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Updated: 1 day 11 hours ago

Cardiovascular mortality in patients with subclinical Cushing.

Tue, 10/02/2018 - 15:14
Related Articles

Cardiovascular mortality in patients with subclinical Cushing.

Ann Endocrinol (Paris). 2018 Jun;79(3):149-152

Authors: Morelli V, Arosio M, Chiodini I

Abstract
Patients with adrenal incidentaloma (AI) and subclinical hypercortisolism (SH) show a high prevalence of cardiovascular risk factors and an increased prevalence and incidence of cardiovascular events. Furthermore, some recent data suggest that in these patients, the cardiovascular mortality is also increased. Unfortunately, to date, the diagnosis of SH is still a matter of debate, and, therefore, it is still not possible to address the treatment of choice (i.e. surgical or conservative approach) in many AI patients. Overall, the available data show that in AI patients with established SH the surgical removal of the adrenal mass causing SH can lead to the improvement of hypertension and diabetes, but in many patients with possible SH the effect of surgery is still largely unknown. Finally, no data are available on the effect of the recovery from SH on the cardiovascular events. Therefore, randomized studies are needed to investigate the possibility of predicting the usefulness of surgery by using the available indexes of cortisol secretion in the individual AI patient. Finally, the development of safe and well-tolerated drugs aimed to control cortisol secretion will be among the goals of the future research.

PMID: 29606280 [PubMed - indexed for MEDLINE]

Metastatic pheochromocytoma in MEN 2A: A rare association.

Tue, 10/02/2018 - 15:14
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Metastatic pheochromocytoma in MEN 2A: A rare association.

BMJ Case Rep. 2018 Mar 28;2018:

Authors: Pal R, Rastogi A, Kumar S, Bhansali A

Abstract
A 45-year-old woman was diagnosed as having multiple endocrine neoplasia type 2A in 2014. She had bilateral pheochromocytoma, medullary thyroid carcinoma and biopsy-proven cutaneous lichen amyloidosis in the interscapular area. She underwent bilateral adrenalectomy; following which, she achieved clinical and biochemical remission. She was planned for total thyroidectomy at a later date; however, she was lost to follow-up. She presented to us again in December 2016 with abdominal pain. Examination revealed hypertension with postural drop. Positron emission tomography scan showed Ga68 and fluorodeoxyglucose (FDG)-avid suprarenal, hepatic, peritoneal and mesenteric masses with abdominal lymph nodes. Twenty-four-hour urinary metanephrines/normetanephrines were elevated. Serum calcitonin was as high as it was 2-1/2 years ago. Ultrasonography-guided fine-needle aspiration cytology (FNAC) from the liver mass revealed neuroendocrine cells that did not stain for calcitonin. Hence, a diagnosis of metastatic pheochromocytoma was made. She underwent total thyroidectomy and was started on cyclophosphamide, vincristine, dacarbazine-based chemotherapy regimen.

PMID: 29592980 [PubMed - indexed for MEDLINE]

Efficacy and safety of metyrosine in pheochromocytoma/paraganglioma: a multi-center trial in Japan.

Tue, 10/02/2018 - 15:14
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Efficacy and safety of metyrosine in pheochromocytoma/paraganglioma: a multi-center trial in Japan.

Endocr J. 2018 Mar 28;65(3):359-371

Authors: Naruse M, Satoh F, Tanabe A, Okamoto T, Ichihara A, Tsuiki M, Katabami T, Nomura M, Tanaka T, Matsuda T, Imai T, Yamada M, Harada T, Kawata N, Takekoshi K

