scholarly journals Adrenal incidentaloma – diagnostic and treating problem – own experience

Open Medicine ◽  
2018 ◽  
Vol 13 (1) ◽  
pp. 281-284 ◽  
Author(s):  
Ryszard Pogorzelski ◽  
Krzysztof Celejewski ◽  
Sadegh Toutounchi ◽  
Ewa Krajewska ◽  
Tomasz Wołoszko ◽  
...  
Keyword(s):  
Adrenal Tumor ◽  
Ultrasound Examination ◽  
Adrenal Incidentaloma ◽  
Adrenal Tumors ◽  
Hormonal Activity ◽  
Imaging Studies ◽  
Costs Of Treatment ◽  
Long Term Observation

AbstractIntroductionIncidentaloma is defined as an tumor diagnosed accidentally using imaging studies performed due to other indications. The aim of this paper was to describe the diagnostic and treatment problems experienced by patients with adrenal incidentaloma in a clinical practice.Material and methodsIn years 2009-2012 there were 33(16,5%) adrenal tumors diagnosed incidentally out of 200 cases treated due to adrenal pathology. The group consisted of 54 patients aged 27-77. In 15(45,5%) patients the diagnosis was made based on ultrasound examination, while in 18(54,5%) the tumor was visualized in CT/MRI.ResultsOnly after the diagnostics was finalized, in which in all cases no signs of hormonal activity were detected, 26(78,8%) patients were qualified for the surgery. In 7(21,2%) cases no indications for such a management were found. The latter group was followed-up and in all patients the indications for the surgery arose due to enlargement of the tumor or/and the existence of hormonal activity. Our observations suggest that the incident finding of adrenal tumor is an indication of long-term observation. The analysis of our material shows that all patients observed needed surgical treatment.ConclusionsThe small adrenal tumors under follow-up have a tendency to enlarge and acquire hormonal activity. Long-term observation significantly increases the costs of treatment in that group, which eventually results in surgical management.

scholarly journals Problems in the diagnosis of the adrenals with incidental

2003 ◽  
Vol 49 (1) ◽  
pp. 27-32
Author(s):  
N. S. Kuznetsov ◽  
L. V. Belchenko ◽  
P. V. Yushkov ◽  
A. V. Manovitskaya ◽  
К. V. Opalenov ◽  
...  
Keyword(s):  
Adrenal Tumor ◽  
Adrenal Incidentaloma ◽  
Primary Diagnosis ◽  
Morphological Data ◽  
Adrenal Tumors ◽  
Hormonal Activity ◽  
Resonance Imaging ◽  
Medical Sciences ◽  
Surgical Department ◽  
The Past

The paper analyzes the case records of 123 patients with a primary diagnosis ofadrenal incidentaloma who were treated at the Endocrinology Research Center, Russian Academy of Medical Sciences, in the past 5 years. Ofthem, 87patients were operated on at the surgical department of the Center. Thirty  six patients with a clinically verified diagnosis ofhormonally inactive adrenal tumor without signs ofmalignant growth werefollowed up. All the patients underwent comprehensive clinical and instrumental studies (ultrasonography, magnetic resonance imaging, computed tomography, hormonalstudies). Theirresults were comparedwith the morphological data on distal adrenal changes. The hormonal activity ofadrenal tumors was morphologically determined by histochemical techniques. The study revealed true hormonally inactive tumors only in 12 cases. It is concluded that the concepts of adrenal incidentaloma and of true hormonally tumor are not equivalent and that it is necessary to make a comprehensive clinical and morphobiochemical analysis in adrenal tumors to establish a final nosological diagnosis.

