scholarly journals A case report on asymptomatic and biochemically silent pheochromocytoma in adrenal incidentaloma

2021 ◽  
Author(s):  
Ashiq Ahmed ◽  
S. Swetha Priyadharshini ◽  
R. Kannan
Keyword(s):  
Urine Analysis ◽  
Biochemical Study ◽  
Clinical Manifestations ◽  
Adrenal Incidentaloma ◽  
Beta Blockade ◽  
Surgical Removal ◽  
Mortality And Morbidity ◽  
Adrenal Hormones ◽  
Rare Tumours ◽  
Plasma Metanephrines

Pheochromocytoma are rare tumours originating from the chromaffin tissue. The clinical manifestations are variable and are not specific as pheochromocytoma and often imitate other diseases. The diagnosis is established by measurement of catecholamines and their metabolites in urine or plasma and by radiographic studies for localisation. Surgical removal of the tumour is the preferred treatment. 45 years old female presented with adrenal incidentaloma of about 6.1×6.2×5.4 cm well defined heterogenous lesion with internal cystic areas seen in right adrenal region abutting upper pole of right kidney. Biochemical investigations for adrenal hormones including plasma aldosterones, cortisols, plasma metanephrines, 24 hrs urinary metanephrines and VMA were found to be normal. Proceeded with adrenelectomy and histopathology of the specimen revealed pheochromocytoma as diagnosis. Pheochromocytoma leads to high mortality and morbidity rates if untreated. Fractionised metanephrines and catecholamines in a 24 hrs urine analysis is the preferred biochemical test. In a biochemically silent pheochromocytoma imaging modalities are used to identify and locate the tumour. Adequete alpha and beta blockade should be ensured before tumour removal. Surgery is recommenced irrespective of size and normal biochemical study to prevent complications.

scholarly journals Adrenal incidentaloma in neurofibromatosis type 1

2008 ◽  
Vol 136 (5-6) ◽  
pp. 295-298
Author(s):  
Milina Tancic-Gajic ◽  
Svetlana Vujovic ◽  
Svetislav Tatic ◽  
Milos Stojanovic ◽  
Miomira Ivovic ◽  
...  
Keyword(s):  
Neurofibromatosis Type 1 ◽  
Plexiform Neurofibroma ◽  
Fatal Outcome ◽  
Clinical Manifestations ◽  
Adrenal Incidentaloma ◽  
Neurofibromatosis Type ◽  
Clinical Criteria ◽  
Abdominal Magnetic Resonance Imaging ◽  
Rare Tumours

INTRODUCTION Neurofibromatosis type 1 is one of the most common genetically transmitted diseases with a high index of spontaneous mutations and extremely varied and unpredictable clinical manifestations. It is diagnosed by the existence of certain clinical criteria. The presence of numerous localised cutaneous neurofibromas or a plexiform neurofibroma is virtually pathognomonic of neurofibromatosis type 1. The incidence of pheochromocytoma in neurofibromatosis type 1 is 0.1-5.7%. CASE OUTLINE A 56-year old female patient was admitted for further evaluation of incidental adrenal tumour previously diagnosed on computerized tomography (CT). She had previously unrecognized neurofibromatosis type 1 and a clinical picture which could remind of pheochromocytoma. None of the catecholamine samples in 24 hr urine indicated functionally active pheochromocytoma. Chromogranin A was moderately increased. Decision for operation was made after performing the image techniques. Adrenal incidentaloma had features of pheochromocytoma on abdominal magnetic resonance imaging (MRI), with positive 131I-MIBG (iodine 131-labelled metaiodobenzylguanidine scintigraphy). After being treated with phenoxybenzamine and propranolol, she was operated on. The pathohistological finding showed the case of left adrenal pheochromocytoma. CONCLUSION Detailed diagnostic procedure for pheochromocytoma should be performed with patients having neurofibromatosis type 1 and adrenal incidentaloma. Pheochromocytomas are rare tumours with fatal outcome if not duly recognized and cured.

scholarly journals Asymptomatic Pheochromocytoma With Delayed Resection Due to Covid-19 and Persistent Postoperative Hypertension

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A117-A117
Author(s):  
Trisha Menon ◽  
Avani G Sinha
Keyword(s):  
Breast Cancer ◽  
Adrenal Mass ◽  
Asymptomatic Patient ◽  
Tracer Uptake ◽  
Uncontrolled Hypertension ◽  
Beta Blockade ◽  
Surgical Removal ◽  
Pathology Report ◽  
Postoperative Hypertension ◽  
Plasma Metanephrines