Abstract
To assess the efficacy, safety, and pharmacokinetics of metyrosine (an inhibitor of catecholamine synthesis) in patients with pheochromocytoma/paraganglioma (PPGL), we conducted a prospective, multi-center, open-label study at 11 sites in Japan. We recruited PPGL patients aged ≥12 years requiring preoperative or chronic treatment, receiving α-blocker treatment, having baseline urinary metanephrine (uMN) or normetanephrine (uNMN) levels ≥3 times the upper limit of normal values, and having symptoms associated with excess catecholamine. Metyrosine treatment was started at 500 mg/day and modified according to dose-adjustment criteria up to 4,000 mg/day. The main outcome measure was the proportion of patients who achieved at least 50% reduction in uMN or uNMN levels from baseline. Sixteen patients (11 males/5 females) aged 12-86 years participated. After 12 weeks of treatment and at the last evaluation of efficacy, the primary endpoint was achieved in 31.3% of all patients, including 66.7% of those under preoperative treatment and 23.1% of those under chronic treatment. Sedation, anemia, and death were reported in 1 patient each as serious adverse drug reactions during the 24-week treatment. Metyrosine was shown to be tolerated and to relieve symptoms by reducing excess catecholamine in PPGL patients under both preoperative and chronic treatment.

PMID: 29353821 [PubMed - indexed for MEDLINE]

Paraganglioma as a risk factor for bone metastasis.

Tue, 10/02/2018 - 15:14
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Paraganglioma as a risk factor for bone metastasis.

Endocr J. 2018 Mar 28;65(3):253-260

Authors: Yokomoto-Umakoshi M, Umakoshi H, Tsuiki M, Ogasawara T, Hamanaka-Hiroshima K, Tanabe A, Tagami T, Shimatsu A, Naruse M

Abstract
Malignant pheochromocytoma (PHEO) and paraganglioma (PGL) (PHEO and PGL: PPGL) are frequently associated with bone metastasis. Bone metastasis requires long-term management and may lead to skeletal-related events (SREs) that remarkably reduce patients' quality of life (QOL). The aim of this study was to elucidate the risk factors for developing bone metastasis in patients with PPGL. The medical records of 40 consecutive adult patients with malignant PPGL at the National Hospital Organization Kyoto Medical Center between 2006 and 2016 were reviewed. SREs were defined as pathologic fracture, spinal cord compression, and the need for bone irradiation and/or surgery. PHEO (20/40) and PGL (20/40) were each present in 50% of the patients. Bone was the most frequent site of metastasis, detected in 60% (24/40). Bone metastasis was more frequent in patients with PGL (16/20, 80%) than in patients with PHEO (8/20, 40%) (p = 0.02). Half (12/24) of the patients with bone metastasis had at least one SRE. Extra-skeletal invasion of the spine, defined as local infiltration to the surrounding tissue beyond the cortical bone, was more frequently observed in patients with bone metastasis associated with SREs than without them (p = 0.001). Careful follow-up and management are warranted especially in patients with PGL as a risk factor for bone metastasis and with extra-skeletal invasion of the spine as risk factor of SREs.

PMID: 29187703 [PubMed - indexed for MEDLINE]

Tumor necrosis factor-associated periodic syndrome in adults.

Tue, 10/02/2018 - 15:14
Related Articles

Tumor necrosis factor-associated periodic syndrome in adults.

Rheumatol Int. 2018 Jan;38(1):3-11

Authors: Menon SG, Efthimiou P

Abstract
Tumor necrosis factor-associated periodic syndrome is an autoinflammatory disorder classified under hereditary periodic fever syndromes. Mutations in the tumor necrosis factor receptor contribute to tumor necrosis factor-associated periodic syndrome. Decreased shedding of receptors and increased mitochondrial reactive oxygen species production leading to elevated proinflammatory cytokines are documented. Inflammation in various organs is hallmark of tumor necrosis factor-associated periodic syndrome and manifests as spiking fever, abdominal pain, conjunctivitis and polyserositis in adults. The ongoing challenge is to diagnose the disease early in its course to prevent amyloidosis. The treatment options have evolved from use of nonsteroidal anti-inflammatory drugs and corticosteroids to targeted therapy like tumor necrosis factor receptor inhibitors and interleukin-1 blockers. The aim of this review is to give an overview of the pathogenesis, clinical features and the various treatment modalities available for tumor necrosis factor-associated periodic syndrome and aid physicians in recognizing the signs of the disease earlier.

