A CASE OF CUSHING SYNDROME SUCCESSFULLY TREATED WITH SUPERSELECTIVE ADRENAL ARTERIAL EMBOLIZATION OF AN ADRENOCORTICAL ADENOMA WITH A 6-MONTH FOLLOW-UP

Abstract Context Information about adrenal medullary hyperplasia (AMH) is scarce. Objective To study a large cohort of AMHs. Design, Setting, and Participants Nineteen AMH cases were compared with 95 pheochromocytomas (PCCs) without AMH. AMH without (n = 7) and with PCC (n = 12) were analyzed separately. Results Of 936 adrenalectomies, 2.1% had AMH. Mean age was 47.2 ± 15.1 years. Only two (11%) AMHs had no concurrent PCC or adrenocortical adenoma. In AMHs, a genetic syndrome was present in 58% vs 4% in PCCs (P < 0.001). The noradrenaline/metanephrine levels were lower in AMHs, whereas suppression of dexamethasone was less than in PCCs. Cushing syndrome was found in 11% of AMHs. More AMHs were found during screening and less as incidentalomas. PCC symptoms were less prevalent in AMHs. Surgical management was similar; however, fewer of the AMHs were pretreated with alpha-blockers. Adrenalectomy improved blood pressure slightly less in AMHs. The disappearance of glycemic disturbances was similar to the PPCs. During a period of 11.2 ± 9.4 years, a new PCC developed in 32% of patients with AMH, 11% died, but no PCC metastasis occurred (PCCs: 4%, P < 0.001; 14% and 5%). AMHs without PCC had milder symptoms but more often Cushing disease than patients with PCC, whereas AMH with PCC more often displayed a familiar syndrome with more PCC recurrences. Conclusion A total of 2.1% of all adrenalectomies displayed AMH. AMH seemed to be a PCC precursor. The symptoms and signs were milder than PCCs. AMHs were mainly found due to screening. Outcomes seemed favorable, but new PCCs developed in many during follow-up.

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Image-Guided Radiofrequency Ablation for Adrenocortical Adenoma with Cushing Syndrome: Outcomes After Mean Follow-up of 33 Months

Urology ◽

10.1016/j.urology.2007.04.032 ◽

2007 ◽

Vol 70 (3) ◽

pp. 407-411 ◽

Cited By ~ 30

Author(s):

Kiminobu Arima ◽

Kouichirou Yamakado ◽

Ryuichi Suzuki ◽

Hiroshi Matsuura ◽

Atsuhiro Nakatsuka ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Cushing Syndrome ◽

Adrenocortical Adenoma ◽

Image Guided

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Renal Angiomyolipoma: Superselective Arterial Embolization and Long Term Follow-up

Journal of the Korean Radiological Society ◽

10.3348/jkrs.1997.37.1.71 ◽

1997 ◽

Vol 37 (1) ◽

pp. 71

Author(s):

Young Hwan Lee ◽

Young Min Han ◽

Chong Soo Kim ◽

Gyung Ho Chung ◽

Sang Yong Lee ◽

...

Keyword(s):

Arterial Embolization ◽

Renal Angiomyolipoma ◽

Long Term Follow Up

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Palliative Treatment of Hepatocellular Carcinoma with Transcatheter Arterial Embolization

Acta Radiologica ◽

10.1177/028418519303400106 ◽

1993 ◽

Vol 34 (1) ◽

pp. 26-29 ◽

Cited By ~ 4

Author(s):

S. Savastano ◽

G. P. Feltrin ◽

D. Neri ◽

P. da Pian ◽

M. Chiesura-Corona ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Transcatheter Arterial Embolization ◽

Palliative Treatment ◽

Arterial Embolization ◽

Percutaneous Ethanol Injection ◽

Ethanol Injection ◽

History Of ◽

The Mean ◽

Hcc Recurrence

Thirty-three consecutive patients with previously untreated hepatocellular carcinoma (HCC) and 6 patients with recurrent HCC were treated with transcatheter arterial embolization (TAE). The patients were not eligible for surgical resection or percutaneous ethanol injection. TAE was performed with Lipiodol Ultra-Fluid, epidoxorubicin and Gelfoam, with a mean of 1.7 treatments per patient. CT was performed 15 days after TAE. The mean cumulative survival was 14.2 months in patients with previously untreated HCC. The survival of patients stages Okuda I and II did not differ significantly (p > 0.05); tumor size did not affect survival (p > 0.05). Two patients with recurrent HCC died 7.0 and 9.3 months after the diagnosis of tumor recurrence; the remaining 4 patients are still alive with a maximum follow-up of 22.5 months from the diagnosis of HCC recurrence. Ten complications occurred in 8 patients, and were controlled by medical therapy. Eleven patients died during the study; no death was related to TAE. The series was not randomized, but comparison with the natural history of HCC suggests that TAE is effective as palliative treatment of advanced or recurrent HCC.

