consistent with an adenoma. However, as demonstrated by these two cases, washout exceeding 60% can also be seen in non-adenomas, perhaps secondary to degeneration of the nodule causing necrotic or cystic changes or uncommonly, the presence of a high lipid content in the tumor [1]. Thus, when clinical suspicion is strong and/or there is a positive biochemical workup, confirmatory imaging should be considered to establish the diagnosis. References: [1] Blake, M. A., Kalra, M. K., Maher, M. M., Sahani, D. V., Sweeney, A. T., Mueller, P. R., ... & Boland, G. W. (2004). Pheochromocytoma: an imaging chameleon. Radiographics, 24(suppl_1), S87-S99.

Effective Therapy of Insulinoma by Using Long-Acting Somatostatin Analogue. A Case Report and Literature Review

2011 ◽  
Vol 120 (02) ◽  
pp. 68-72 ◽  
Author(s):  
A. Jawiarczyk ◽  
M. Bolanowski ◽  
J. Syrycka ◽  
G. Bednarek-Tupikowska ◽  
M. Kałużny ◽  
...  
Keyword(s):  
Adrenal Gland ◽  
Somatostatin Receptors ◽  
Subcutaneous Administration ◽  
Pancreatic Neuroendocrine Tumor ◽  
Somatostatin Analogue ◽  
Left Adrenal Gland ◽  
Glucose Levels ◽  
Long Acting ◽  
The Right

AbstractWe are reporting a case of 68-year-old woman with insulinoma, after a non-successful tumor surgery and a long-term diazoxide treatment. She had a lot of hypoglycemia cases, and a weight gain of 50 kg. An abdominal CT scan demonstrated a tumor 28 mm in the diameter, in the head of the pancreas. The patient did not agree for the repeated insulinoma surgery. Furthermore, we found a lesion in the left adrenal gland (14 mm in the diameter) and in the right lung (8 mm in the diameter). Pheochromocytoma was diagnosed on the basis of hypertension, elevated levels of normetanephrine in the 24-h urine collection, and an elevated level of norepinephrine in a plasma sample. After the left adrenal gland removal we observed lower blood pressure. Since we had revealed the presence of somatostatin receptors by the somatostatin receptors scintigraphy, we decided to control hypoglycemia by a monthly subcutaneous administration of the long-acting lanreotide. Because of higher glucose levels (300–400 mg/dl) we started an intense insulin therapy. Nowadays, the patient feels better, she has lost 20 kg of her body weight, and we have observed normal blood glucose levels during the long-term lanreotide treatment. We have noticed neither side effects nor hypoglycemic episodes and we have reduced the dose of insulin. The presented case can be an evidence of the effective treatment of the pancreatic neuroendocrine tumor of insulinoma type, with somatostatin analogue.

BECKWITH'S SYNDROME WITH EXTREME ORGAN HYPERPLASIA

PEDIATRICS ◽  
1973 ◽  
Vol 52 (3) ◽  
pp. 372-381
Author(s):  
Thomas F. Roe ◽  
Ann K. Kershnar ◽  
Jordan J. Weitzman ◽  
Luis Salinas Madrigal
Keyword(s):  
Adrenal Gland ◽  
Abdominal Mass ◽  
Severe Hypoglycemia ◽  
Immunoreactive Insulin ◽  
Left Adrenal Gland ◽  
Adrenal Steroid ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Pedunculated Tumor ◽  
The Right

A large newborn infant with hemihypertrophy, omphalocele, hepatomegaly, left upper quadrant abdominal mass, and zoster-like skin rash had severe hypoglycemia at 4 hours of age. Serum immunoreactive insulin levels were markedly elevated. Hypoglycemia was not controlled by vigorous medical therapy but blood glucose levels returned toward normal following subtotal excision of the markedly hyperplastic pancreas at 24 days of age. At 4½ months of age, a right upper quadrant abdominal mass was noted and urinary adrenal steroid levels were elevated. The right adrenal gland was found to be markedly hyperplastic and it was removed; the left adrenal gland was slightly hyperplastic. Between the ages of 5 and 8 months the umbilical stump enlarged progressively forming a large pedunculated tumor which was removed. This patient presents an unusually severe example of Beckwith's syndrome with both prenatal and postnatal organ overgrowth, severe hypoglycemia and hyperinsulinism.