PMID: 28942479 [PubMed - indexed for MEDLINE]

adrenal tumor; +24 new citations

Tue, 09/25/2018 - 14:50

24 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

adrenal tumor

These pubmed results were generated on 2018/09/25

PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

Composite Paraganglioma: Pioneering in the Head and Neck.

Tue, 09/18/2018 - 12:31
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Composite Paraganglioma: Pioneering in the Head and Neck.

Int J Surg Pathol. 2018 Sep 16;:1066896918799940

Authors: Delgado S, Smith SM, Mehra S, Prasad ML

Abstract
Composite paragangliomas are rare with less than 20 cases documented in the abdomen, retroperitoneum, and urinary bladder. In this article, we report the first case of composite paraganglioma in the head and neck presenting as a soft tissue mass in the neck adjacent to the carotid artery in a 50-year-old woman. We discuss the clinicopathologic findings and genetic implications, and we review the literature of this rare entity.

PMID: 30222023 [PubMed - as supplied by publisher]

Clinical and molecular prognostic factors in adrenocortical carcinomas.

Tue, 09/18/2018 - 12:31
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Clinical and molecular prognostic factors in adrenocortical carcinomas.

Minerva Endocrinol. 2018 Sep 12;:

Authors: Libé R

Abstract
INTRODUCTION: Adrenocortical carcinoma (ACC) is a rare cancer, with an incidence less than 0.7-1.5 per 1 million people per year, with a poor prognosis. The overall survival (OS) depens on the ENSAT stage: in particular in metastatic ACC the OS varies between 10 and 20 months, with a 5-yrs survival around 10%. ACC present a different behaviour, probably due to a different biology. For these reason a careful prognostic classification is mandatory, in order to stratify the patients and purpose a specific management.
EVIDENCE ACQUISITION: Prognostic factors can be divides in three groups: clinical factors (tumor stage, Age, hormone- related symptoms), pathological factor (Weiss score, mitotic count, Ki67,SF-1 and AVA2, P53, beta-catenin immunohistochemistry, resection status), molecular factor (chromosomal aberrations, methylation profile, altered gene expression and miRNA expression, gene mutations).
EVIDENCE SYNTHESIS: The best way in order to stratify ACC patients and purpose the best therapeutic option is to combine clinical, pathological and molecular factors.
CONCLUSIONS: Individualizing patients' prognosis and tumor biology appears as a necessary step for personalized medicine. In addition to tumor stage and tumor grade, the genomic classification may precise the risk stratification and thus help defining therapeutic strategy.

PMID: 30221891 [PubMed - as supplied by publisher]

Autogenous transplants of adrenal fragments in an animal model.

Tue, 09/18/2018 - 12:31
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Autogenous transplants of adrenal fragments in an animal model.

Pol Przegl Chir. 2018 Jun 13;90(4):22-28

Authors: Dworzyńska A, Paduszyńska K, Pomorski L

Abstract
Introduction Adrenal insufficiency is a typical complication after surgical treatment of adrenal tumors, especially after the removal of both adrenal glands. Human beings are not able to survive without adrenal glands and without proper hormonal substitution. Autotransplantation of a fragment of the adrenal gland may prevent this complication. This can be done by transplanting the entire adrenal glands or its fragment, such as the adrenal cortex cells. In the case of adrenal tumors, the entire adrenal gland can not be transplanted. However, it is possible to transplant cells from the tumor-free part. Succesful adrenal autografts may result in a new treatment of adrenal insufficiency.
MATERIALS AND METHODS: Autograft transplantation was performed on 3 groups of Sprague Dawley rats. In the first group, physiological corticosterone concentrations were determined. These animals were not operated. In the second group, both adrenal glands were removed. Corticosterone concentrations were determined after bilateral adrenalectomy. The third group was divided into two parts. In the first subgroup, bilateral adrenalectomy was performed simultaneosly with adrenal transplant into the omentum. In the second subgroup, right adrenalectomy was performed simultaneosly with and adrenal transplant into the omentum followed a month later by left adrenalectomy. During the experiment, corticosterone concentrations were measured at 4 time points.
RESULTS: The statistical difference between corticosterone concentrations in rats after two timed adrenalectomies and rats after bilateral adrenalectomy was statistically different, but these results were far from physiological concentrations.