Long-term effectiveness and safety of antiepileptic drugs in children and adults

2021 ◽  
Vol 19 (2) ◽  
pp. 221-228
Author(s):  
Roza M. Shaimardanova ◽  
Rimma G. Gamirova
Keyword(s):  
Valproic Acid ◽  
Antiepileptic Drugs ◽  
Focal Epilepsy ◽  
City Hospital ◽  
Long Term Follow Up ◽  
Short And Long Term ◽  
Long Term Observation ◽  
Patients With Epilepsy

AIM: To conduct a retrospective comparative analysis of the efficacy and safety of epilepsy therapy with antiepileptic drugs. MATERIALS AND METHODS: The analysis of the treatment of 428 patients with epilepsy at the Childrens City Hospital No. 8 in Kazan, receiving antiepileptic drugs. RESULTS: It was found that valproic acid is more effective in the treatment of idiopathic generalized epilepsies compared to focal epilepsies (p = 0.0006). Valproate and carbamazepine were the most effective in the treatment of focal epilepsy with short- and long-term follow-up. Valproic acid is more effective than topiramate (p = 0.02), oxcarbazepine (p = 0.003), and levetiracetam (p = 0.003) in the treatment of focal epilepsy in short- and long-term follow-up. Carbamazepine is more effective than topiramate (p = 0.01), oxcarbazepine (p = 0.02), and levetiracetam (p = 0.001) in the treatment of focal epilepsy in long-term follow-up. It was revealed that more often they complained about side effects when using carbamazepine (63.2%). Levetiracetam was found to be better tolerated compared to valproate (p = 0.0006) and carbamazepine (p = 0.0006). Topiramate is better tolerated than carbamazepine (p = 0.02) and valproate (p = 0.03). Oxcarbazepine is better tolerated than carbamazepine in women (p = 0.04). CONCLUSIONS: When choosing an antiepileptic drug, it is necessary to be guided by the principle: first the basic, and then the drugs of the next generations, in the future, rely on information about the tolerability of the drug. It is necessary to evaluate the therapeutic effect of antiepileptic drugs with long-term observation, and use the criterion of complete absence of seizures as an indicator of the effectiveness of drugs.

scholarly journals Clinical features, risk of mass enlargement, and development of endocrine hyperfunction in patients with adrenal incidentalomas: a long-term follow-up study

Endocrine ◽  
2020 ◽  
Author(s):  
Pierpaolo Falcetta ◽  
Francesca Orsolini ◽  
Elena Benelli ◽  
Patrizia Agretti ◽  
Paolo Vitti ◽  
...  
Keyword(s):  
Adrenal Incidentaloma ◽  
Plasma Renin ◽  
Serum Cortisol ◽  
Urinary Free Cortisol ◽  
Endocrine Function ◽  
Adrenal Tumors ◽  
Hormonal Function ◽  
Free Cortisol ◽  
Hormonal Evaluation

Abstract Purpose To evaluate the risk of mass enlargement and endocrine function modification in patients with adrenal incidentaloma (AI). Methods In this retrospective study, we examined clinical and hormonal characteristics of 310 patients with AI (200 females and 110 males; age: 58.3 ± 12.9 years), followed up for a median (interquartile range) of 31.4 months (13.0–78.6) and evaluated for possible modification in adrenal mass size and hormonal function. The hormonal evaluation included morning serum cortisol and plasma ACTH at 8 a.m., aldosterone, plasma renin activity/direct renin concentration, and 24-h urine metanephrines/normetanephrines. One microgram overnight dexamethasone suppression test (DST) was performed. Autonomous cortisol secretion (ACS) was diagnosed in the presence of cortisol after 1 mg DST > 5 μg/dl (138 nmol/l) or >1.8 and ≤5 μg/dl (50–138 nmol/l) and at least one of the following: (i) low ACTH; (ii) increased 24-h urinary-free cortisol; (iii) absence of cortisol rhythm; and (iv) post-LDDST cortisol level > 1.8 μg/dl (50 nmol/l). When there was no biochemical evidence of adrenal hormonal hyperactivity, AIs were classified as nonfunctioning (NFAIs). The mass was considered significantly enlarged when the size increase was more than 20% and at least 5 mm compared to baseline. Results At diagnosis, NFAIs were found in 209 patients, while ACS and overt adrenal hyperfunction were diagnosed in 81 and 20 patients, respectively. During follow-up, 3.3% and 1.5% of patients with NFAI developed subtle and overt endocrine hyperfunction, respectively, while a significant mass enlargement was observed in 17.7% of all AIs. The risk of developing ACS was significantly higher in patients with adenoma >28 mm (hazard ratio [HR] 12.4; 95% confidence interval [CI], 2.33–66.52, P = 0.003), in those with bilateral adrenal tumors (HR: 5.36; 95% CI, 1.17–24.48, P = 0.030), and with low/suppressed ACTH values (HR: 11.2, 95% CI 2.06–60.77; P = 0.005). The risk of mass enlargement was lower for patients in the fourth quartile of body mass index than those in the first quartile (HR 0.33; 95% CI, 0.14–0.78; P = 0.012). Conclusions In patients with AI, the risk of developing hormonal hyperfunction and mass enlargement is overall low, although some tumor characteristics and anthropometric features might increase this risk. Taking account of all these aspects is important for planning a tailored follow-up in AI patients.