Laparoscopic Adrenalectomy for a 6-cm Pheochromocytoma of the Left Adrenal Gland

2008 ◽  
Vol 22 (9) ◽  
pp. 1947-1948 ◽  
Author(s):  
Nobuo Tsuru ◽  
Hiroyuki Ihara ◽  
Kazuo Suzuki
Keyword(s):  
Adrenal Gland ◽  
Laparoscopic Adrenalectomy ◽  
Left Adrenal Gland

scholarly journals Resistant hypertension with adrenal nodule: are we removing the right gland?

2015 ◽  
Vol 2015 ◽  
Author(s):  
Gautam Das ◽  
Peter N Taylor ◽  
Arshiya Tabasum ◽  
L N Rao Bondugulapati ◽  
Danny Parker ◽  
...  
Keyword(s):  
Adrenal Gland ◽  
Resistant Hypertension ◽  
Elevated Serum ◽  
Adrenal Incidentaloma ◽  
Adrenal Vein ◽  
List Type ◽  
Antihypertensive Medications ◽  
Adrenal Vein Sampling ◽  
The Right ◽  
Adrenal Nodule

Summary Resistant hypertension is often difficult to treat and may be associated with underlying primary aldosteronism (PA). We describe the case of an elderly gentleman who presented with severe and resistant hypertension and was found to have a left adrenal incidentaloma during evaluation but had aldosterone excess secondary to unilateral adrenal hyperplasia (UAH) of the contralateral gland, which needed surgical intervention. A 65-year-old gentleman was evaluated for uncontrolled high blood pressure (BP) in spite of taking four antihypertensive medications. The high BP was confirmed on a 24-h ambulatory reading, and further biochemical evaluation showed an elevated serum aldosterone renin ratio (ARR) (1577 pmol/l per ng per ml per h). Radiological evaluation showed an adrenal nodule (15 mm) in the left adrenal gland but an adrenal vein sampling demonstrated a lateralization towards the opposite site favouring the right adrenal to be the source of excess aldosterone. A laparoscopic right adrenalectomy was performed and the histology of the gland confirmed nodular hyperplasia. Following surgery, the patient's BP improved remarkably although he remained on antihypertensives and under regular endocrine follow-up. PA remains the most common form of secondary and difficult-to-treat hypertension. Investigations may reveal incidental adrenal lesions, which may not be the actual source of excess aldosterone, but UAH may be a contributor and may coexist and amenable to surgical treatment. An adrenal vein sampling should be undertaken for correct lateralization of the source, otherwise a correctable diagnosis may be missed and the incorrect adrenal gland may be removed. Learning points Severe and resistant hypertension can often be associated with underlying PA. ARR is an excellent screening tool in patients with suspected PA. Lateralization with adrenal venous sampling is essential to isolate the source and differentiate between unilateral and bilateral causes of hyperaldosteronism. Adrenal incidentalomas and UAH may coexist and the latter may often be the sole cause of excess aldosterone secretion. Decisions about adrenalectomy should be made only after integrating and interpreting radiological and biochemical test findings properly.