PMID: 30220673 [PubMed - in process]

[Clinical characteristics of silent pheochromocytoma].

Tue, 09/18/2018 - 12:31
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[Clinical characteristics of silent pheochromocytoma].

Zhonghua Yi Xue Za Zhi. 2018 Sep 11;98(34):2727-2731

Authors: Yang H, Wu HH, Bu N, Zhou L, Zhang JQ, Zhou LQ, Guo XH

Abstract
Objective: To summarize the clinical characteristics of silent paraganglioma. Methods: A total of 247 pheochromocytoma cases in Peking University First Hospital between January 1993 and December 2015 were analyzed retrospectively.The cases were divided into two groups according to whether they had hypertension: non-silent group (193 cases) and silent group (53 cases), then the clinical characteristics between the groups were compared, and the clinical features of silent pheochromocytoma were reviewed. Results: There were 53 silent pheochromocytoma cases in this study, which accounted for 21.5% (53/247), and imaging was the main way to find the tumor. Forty-one in 53 cases (77.4%) located in adrenal gland, in which 31 cases (75.6%) were benign and 2.3-8.0 cm in diameter, while 10 cases (24.4%) were malignant and 3.5-12.0 cm in diameter. Twelve in 53 cases (22.6%) located in extra-adrenal tissue, in which 4 cases were benign and 2.0-5.5 cm in diameter, while 8 cases were malignant and 5.0-10.5 cm in diameter. With the tumor diameter increased, the malignant rate increased: 1 in 8 cases in diameter<3 cm, 2 in 12 cases in diameter 3-5 cm, 15 in 33 cases in diameter>5 cm were malignant. There was no significant difference in age, sex, tumor location, benign or malignant rate between the two groups (all P>0.05). Compared with the non-silent group, the proportion of tumor size≥5 cm in silent group was significantly higher (62.3% vs 45.9%, P=0.034), and the incidence of hyperglycemia and the concentrations of norepinephrine and epinephrine were lower (all P<0.05) in silent group.Misdiagnosis was common in silent group, and up to 35.8% (19/53) had not been diagnosed correctly before operation. Twenty-one in 53 (39.6%) silent pheochromocytoma cases occured severe intra-operative blood pressure fluctuation. Conclusions: Silent pheochromocytoma was not uncommon and imaging was the main way to find it. The tumor size was always big and misdiagnosis was common, especially extra-adrenal tumors. Therefore, regardless of the adrenal or extra-adrenal tumors, especially in diameter>3.0 cm but with normal blood pressure, the possibility of silent pheochromocytoma should be considered. In order to reduce misdiagnosis and intra-operative blood pressure fluctuations, preoperative diagnosis and preparation, as well as intra-operative monitoring should be fully made.

PMID: 30220169 [PubMed - in process]

Laparoscopic Trans-Abdominal Right Adrenalectomy for a Large Primitive Adrenal Oncocytic Carcinoma: A Case Report and Review of Literature.

Tue, 09/18/2018 - 12:31
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Laparoscopic Trans-Abdominal Right Adrenalectomy for a Large Primitive Adrenal Oncocytic Carcinoma: A Case Report and Review of Literature.