Abstract Background: Pheochromocytoma is promptly treated by surgical removal and usually results in resolution of hypertension. This case discusses an asymptomatic patient with two new malignancies-breast cancer and pheochromocytoma- who had positive outcomes despite delayed resection of pheochromocytoma due to COVID-19, but with a persistence of postoperative hypertension. Clinical Case: A 60 year old woman with newly diagnosed breast cancer presented for workup of an adrenal mass found on PET scan. An abdominal contrast CT-scan demonstrated a left 3.2 cm indeterminant adrenal mass. Initial laboratory testing demonstrated positive 24 hour urine metanephrines (metanephrine 951 mcg/24hr, n < 400 mcg/24hr for HTN and normetanephrine 1302 mcg/24hr, n < 900 mcg/24h for HTN) and plasma metanephrines (normetanephrine 826 pg/mL, n < 145 pg/mL and metanephrine 391 pg/mL, n < 62 pgmL), suggestive of pheochromocytoma. An MIBG scintigraphy showed tracer uptake in the left adrenal gland, suspicious for pheochromocytoma. The patient was started on alpha then beta blockade with plan for removal, but due to the COVID-19 pandemic, surgery was delayed. In the interim, breast cancer therapy was adjusted to avoid complications or symptoms from the possible pheochromocytoma. The patient had always been asymptomatic, even during the physical and emotional stress of cancer and chemotherapy. She only had a diagnosis of uncontrolled hypertension for four years prior to presentation, treated with Valsartan-Hydrochlorothiazide, with average systolic BP of 140–180, and diastolic BP of 80–100. With the addition of Doxazosin and Metoprolol, the patient’s BP improved, with all readings < 120/90. A left adrenalectomy was performed nearly six months after initial presentation, with final pathology report demonstrating moderately differentiated pheochromocytoma, with clean surgical margins. The patient remained hypertensive for months after the procedure, with initial systolic (SBP) readings of 150–160, and diastolic (DBP) readings of 90–100. However, follow up plasma metanephrine levels were normal (normetanephrine 165 pg/mL n < 191.8 pg/mL and metanephrine 22.1 pg/mL n < 88 pg/mL). The patient was then started on Amlodipine and Valsartan, with most recent SBP readings in the 130s. Conclusion: This case demonstrated a clinically asymptomatic patient with persistent postoperative hypertension and normal plasma metanephrines, which has been demonstrated only in a minority of patients. Additionally, pheochromocytoma needs to be promptly removed if possible; this case demonstrated successful resection and clinical course despite the delay for this urgent surgery due to COVID-19.

scholarly journals Male circumcision and global HIV/AIDS epidemic challenges

2019 ◽  
Vol 25 (1) ◽  
Author(s):  
Emiola Oluwabunmi Olapade-Olaopa ◽  
Mudasiru Adebayo Salami ◽  
Taiwo Akeem Lawal
Keyword(s):  
Sexual Behavior ◽  
Male Circumcision ◽  
Preventive Measure ◽  
Population Level ◽  
Surgical Removal ◽  
Main Body ◽  
Prevention Measures ◽  
Mortality And Morbidity ◽  
Aids Epidemic ◽  
Hiv Aids

Abstract Background Given the devastating mortality and morbidity associated with HIV/AIDS, many potential prevention measures against HIV infection continue to be explored. Most prevention methods are in the realm of sexual behavior change. However, of all aspects of human behavior, it is sexual behavior that is least amenable to change. Newer and simpler interventions are therefore required. Male circumcision, the surgical removal of some or all of the foreskin (or prepuce) from the penis, is one of the ways being promoted as a preventive measure. This paper reviews the scientific basis and evidence for the efficacy of male circumcision within the context of the global challenges involved. Main body We reviewed articles with emphasis on male circumcision and HIV/AIDS transmission. Published abstracts of presentations at international scientific meetings were also reviewed. Conclusions Current epidemiological evidence supports the promotion of male circumcision for HIV prevention, especially in populations with high HIV prevalence and low circumcision rates. Three notable randomized control trials strengthen the case for applied research studies to demonstrate that safe male circumcision is protective at the population level, particularly as ideal and well-resourced conditions of a randomized trial are often not replicated in other service delivery settings. Ethically and culturally responsive strategies in promoting circumcision in a culturally heterogenous world need to be developed, too. Male circumcision should also be viewed as a complementary measure along with other proven approaches to turn the HIV/AIDS epidemic around.

scholarly journals Post-surgical hypocortisolism after removal of an adrenal incidentaloma: is it predictable by an accurate endocrinological work-up before surgery?