Adrenal Pheochromocytoma With Contralateral Adrenocortical Adenoma in a Cat

2010 ◽  
Vol 46 (1) ◽  
pp. 36-42 ◽  
Author(s):  
Jon David R. Calsyn ◽  
Rebecca A. Green ◽  
Garrett J. Davis ◽  
Christopher M. Reilly
Keyword(s):  
Adrenal Gland ◽  
Low Dose ◽  
Clinical Signs ◽  
Adrenocortical Adenoma ◽  
Left Adrenal Gland ◽  
Adrenal Pheochromocytoma ◽  
History Of ◽  
Suppression Test ◽  
The Right ◽  
Dexamethasone Suppression

A 7-year-old, neutered male cat was presented with a 6-month history of progressive polyuria, polydipsia, polyphagia, aggression, and weight gain. Previous blood work, urinalysis, and radiographs did not delineate a cause for the clinical signs. An ultrasound revealed bilateral adrenal gland enlargement. A low-dose dexamethasone suppression test was consistent with hyperadrenocorticism. Based on these findings, bilateral adrenalectomy was attempted and successfully performed. Histopathology was consistent with a cortical adenoma in the right adrenal gland and a pheochromocytoma in the left adrenal gland. This association has never been reported in the cat.

scholarly journals The diagnosis and treatment of primary adrenal lipomatous tumors in Chinese patients: a 31-year follow-up study

2014 ◽  
Vol 8 (3-4) ◽  
pp. 132 ◽  
Author(s):  
Fukang Sun ◽  
Juping Zhao ◽  
Xiaolong Jing ◽  
Wenlong Zhou ◽  
Xin Huang ◽  
...  
Keyword(s):  
Adrenal Gland ◽  
Diagnosis And Treatment ◽  
Chinese Patients ◽  
Preoperative Imaging ◽  
Left Adrenal Gland ◽  
Single Centre ◽  
Follow Up Study ◽  
The Right ◽  
Lipomatous Tumors

Introduction: Adrenal lipomatous tumours (ALTs) are rarely encountered in clinical practice and consequently little is known about their clinical features.Methods: We analyze the clinical features, diagnosis and treatment of ALTs based on cases presenting at a single centre over a 31-year period. We reviewed clinical data from patients with primary adrenal tumours treated at the Ruijin Hospital, Shanghai between January 1980 and December 2010.Results: A total of 73 cases of primary ALTs in 22 men and 51 women (mean age 51.1±14.2 years) were reviewed. The ALTs included 65 myelolipomas (89.0%), 3 lipomas (4.1%), 2 angiomyolipomas (2.7%), 2 teratomas (2.7%), and 1 liposarcoma (1.4%). Of the total 73 patients, 24 of them had tumours in the left adrenal gland, 47 in the right gland and 2 had bilateral tumours. In total, 51 patients underwent open surgery and 22 laparoscopic surgery.Conclusion: Myelolipoma is predominant among the various types of lipomatous adrenal gland tumours; it accounts for about 90% of all cases. Surgery is recommended for tumours ≥3.5 cm in diameter, for all cases of symptomatic tumour, and for cases of teratoma or liposarcoma identified by preoperative imaging.

scholarly journals Ultrasonography of Normal Adrenal Glands in Adult Holstein–Friesian Cows: A Pilot Study

Animals ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. 1171
Author(s):  
J. Daniel Barreiro-Vázquez ◽  
Andrés Barreiro-Lois ◽  
Marta Miranda
Keyword(s):  
Adrenal Gland ◽  
Adrenal Glands ◽  
Transabdominal Ultrasound ◽  
Left Adrenal Gland ◽  
Sagittal Section ◽  
Holstein Friesian ◽  
The Right ◽  
Ultrasonographic Appearance ◽  
Apparent Influence ◽  
Friesian Cows

Ultrasonographic reference values for the adrenal glands of cattle have not been reported to date. Adrenal glands can be affected by different pathologies, such as hyperplasia, neoplasia and atrophy (either primary or secondary). The present findings indicate that the right adrenal gland can be easily characterized by transabdominal ultrasound in adult Holstein–Friesian cows, with no apparent influence of age or weight. The right adrenal gland (mean length 3.86 ± 1.39 cm; and mean thickness 1.39 ± 0.26 cm) was consistently and mainly located in the 12th intercostal space. The left adrenal gland was more difficult to locate due to its more medial position, and to the presence of gas in the gastrointestinal tract, so it could not be visualized in most animals (18/25). Its mean length was 3.72 ± 0.95 cm, and mean thickness was 1.36 ± 0.33 cm, in the sagittal section. This is the first report of the ultrasonographic appearance of the adrenal glands of cows and of the corresponding reference preliminary values.