Am J Case Rep. 2018 Sep 15;19:1096-1102

Authors: Panizzo V, Rubino B, Piozzi GN, Ubiali P, Morandi A, Nencioni M, Micheletto G

Abstract
BACKGROUND Adrenocortical oncocytic neoplasms (AONs) are extremely rare tumors. AONs are classified as: oncocytoma (AO), oncocytic neoplasm of uncertain malignant potential (AONUMP), and oncocytic carcinoma (AOC). Among the 162 reported cases of AONs in the literature, 30 cases were classified as malignant. Adrenalectomy is the treatment of choice for AON. CASE REPORT We report the case of a 48-year-old man with a primitive 12-cm mass affecting the right adrenal gland, detected by ultrasonography during follow-up for alcoholic liver cirrhosis. Computed tomography (CT) scan and magnetic resonance imaging (MRI) showed a mass of the right adrenal gland compressing the inferior vena cava (IVC) and dislocating the right lobe of the liver, with no invasion of kidney, liver, or IVC. Preoperative blood tests showed mild transaminase increase. Laparoscopic right adrenalectomy with lateral transperitoneal approach was performed. The postoperative course was uneventful. The lesion was diagnosed as a primitive adrenal oncocytic carcinoma (AOC). No recurrence was evidenced during 24-month follow-up. CONCLUSIONS Although AONs are very rare, they must be considered in the differential diagnosis of adrenal masses due to their prognostic difference compared to non-oncocytic tumors. AOCs are a rare presentation of AONs. Only 30 cases are described in the literature. Laparotomic adrenalectomy is the treatment of choice for AOC. We report the first case of laparoscopic lateral trans-abdominal adrenalectomy for a voluminous AOC (120×95×110 mm) and we review the literature regarding AOCs. Laparoscopy in experienced hands is safe and effective for the treatment of AONs. Despite the rarity of AOC, a case series should be performed to confirm the results of our case report.

PMID: 30217968 [PubMed - in process]

Primary adrenal teratoma: A case series and review of the literature.

Tue, 09/18/2018 - 12:31
Related Articles

Primary adrenal teratoma: A case series and review of the literature.

Mol Clin Oncol. 2018 Oct;9(4):437-442

Authors: Zhou L, Pan X, He T, Lai Y, Li W, Hu Y, Ni L, Yang S, Chen Y, Lai Y

Abstract
Primary adrenal teratoma is a rare type of cancer. Of the 338 patients who underwent adrenalectomy during this study, only 2 (aged 69 and 29 years) were diagnosed with adrenal teratoma and underwent laparoscopic retroperitoneal adrenalectomy. For the purposes of the present study, the term 'adrenal teratoma' was searched in the PubMed database, and 237 articles published between June 1952 and March 2017 were retrieved. However, we were only able to identify 10 relevant studies. In total, these studies reported a series of 18 cases of primary adrenal teratoma in patients aged >16 years, another 8 cases of adult adrenal retroperitoneal teratoma, and 7 cases of adrenal teratoma in children aged <16 years. In the 18 cases aged >16 years, the age range was 17-61 years (mean ± standard deviation, 33.06±15.47 years), the median tumor diameter was 8.25 cm and 13 patients (72.22%) were female. Almost all patients underwent laparoscopic surgery between 2006 and 2017 (75%). Among the 7 cases of adrenal teratoma in children under the age of 16 years, 5 cases (71.43%) were male, the median tumor diameter was 10 cm, the oldest patient was aged 8 years, 5 cases (71.43%) were selected for open surgical resection of the tumor, and 5 cases (71.43%) were followed up without recurrence or death. These data indicate that primary adrenal teratomas in children are rarer compared with adults. Although the data are limited, it was observed that the clinical symptoms of primary adrenal teratoma are not typical, the preferred treatment is retroperitoneal laparoscopic surgery, and the prognosis is favorable. The aim of the present study was to elucidate the clinical characteristics associated with primary adrenal teratoma, in order to further raise awareness of this rare disease.

PMID: 30214733 [PubMed]

AZD8055 inhibits ACTH secretion in a case of bilateral ACTH-secreting pheochromocytoma.

Tue, 09/18/2018 - 12:31
Related Articles

AZD8055 inhibits ACTH secretion in a case of bilateral ACTH-secreting pheochromocytoma.