2010 ◽  
Vol 162 (1) ◽  
pp. 91-99 ◽  
Author(s):  
Cristina Eller-Vainicher ◽  
Valentina Morelli ◽  
Antonio Stefano Salcuni ◽  
Massimo Torlontano ◽  
Francesca Coletti ◽  
...  
Keyword(s):  
Hpa Axis ◽  
Adrenal Incidentaloma ◽  
Serum Cortisol ◽  
Urinary Free Cortisol ◽  
Tolerance Test ◽  
Surgical Removal ◽  
Acth Stimulation ◽  
Unilateral Adrenalectomy ◽  
Free Cortisol ◽  
Few Data

ObjectiveFew data are available regarding the need of steroid substitutive therapy after unilateral adrenalectomy for adrenal incidentaloma (AI). It is unknown whether, before surgery, the hypothalamic–pituitary–adrenal (HPA) axis secretion parameters can predict post-surgical hypocortisolism.AimThis study aimed to evaluate whether, in AI patients undergoing unilateral adrenalectomy, post-surgical hypocortisolism could be predicted by the parameters of HPA axis function.DesignProspective, multicenter.MethodsA total of 60 patients underwent surgical removal of AI (surgical indication: 29 subclinical hypercortisolism (SH); 31 AI dimension). Before surgery, SH was diagnosed in patients presenting at least three criteria out of urinary free cortisol (UFC) levels>60 μg/24 h, cortisol after 1-mg dexamethasone suppression test (1 mg-DST)>3.0 μg/dl, ACTH levels<10 pg/ml, midnight serum cortisol (MSC)>5.4 μg/dl.Two months after surgery, HPA axis function was assessed by low dose ACTH stimulation test or insulin tolerance test when needed: 39 patients were affected (Group B) and 21 were not affected (Group A) with hypocortisolism. The accuracy in predicting hypocortisolism of pre-surgical HPA axis parameters or their combinations was evaluated.ResultsThe presence of >2 alterations among 1 mg-DST>5.0 μg/dl, ACTH<10 pg/ml, elevated UFC and MSC has the highest odds ratio (OR) for predicting post-surgical hypocortisolism (OR 10.45, 95% confidence interval, CI 2.54–42.95, P=0.001). Post-surgical hypocortisolism was predicted with 100% probability by elevated UFC plus MSC levels, but not ruled out even in the presence of the normality of all HPA axis parameters.ConclusionPost-surgical hypocortisolism cannot be pre-surgically ruled out. A steroid substitutive therapy is indicated after unilateral adrenalectomy for SH or size of the adenoma.

scholarly journals Intraosseous Odontoma

2011 ◽  
Vol 2 (3) ◽  
pp. 277-279
Author(s):  
Shadab Mohammad ◽  
Laxman R Malkunje ◽  
Nimisha Singh
Keyword(s):  
Clinical Manifestations ◽  
Surgical Removal ◽  
Tumor Treatment ◽  
Mandibular Angle ◽  
Impacted Teeth ◽  
X Ray ◽  
Patient Gender ◽  
Large Compound

ABSTRACT Odontomes show no gender predilection, and are most often diagnosed in the second decade of life. They are preferentially located in the upper maxilla, particularly in the anterior sector. Compound odontome are more prevalent than complex odontome, and show no predilection in terms of patient gender, age or location. We hereby report a case of large compound odontome in the mandibular angle region of a 55- year-old woman. Most such lesions are asymptomatic and constitute casual findings in X-ray studies indicated for other reasons. The most common clinical manifestations are absence of impacted teeth and the presence of a tumor. Treatment consists of surgical removal of the lesion. The prognosis is very good, with a scant tendency towards relapse.

scholarly journals Awareness About Oral Cancer Among Dental Students

2020 ◽  
Vol 11 (SPL3) ◽  
pp. 892-895
Author(s):  
Nishanthi R ◽  
Ashok Velayudhan ◽  
Dhanraj Ganapathy
Keyword(s):  
Risk Factors ◽  
Oral Cancer ◽  
Management Strategies ◽  
Clinical Manifestations ◽  
Dental Students ◽  
Cancer Knowledge ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Mortality And Morbidity ◽  
Self Administered Questionnaire