scholarly journals SAT-196 The Use of 11C-metomidate PET-CT to Detect Unilateral Primary Hyperaldosteronism

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Sumitro Harjanto ◽  
Aye Chan Maung ◽  
Troy Puar ◽  
Daphne Gardner
Keyword(s):  
Blood Pressure ◽  
Adrenal Gland ◽  
Primary Hyperaldosteronism ◽  
Left Adrenal Gland ◽  
Active Renin ◽  
Potassium Supplementation ◽  
Serum Aldosterone ◽  
Pet Ct ◽  
History Of ◽  
The Right

Abstract Background Identifying causative adrenal lesions presents a significant diagnostic burden for physicians and radiologists. We describe the use of radiolabelled metomidate to lateralise primary hyperaldosteronism. Case presentation A 52-year old Chinese man with a 5-year history of hypertension was referred for hypokalemia [K 2.7 mmol/L (3.6 - 5.0)]. He had been on Telmisartan 80 mg and Amlodipine 10 mg daily and blood pressure at home ranged 110-120 / 70-80 mmHg. There was no history of poor oral intake, persistent diarrhea or vomiting, and he was not on any other prescription or alternative medications. There was no significant family history of hypertension or sudden cardiac death. Clinic blood pressure was 140/84 mmHg. There were no features suggestive of Cushing’s syndrome. Repeat biochemical tests confirmed hypokalemia (K 3.1 mmol/L), and associated raised bicarbonate 37.3 mmol/L [19 - 29]. Magnesium and creatinine were normal. Aldosterone-renin Ratio was elevated at 8.1 (serum Aldosterone 611 pmol/L [97.3 - 834.0], active renin 2.7 pg/ml [1.8 – 59.4]). Post-saline infusion, non-suppressible serum aldosterone levels of 1137 pmol/L was demonstrated, consistent with autonomous aldosterone production. A computed tomography of the adrenal revealed a 2.3 cm x 1.9 cm nodule on the left adrenal gland consistent with lipid rich adenoma. Adrenal vein sampling (AVS) under continuous synacthen infusion was performed. Adrenal to peripheral cortisol ratio was ≥10 for either adrenal veins, confirming cannulation of the adrenal veins. Aldosterone-cortisol ratios showed lateralization to the left adrenal gland (lateralization ratio of 10.35). There was contralateral suppression of the right adrenal gland with ratio of 0.41. 11C-Metomidate PET-CT scan demonstrated a maximum standardised uptake value (SUVmax) of 26.8 over the left adrenal nodule, while the SUVmax of the right adrenal gland was 16.2. Ratio of the left to right adrenal gland SUVmax was 1.65 (above the threshold of 1.25); and was concordant with AVS. This confirmed that the patient had a left functional adrenal adenoma responsible for hyperaldosteronism. Our patient underwent a left adrenalectomy, and histology was consistent with adrenal cortical adenoma. Prior to surgery he required 72 mmol/l of potassium supplementation daily to maintain K levels of 3.3 – 4.0 mmol/L. Two weeks post-operatively, he was normokalemic (K 4.9 mmol/L) without potassium supplementation. Serum aldosterone normalized to 159.3 pmol/L (active renin 9.3 pg/ml). Blood pressure is well controlled on amlodipine 5mg daily. Conclusion Targeted molecular imaging such as 11C-Metomidate PET-CT could aid localisation of functional adrenal disease to guide definitive surgical management. In the future, this could obviate the need for invasive and technically complex procedures like AVS.