Oncol Lett. 2018 Oct;16(4):4561-4566

Authors: Wang F, Tong A, Li C, Cui Y, Sun J, Song A, Li Y

Abstract
Ectopic adrenocorticotropic hormone (ACTH) syndrome is usually caused by pulmonary and bronchial tumors and rarely by pheochromocytoma. To date, the majority of ACTH-secreting pheochromocytomas have been unilateral, with the exception of two cases. A 54-year-old male presented with hypertension and bilateral adrenal tumors. The patient did not report having classic cushingoid features or experience of paroxysmal headaches or sweating, but presented with a slight abdominal obesity. The patient was clinically and pathologically diagnosed with bilateral ectopic ACTH-secreting pheochromocytomas. Whole-exome sequencing demonstrated that the 19 pheochromocytoma-related genes were unmutated. The pheochromocytomas on the two sides exhibited negative ACTH staining, but the ACTH concentration was markedly higher in the tumor tissue homogenates than in those tumors of another 3 patients with non-ACTH secretion pheochromocytoma. Electron microscopy identified two types of neuroendocrine cells in the tumor tissues. Primary culture of the pheochromocytoma cells revealed that ACTH secretion was inhibited by a mechanistic target of rapamycin inhibitor, AZD8055.

PMID: 30214591 [PubMed]

Anaplastic Kaposi's Sarcoma of the Adrenal in an HIV-negative Patient With Literature Review.

Tue, 09/18/2018 - 12:31
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Anaplastic Kaposi's Sarcoma of the Adrenal in an HIV-negative Patient With Literature Review.

Adv Anat Pathol. 2018 Sep 12;:

Authors: Bisceglia M, Minenna E, Altobella A, Sanguedolce F, Panniello G, Bisceglia S, Ben-Dor DJ

Abstract
Kaposi's sarcoma (KS) is a peculiar tumor of viral etiology, with the HHV8 rhadinovirus playing a fundamental role in its development. Several epidemiological categories of KS have been identified, of which the sporadic, endemic, iatrogenic, and the epidemic are the main ones. Several histologic disease morphologies have been described, such as inflammatory, angiomatous, spindle cell, mixed, and the anaplastic (sarcomatous) subtypes. The skin of the limbs is most commonly affected, but any other organ or site may be involved. Microscopically KS may enter the differential diagnosis with several different entities, and for this purpose the immunohistochemical detection of the viral latent nuclear antigen-1 (LNA-1) may be crucial. Sporadic KS is usually benign, but rarely it may be aggressive. Anaplastic histology heralds an ominous course in any clinical context. We report a case of anaplastic retroperitoneal KS, occurring in an HIV-negative adult man. This patient presented with a huge left suprarenal mass, which was totally resected, and initially diagnosed as inflammatory leiomyosarcoma, because of the monomorphic spindle cell tumor morphology. After 12 years the tumor recurred locally as an unresectable mass, which was biopsied and examined. At the time of recurrence, the histologic slides of the primary tumor were reviewed, and the previous diagnosis was changed to that of atypical KS. Histologically the recurrent tumor showed both spindle cell and epithelioid appearances. Strongly diffuse HHV8/LAN-1 immunopositivity was documented in both tumors. The final diagnosis for the entire case was anaplastic KS. Then, the patient died in a few months.

PMID: 30212382 [PubMed - as supplied by publisher]

Large adrenal cyst masquerading as a pancreatic cystic tumor: a rare diagnosis based on endoscopic ultrasound.

Tue, 09/18/2018 - 12:31
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Large adrenal cyst masquerading as a pancreatic cystic tumor: a rare diagnosis based on endoscopic ultrasound.