Oral cancer affects people in the 6th and seventh many years of existence with a background marked by smoking tobacco and, or liquor utilization. Early acknowledgement and referral are basic as less treatment is required to decrease mortality and morbidity. Past examinations have demonstrated that oral cancer can be quiet in symptoms with attention to primal signs being increasingly advantageous in diagnosis. To assessing oral cancer knowledge and awareness among undergraduate dental studentsA cross-sectional survey was done with a self-administered questionnaire with 10 questions circulated among 100 dental students. The questionnaire assessed the awareness about oral cancer, their risk factors, clinical manifestations, diagnosis and management strategies. The responses were recorded and analysed. 96 % of dental students were aware of oral cancer.95% said smoking and tobacco-related products are the major risk factors of oral cancer.85% were aware of clinical manifestation of oral cancer.71% were aware of the diagnosis of oral cancer and 65% were aware of management strategies for oral cancer.Greater part of the responders in this investigation had satisfactory information about clinical indications of oral cancer. Efforts ought to be made to develop inspirational disposition towards avoidance of oral cancer. There is a necessity to present instructions on counteraction, early referral and demonstrative techniques for oral cancer.

Gnathostomiasis

2010 ◽  
pp. 1182-1184
Author(s):  
Valai Bussaratid ◽  
Pravan Suntharasamai
Keyword(s):  
Freshwater Fish ◽  
Clinical Manifestations ◽  
Human Infection ◽  
Definitive Diagnosis ◽  
Neurological Deficits ◽  
Surgical Removal ◽  
Serological Testing ◽  
Presumptive Diagnosis ◽  
Common Mode ◽  
Creeping Eruption

Gnathostomiasis is an extraintestinal infection with larval or immature nematodes of the genus Gnathostoma (order Spirurida), the most common mode of human infection being consumption of undercooked freshwater fish. Clinical manifestations include recurrent cutaneous migratory swellings (common), creeping eruption (rare), and neurological deficits (occasional). Definitive diagnosis is by identification of the worm in surgical specimens; serological testing for antibody against gnathostoma antigen can confirm a presumptive diagnosis. Treatment of choice is albendazole or if possible, surgical removal of the worm in accessible areas and when the parasite can be located. Prevention is by avoiding all dishes that contain raw or poorly cooked flesh of animals or fish in or imported from endemic areas....

scholarly journals A historical note on an imported case of loiasis in Rio de Janeiro, Brazil, 1964

2011 ◽  
Vol 53 (5) ◽  
pp. 295-297
Author(s):  
Antonio Giardulli ◽  
Guilherme Dolanda Paulo Filho ◽  
Giovanni Nicola Urberto Italiano Colombini ◽  
Walter de Araújo Eyer-Silva ◽  
Carlos Alberto Basilio-de-Oliveira
Keyword(s):  
Rio De Janeiro ◽  
Clinical Manifestations ◽  
Central Africa ◽  
Surgical Removal ◽  
Historical Note ◽  
Loa Loa ◽  
Imported Case ◽  
West And Central Africa ◽  
Inflammatory Edema ◽  
The City

Loiasis is a filarial disease transmitted by the Chrysops spp. tabanid flies in West and Central Africa. It is most commonly diagnosed by the clinical manifestations of Calabar swellings (transient localized inflammatory edema) or, most dramatically, by the appearance of a migrating worm through the conjunctival tissues or the bridge of the nose. We report the case of a 35-year-old resident in the city of Rio de Janeiro who displayed a moving Loa loa in the bulbar conjunctival tissue two years after returning from a six-month trip to Uganda. Surgical removal of the worm was performed.

P5452First data-analysis of the prospective ETiCS-study after study-end confirms acute (microbial-induced) inflammation as a key trigger for the development of cardiac GPCR-autoantibodies

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
V Boivin ◽  
C Zechmeister ◽  
C Schuetz ◽  
N Beyersdorf ◽  
D Berliner ◽  
...  
Keyword(s):  
Time Course ◽  
Cardiovascular Death ◽  
Beta Blockade ◽  
Myocardial Inflammation ◽  
University Hospitals ◽  
Mortality And Morbidity ◽  
The Past ◽  
Experimental Therapies ◽  
Membrane Antigens ◽  
Cardiac Necrosis