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A rare case of Cushing syndrome by cyclic ectopic-ACTH

Arquivos Brasileiros de Endocrinologia & Metabologia ◽

10.1590/s0004-27302012000500008 ◽

2012 ◽

Vol 56 (5) ◽

pp. 324-330 ◽

Cited By ~ 5

Author(s):

Mariana Farage ◽

Mario Alberto da Dantas Loures Costa ◽

Amélio Fernando Godoy-Matos

Keyword(s):

Primary Tumor ◽

Rare Case ◽

Glomus Tumor ◽

Cushing Syndrome ◽

Severe Hypertension ◽

Abdominal Fat ◽

Ectopic Acth ◽

Mood Changes ◽

Ectopic Acth Production

ACTH-dependent Cushing syndrome (CS) due to ectopic ACTH production is most times difficult to manage. The identification of the source of ACTH may take many years. Surgery or chemotherapy for the primary tumor is not always possible. Control of Cushing symptoms is many times achieved using medication, or bilateral adrenalectomy in refractory cases. This case presents a Brazilian male who showed severe hypertension, mood changes, muscle weakness, darkening of skin, and increased abdominal fat. An investigation for Cushing syndrome was carried out and, after a four-year follow-up, a carotid glomus tumor (chemodectoma) was confirmed, a rare ectopic ACTH-producing tumor. Besides, the patient presented cyclic Cushing syndrome that was exacerbated by diverticulitis episodes. This case presents interesting pitfalls on diagnosis and management of ACTH-dependent CS. This is the only report of a chemodectoma that produced ACTH in the literature.

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Selective Arterial Embolization of Renal Angiomyolipomas with a N-Butyl Cyanoacrylate-Lipiodol Mixture: Efficacy, Safety, Short- and Mid-Term Outcomes

Journal of Clinical Medicine ◽

10.3390/jcm10184062 ◽

2021 ◽

Vol 10 (18) ◽

pp. 4062

Author(s):

François-Victor Prigent ◽

Kévin Guillen ◽

Pierre-Olivier Comby ◽

Julie Pellegrinelli ◽

Nicolas Falvo ◽

...

Keyword(s):

Arterial Embolization ◽

Volume Reduction ◽

Renal Angiomyolipoma ◽

Cyanoacrylate Glue ◽

Selective Arterial Embolization ◽

Before And After ◽

The Mean ◽

Magnetic Resonance Imaging Mri ◽

Postembolization Syndrome

Selective arterial embolization (SAE) for renal angiomyolipoma (rAML) is effective to treat or prevent bleeding. We report our experience using a cyanoacrylate–Lipiodol mixture. We performed a single-center retrospective review of all rAMLs embolized with cyanoacrylate glue between July 2014 and June 2020. Demographics, tuberous sclerosis complex (TSC) status, clinical presentation, angiography features, and follow-up data were recorded. Pre- and post-procedure rAML sizes and volumes were estimated from computed tomography (CT) or magnetic resonance imaging (MRI) studies. Kidney function was assessed before and after the procedure. We identified 24 patients (22 females and 2 males, mean age 51 years) treated for 27 AMLs, either prophylactically (n = 20) or as an emergency (n = 4). Technical success was achieved for 25/27 AMLs; two patients, each with a single AML, required nephrectomy and repeated embolization, respectively. Major complications occurred in three patients and minor complications such as postembolization syndrome in 15 patients. AML volume reduction after embolization was 55.1% after a mean follow-up of 15 months (range, 1–72 months). Factors associated with greater volume reduction were a smaller percentage of fat (p = 0.001), larger initial rAML volume (p = 0.014), and longer follow-up (p = 0.0001). The mean creatinine level did not change after SAE. Embolization of rAMLs with a mixture of cyanoacrylate and Lipiodol is feasible, safe, and effective in significantly decreasing tumor volume.

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Transcatheter Arterial Embolization with N-butyl-2 Cyanoacrylate Glubrans 2 for the Treatment of Acute Renal Hemorrhage Under Coagulopathic Condition

10.21203/rs.3.rs-26879/v1 ◽

2020 ◽

Author(s):

Maofeng Gong ◽

Xu He ◽

Boxiang Zhao ◽

Jie Kong ◽

Tao Wang ◽

...