scholarly journals Adrenal Incidentaloma: Challenges in Diagnosing Adrenal Myelolipoma

2019 ◽  
Vol 7 ◽  
pp. 232470961987031 ◽  
Author(s):  
Sreedhar Adapa ◽  
Srikanth Naramala ◽  
Vijay Gayam ◽  
Frank Gavini ◽  
Hemant Dhingra ◽  
...  
Keyword(s):  
Adrenal Tumor ◽  
Fluid Overload ◽  
Elevated Serum ◽  
Adrenal Incidentaloma ◽  
Uncontrolled Hypertension ◽  
Adrenal Tumors ◽  
Functional Aspect ◽  
Hematopoietic Tissue ◽  
Norepinephrine Level ◽  
Adrenal Myelolipoma

Adrenal myelolipomas (AMLs) are rare benign adrenal tumors, containing adipose and hematopoietic tissue, a result of reticuloendothelial cell metaplasia. Incidence on autopsy has been reported from 0.08% to 0.4%. AMLs are generally considered nonsecretory. The functional aspect of adrenal incidentaloma should be evaluated. In this article, we report a case of a 40-year-old male, who presented with uncontrolled hypertension and renal failure, with imaging revealing an adrenal incidentaloma. He was started on dialysis for acute fluid overload, and workup for pheochromocytoma revealed an elevated serum norepinephrine level of 1181 pg/mL. Free metanephrine and normetanephrine levels were low when checked pre- and post-dialysis. Complete resection of the encapsulated right adrenal mass was performed. Pathology of the adrenal tumor demonstrates an 11.5 × 9.5 × 7.5 cm well-circumscribed, partially encapsulated proliferation of mature adipose tissue with admixed hemopoietic elements consistent with myelolipoma weighing 29.3 g. This case highlights the inclusion of a full metabolic workup for all adrenal incidentalomas, including AML.

Long-Term Observation of Adolescents Initiating HAART Therapy: Three-Year Follow-Up

2007 ◽  
Vol 23 (10) ◽  
pp. 1208-1214 ◽  
Author(s):  
Patricia M. Flynn ◽  
Bret J. Rudy ◽  
Jane C. Lindsey ◽  
Steven D. Douglas ◽  
Janet Lathey ◽  
...  
Keyword(s):  
Long Term Observation ◽  
Haart Therapy

Pseudocyesis in peri- and postmenopausal women

Open Medicine ◽  
2010 ◽  
Vol 5 (3) ◽  
pp. 372-374 ◽  
Author(s):  
Habek Dubravko
Keyword(s):  
Postmenopausal Woman ◽  
Clinical Picture ◽  
Mental Stress ◽  
Ultrasound Examination ◽  
Team Approach ◽  
Abdominal Tumors ◽  
Biochemical Pregnancy ◽  
Β Hcg

AbstractPseudocyesis or delusion of pregnancy is a rare psychopathological syndrome described in humans and higher mammals. We describe and discuss two cases of this rare syndrome in a 46-year perimenopausal and a 59-year old postmenopausal woman. Gynecologic, ultrasound examination, and biochemistry testing (β-HCG) confirm the diagnosis of nonexistent clinical and biochemical pregnancy. These examinations have the potential to confirm abdominal tumors, while psychiatric examinations generally reveal the psychic basis of the disease; which should be treated through team approach by both the psychiatrist and gynecologist. Additionally, special reference should be given to long-term psychiatric follow-up and management of the current mental stress and emotional problems by a combination of antipsychotics and psychotherapy, depending on each individual clinical picture.

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