Abstract Heart failure (HF) is the leading cause of mortality and morbidity in Western countries. In the past two decades, evidence for the clinical relevance of GPCR-autoimmunity in human HF has substantially increased. Stimulating autoantibodies targeting the second extracellular loop (ECII) of the cardiac beta1-adrenoceptor (beta1-aabs) have been claimed to be involved in the pathogenesis of HF and to increase the risk of cardiovascular death by three-fold. Still, the events triggering the formation of beta1-aabs and their impact on HF-progression are unknown. Methods In total 13 University Hospitals (12 German, 1 Serbian) prospectively recruited 226 patients (pts.) with a first acute myocardial infarction (FAMI), and 140 pts with acute (biopsy- or cMRI-proven) myocarditis (AMitis) into the Etiology, Titer-Course and effect on Survival of cardiac autoantibodies-study (ETiCS-study). This study aimed to investigate whether the presentation of cardiac membrane antigens (e.g., the beta1-adrenoceptor) following cardiac necrosis/inflammation triggers the formation of beta1-aabs. At baseline (BL) and three follow-ups (Fup1–3), blood was sampled to analyze the time-course of beta1-aabs. Beta1-aab titers were measured by FACS using Dyna-beads® M-270-Epoxy coated with increasing amounts of beta1-ECII-peptides (2.5–100 μg/ml), checked versus scrambled peptides (a mixture of same amino-acids). After reacting, the samples were measured by FACScan flow-cytometry; obtained data were analyzed with FlowJo (Treestar). When half-maximal binding was calculable the serum was classified beta1-aab-positive. Results From n=366 pts (226 FAMI/140 AMitis) recruited into the ETiCS-study 45 pts had to be excluded because of unperformed cMRI's; 46 pts stopped the study before Fup-1 (month 3). Only 180/226 FAMI- and 98/140 AMitis-pts had complete Fup1–3 (after 3, 6, and 12 months with clinical assessment, echocardiograms, and cMRI's at BL and Fup-3). In all valid ETiCS-pts (197 FAMI-/123 AMitis-pts) the titer-course of beta1-aabs was compared with the development of echo-LVEF. Relevant (high-affinity) beta1-aab-titers were detected in ∼31% (37/123) of the AMitis-pts compared to only ∼21% (42/197) of the FAMI-pts. In aab-positive AMitis-pts echo-LVEF did not recover and was always significantly inferior to aab-negative AMitis-pts (BL: 38 vs. 49% LVEF; Fup-3: 49 vs. 64% LVEF) whereas such a difference was not noted in FAMI-pts. In addition, aab-positive AMitis-pts had higher NT pro-BNP-, renin-, and aldosterone-levels than aab-negative AMitis-pts. Conclusion The first evaluation of the completed ETiCS-study clearly suggests that acute microbial-induced rather than post-infarction myocardial inflammation triggers the formation of clinically relevant beta1-aabs. AAb-positive AMitis-patients might profit from early intensification of standard HF-therapy (including early beta-blockade) and/or novel antibody-directed experimental therapies which are currently developed. Acknowledgement/Funding BMBF Grant FKZ 01ES0816

scholarly journals P853 Bilateral lower limb ischemia in a healthy young man what if the heart was hiding the etiology

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Mouadili ◽  
A Tamdy ◽  
B El Fatmi ◽  
S Elkarimi
Keyword(s):  
Popliteal Artery ◽  
Lower Limb ◽  
Cardiac Myxoma ◽  
Clinical Manifestations ◽  
Limb Ischemia ◽  
Atrial Myxoma ◽  
Surgical Removal ◽  
Left Atrial Myxoma ◽  
Tibial Arteries ◽  
The Right

Abstract Cardiac myxoma is the most common benign cardiac tumor with diverse nonspecific clinical manifestations; moreover, atrial myxoma embolization to the peripheral vessels is rare. A 24-year-old man presented tothe emergency departement complaining ofpain and coldness of his two lower extremities. The right femoral pulse was normally felt while the pulses of the left lower limb from the femoral down to the posterior and anterior tibial arteries were not felt. Bilateral thrombectomy was performed on emergency basisand a fatty-like mass from the left femoral artery was removed. The histological examination of this mass was suggestive of myxoma.So, transthoracic echocardiography was done and confirmed the diagnosis of myxoma that was seen in the left atrium and measuring about 10X6 cm in its maximal dimensions. Surgical removal of the myxoma was done later and the patient recovered uneventfully. Conclusion Although myxomas are rare, they should be considered in the differential diagnosis of peripheral embolic disease, especially when an embolic event occurs in a young adult without evidence of endocarditis or arrhythmia. Echocardiography is the modality of choice for diagnosis and follow-up of this type of tumors. FIGURE 1: CTA (computed tomography angiography) showing Occlusion of the left popliteal artery and occlusion of the distal part of the right popliteal artery FIGURE 2: macroscopic view of gelatinous left atrial myxoma

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