Keyword(s):

Transcatheter Arterial Embolization ◽

Clinical Success ◽

Arterial Embolization ◽

Hemodynamic Instability ◽

Attractive Alternative ◽

Safe Alternative ◽

Renal Hemorrhage ◽

Active Hemorrhage ◽

Significant Difference

Abstract Background:The efficacy and safety of transcatheter arterial embolization (TAE) using the N-butyl-2 cyanoacrylate (NBCA) Glubran2 in the treatment of acute renal hemorrhage (RH) under coagulopathic conditionsarestill no consensus.Methods: Between February 2014 and June 2019, 8 patients underwent TAE with the NBCA Glubran2 for acute RH under coagulopathic conditions. Coagulopathy was defined as abnormal values of prothrombin time and activated partial thromboplastin time and/or a reduced platelet count.Angiograms and medical records were retrospectively reviewed to determine technical/clinical success, complications and recurrent hemorrhage after TAE, and follow-up outcomes were assessed.Results: Of note, one patient presented with severe coagulopathy, and three presented with severe RH and hemodynamic instability. The NBCA Glubran2 was employed as a sole embolic material in sixpatients. In the remaining two patients, it was employed for secondary embolization.Under coagulopathic conditions, due to the use of the NBCA Glubran2, both technical success and clinical success for acute RH were achieved in all patients. Duringa mean follow-up time of 30.1 months (range, 3-84 months), neither persistent nor recurrent active hemorrhage required repeat endovascular or surgical treatment for hemostasis. No Glubran2related complications occurred mid-TAE pro-cedure. In addition, renal function information was available for all patients, and there was no significant difference between the serum creatinine levels [(83.8 ± 15.5) vs (85.8 ± 32.2) μmol/L] before and one week after Glubran2 embolization (p=0.89; CI, -34.5 to 30.5).Conclusions: The present findings suggest that TAE with the NBCA Glubran2 may be a safe alternative treatment for the management of RH under coagulopathic conditions. In particular, this method appears to be a potentially attractive alternative when con-ventional embolic materials fail in patients with ongoing hemodynamic instability or even under severe coagulopathic conditions.

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A CASE OF CUSHING SYNDROME SECONDARY TO ADRENOCORTICAL ADENOMA ASSOCIATED WITH SITUS INVERSUS TOTALIS

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) ◽

10.3919/jjsa.65.504 ◽

2004 ◽

Vol 65 (2) ◽

pp. 504-507

Author(s):

Eiji MINATO ◽

Kouhei OOTAKE ◽

Ippei FUJINO ◽

Kazuo MATSUMOTO ◽

Kouichi SHIMA ◽

...

Keyword(s):

Situs Inversus ◽

Cushing Syndrome ◽

Situs Inversus Totalis ◽

Adrenocortical Adenoma

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Treatment of dural arteriovenous fistula using ethylene vinyl alcohol (Onyx) arterial embolization as the primary modality: short-term results

Journal of Neurosurgery ◽

10.3171/jns-07/12/1120 ◽

2007 ◽

Vol 107 (6) ◽

pp. 1120-1125 ◽

Cited By ~ 56

Author(s):

Andrew P. Carlson ◽

Christopher L. Taylor ◽

Howard Yonas

Keyword(s):

Arteriovenous Fistula ◽

Vinyl Alcohol ◽

Dural Arteriovenous Fistula ◽

Clinical Symptoms ◽

Arterial Embolization ◽

Primary Treatment ◽

Embolic Agent ◽

Ethylene Vinyl Alcohol ◽

Treatment Agent

Object A dural arteriovenous fistula (DAVF) typically involves meningeal feeding arteries and can cause clinical symptoms ranging from tinnitus to rupture of draining cortical or parenchymal veins. Surgical treatment may be technically demanding. Ethylene vinyl alcohol (Onyx, ev3 Neurovascular) has several properties that make it potentially useful as a primary treatment agent for DAVF. Onyx is expected to be a permanent embolic agent. It should have a decreased risk of catheter retention when compared with other permanent embolic materials. Methods The authors report a series of six patients with symptomatic DAVF who were treated initially with transarterial Onyx embolization and other endovascular techniques. Results Five patients had complete occlusion of their DAVF noted on the follow-up angiogram obtained between 2 and 4 months. One patient had residual filling via a small arterial branch that was stable on follow-up angiography. None of the patients had worsening of neurological function. One case was complicated by a retained catheter fragment. Conclusions Transarterial Onyx embolization and other endovascular methods can angiographically obliterate DAVF. In some cases, embolization allowed occlusion of multiple arterial feeding arteries from a single arterial injection. Technically, the embolization was optimized when a microcatheter position immediately adjacent to the point(s) of fistulization was achieved.

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