Endosc Int Open. 2018 Sep;6(9):E1109-E1111

Authors: Voudoukis E, Velegraki M, Khamaysi I, Karoumpalis I, Kazamias G, Fragaki M, Mastorakis E, Paspatis G

Abstract
Adrenal cystic lesions constitute a rare finding and usually are diagnosed incidentally as retroperitoneal cysts during imaging studies. A major issue, especially for the large-sized ones, is their preoperative diagnosis and management, as imaging modalities often fail to detect their exact origin prior to surgery. We report a case of a big adrenal cyst that was mistakenly diagnosed and followed up as pancreatic cystic tail tumor. Our thorough workup, which included endoscopic ultrasound (EUS), managed to delineate an adrenal gland-originated cyst and altered further management of the patient. According to our knowledge, this is the first report in literature in which EUS proved its superiority over other imaging studies in clarifying the origin of an ambiguous big retroperitoneal cyst. We believe that for cases of large retroperitoneal cystic lesions, EUS consists the optimal diagnostic and sampling tool.

PMID: 30211299 [PubMed]

A Case of Bilateral Adrenocortical Adenomas along with Virilization and Cushing's Syndrome.

Tue, 09/18/2018 - 12:31
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A Case of Bilateral Adrenocortical Adenomas along with Virilization and Cushing's Syndrome.

Intern Med. 2018 Sep 12;:

Authors: Kobayashi T, Imachi H, Sato S, Ibata T, Fukunaga K, Yoshimoto T, Kikuchi F, Yonezaki K, Yamaji N, Lyu J, Dong T, Nagata H, Kadota K, Kushida Y, Haba R, Murao K

Abstract
We herein present the case of a 27-year-old woman with clinical and biochemical features of virilism. Imaging studies revealed the presence of a bilateral adrenal tumor. Although the secretion of androgens was remarkable, the autonomous production of cortisol was also evident because of a loss of circadian rhythm and the absence of cortisol suppression by dexamethasone. The surgical excision of both adrenal tumors was performed, and the histological examination showed no malignancy. We also report the successful pregnancy and delivery of the patient who showed evolving adrenocortical insufficiency along with virilization and Cushing' s syndrome and who continued to receive glucocorticoid replacement therapy during pregnancy.

PMID: 30210105 [PubMed - as supplied by publisher]

Can Adrenal Adenomas Be Differentiated From Adrenal Metastases at Single-Phase Contrast-Enhanced CT?

Tue, 09/18/2018 - 12:31
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Can Adrenal Adenomas Be Differentiated From Adrenal Metastases at Single-Phase Contrast-Enhanced CT?

AJR Am J Roentgenol. 2018 Sep 12;:1-7

Authors: Tu W, Verma R, Krishna S, McInnes MDF, Flood TA, Schieda N

Abstract
OBJECTIVE: The purpose of this study is to evaluate whether adrenal metastases can be reliably differentiated from adenomas at single-phase contrast-enhanced CT.
MATERIALS AND METHODS: Sixty-one consecutive patients from a single-institution lung cancer registry (40 metastases and 36 adenomas) who underwent single-phase contrast-enhanced CT at baseline diagnosis were retrospectively studied by two radiologists (blinded to the diagnoses) who independently evaluated four features previously described in adenomas: smooth margin, rim enhancement, central vein sign (preserved adrenal vein), and homogeneity (using a 5-point Likert scale). A third radiologist measured size and attenuation and performed quantitative texture analysis. Comparisons were performed using chi-square, logistic regression, and ROC analysis.
RESULTS: Metastases were larger than adenomas (mean [± SD] 24 ± 11 mm [range, 11-66 mm] vs 19 ± 5 mm [range, 11-34 mm]; p = 0.012), with overlap between groups. Attenuation of metastases and adenomas did not differ significantly (58.2 ± 21.0 HU [range, 21.0-108.0] vs 55.5 ± 21.5 HU [range, 14.0-105.0]; p = 0.582). Skewness and kurtosis did not differ between groups (p = 0.612 and 0.978, respectively), whereas entropy was higher in metastases (p = 0.013). The AUC for entropy to diagnose metastases was 0.65 (95% CI, 0.52-0.77). Tumor margin, rim enhancement, and the central vein sign did not differ between groups (p > 0.05). Metastases were considered more heterogeneous by both radiologists (p = 0.001 and 0.011, respectively), and agreement was satisfactory (κ = 0.51). Likert scores of 4 or 5 (mostly or completely heterogeneous) yielded sensitivity and specificity for diagnosis of metastases of 32.5% and 97.2%, respectively, for radiologist 1 and 22.5% and 97.2%, respectively, for radiologist 2.
CONCLUSION: Adrenal metastases cannot be reliably differentiated from adenomas at single-phase contrast-enhanced CT. Increased tumor size and heterogeneity were specific findings but showed unacceptably low sensitivity.