scholarly journals Right Laparoscopic Adrenalectomy in a Bitch

2016 ◽  
Vol 44 (1) ◽  
pp. 4
Author(s):  
Fernando Wiecheteck De Souza ◽  
Cristiano Gomes ◽  
Priscila Natasha Kasper ◽  
Marília Teresa De Oliveira ◽  
João Pedro ScusselFeranti ◽  
...  
Keyword(s):  
Adrenal Gland ◽  
Laparoscopic Adrenalectomy ◽  
Clinical Signs ◽  
Laparoscopic Approach ◽  
Medical Procedure ◽  
Adrenal Neoplasm ◽  
Adrenal Enlargement ◽  
Surgical Access ◽  
Total Adrenalectomy ◽  
The Right

Background: The medical procedure of Laparoscopic adrenalectomy is common in human medicine; however, this is not true in veterinary medicine, where it isperformed rarely. The current treatment of choice for adrenal neoplasms is total adrenalectomy, unless there is a pre-operativediagnosis of metastasis that precludes surgery. The laparoscopic approach option becomes an interesting alternative because, through this technique,it has shown good results. In this report, we demonstrate the experience of a case in which we performed unilateral laparoscopic right adrenalectomy, without caudalvena cava invasion, in a dogsuffering from hyperadrenocorticism caused by adrenocortical carcinoma.Case: A 9-year-old beagle bitch, 12 kg in weight, showedpolyphagia, polydipsia, polyuria, pendular abdomen, thin and dark skin, lumbar alopecic areas and lethargy. The team carried out Complete Blood Count (CBC), blood chemistry (liver and renal functions) and urine sampling by cystocentesis for urinalysis and bacterial culture. All exams had normal results, except for ALP, which reached levels higher than 150 UIL-1. On abdominal radiographic examination, we noted mild adrenal enlargement, and by ultrasonography, it was possible to identify adrenal asymmetry and right adrenal enlargement (2.8x2x2.15 cm) in relation to the left gland (2x1x1.5 cm). As a treatment for adrenal neoplasm-dependent HAC,we recommended the execution of total right adrenalectomy execution. The videosurgery used four accesses arranged in the right hypogastric region; the diameters were 10 (two), 5, and 3mm. The adrenal gland was carefully dissected with the aid of laparoscopic forceps; during the intraoperative period, there was a small laceration of the abdominal phrenic vein that resulted in bleeding, which was overcome with two titanium clips. The dog had an excellent recovery, and the teamdischarged it 48 h after the procedure. The signs of hyperadrenocorticism disappeared about two weeks after surgery. One year after having the procedure, the animal remainswell and has no signs of tumor recurrence or Cushing’s syndrome.Discussion: The choice laparoscopic approach provided less invasiveness in surgical access, reduced animal convalescence, and provided image magnifcation for the more accurate dissection of the adrenal gland. Some reports that middle-aged to older bitches were the most predisposed to present adrenal neoplasm-dependent HAC, and generally, in unilateral form, characteristics which are presented in this report. Among the clinical signs and observed in this report, are polydipsia, polyphagia, tachypnea, alopecia, and skin hyperpigmentation. That recommended the low-dose dexamethasone suppression test to diagnose Cushing’s syndrome and the endogenous ACTH test to distinguish hypophysary from adrenocorticotrophic HAC. The same tests were performed in the case reported here, as these are also important to establish the fnal diagnosisand refer the total adrenalectomy realization. In the current case report, access to the right hypogastric region using four videosurgery portals provided good surgical access. Towards the hospital convalescence time, the animal was discharged early, just 48 h post-operatively; remission of HAC clinical signs occurredwithin three weeks, and the survival alreadyreached 12 months.To the best of the authors’ knowledge, this is the frst successful case of total right adrenalectomy without caudal vena cava invasion via the laparoscopic route as treatment for adrenocortical carcinoma in the national literature.Keywords: adrenal gland, neoplasm, videosurgery, dogs.

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