PMID: 30207794 [PubMed - as supplied by publisher]

Vagus Nerve Stimulation at the Interface of Brain-Gut Interactions.

Tue, 09/18/2018 - 12:31
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Vagus Nerve Stimulation at the Interface of Brain-Gut Interactions.

Cold Spring Harb Perspect Med. 2018 Sep 10;:

Authors: Bonaz B, Sinniger V, Pellissier S

Abstract
The vagus nerve, a key component of the cross-communication between the gut and the brain, is a major element of homeostasis sensing the "milieu intérieur" and boosting the nervous and endocrine responses to maintain the gastrointestinal health status. This nerve has anti-inflammatory properties regulating the gut through the activation of the hypothalamic-pituitary-adrenal axis and the release of cortisol and through a vagovagal reflex, which has an anti-tumor necrosis factor (TNF) effect called the cholinergic anti-inflammatory pathway. Stimulating this nerve is an interesting tool as a nondrug therapy for the treatment of gastrointestinal diseases in which brain-gut communication is dysfunctional, such as inflammatory bowel disorders and others. This review presents the rationale of vagal gastrointestinal physiology and diseases and the most recent advances in vagus nerve stimulation. It also highlights the main issues to be addressed in the future to improve this bioelectronic therapy for gastrointestinal disorders.

PMID: 30201788 [PubMed - as supplied by publisher]

Cardiac pheochromocytoma encasing the left main coronary artery.

Tue, 09/18/2018 - 12:31
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Cardiac pheochromocytoma encasing the left main coronary artery.

J Card Surg. 2018 Apr;33(4):176-178

Authors: Alraddadi HO, Alsagheir A, Belley-Côté EP, McClure GR, Whitlock RP

PMID: 29573472 [PubMed - indexed for MEDLINE]

Recurrent epistaxis leading to diagnosis of primary sinonasal melanoma.

Tue, 09/18/2018 - 12:31
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Recurrent epistaxis leading to diagnosis of primary sinonasal melanoma.

BMJ Case Rep. 2018 Feb 16;2018:

Authors: Tawagi K, Akaraz-Avedissian R, Burman-Solovyeva I

Abstract
A 48-year-old man presented to urgent care with recurrent epistaxis over 6 months. Initially, nosebleeds were controlled with packing or cautery. Ultimately, he was referred to ear, nose and throat department and underwent nasal endoscopy which revealed polypoid tissue. A biopsy of the polyp showed non-specific inflammation with no evidence of malignancy. Follow-up maxillofacial CT revealed a large mass lesion in the right maxillary sinus, right nasal fossa, much of the ethmoids and right sphenoid, with destruction of adjacent bony structures. MRI revealed a mass in the right nasal cavity with extension into the ethmoid and anterior sphenoid sinus, anterior cranial fossa and medial orbits. Staging CT discovered metastatic disease in the adrenal glands and lymphadenopathy in the neck. The patient underwent endoscopic sinus surgery with debulking and tissue diagnosis of malignant melanoma. He completed radiation therapy to sinus and was subsequently enrolled in a clinical trial. Most recent imaging revealed complete metabolic response on positron emission tomography.

PMID: 29453209 [PubMed - indexed for MEDLINE]

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