Our experience of surgical management of 20 adrenal tumors was present during the period from June, 1988 to May, 1993. The results of clinical study were as follows ; 1. Average age of patients was 40.9 years with the highest incidence in sixth decade occupying 40% and male to female ratio was 1:1 and right to left ratio was equal also. 2. The adrenal tumors consist of 8 adrenocortical adenoma( including 3 primary aldosteronisms and 1 Cushing syndrome), 4 adrenocortical carcinoma(including 1 Cushing syndrome), 7 pheochromocytomas and l neuroblastoma. 3. The 11 functioning adrenal tumors( including 4 adrenocortical adenomas, 1 adrenocortica1 carcinoma and 6 pheochromocytomas) showed specific symptoms and signs and the majority symptom and sign of the 9 non-functioning adrenal tumors( including 4 adrenocortical adenomas, 3 adrenocortical carcinomas, 1 neuroblastoma and 1 pheochromocytoma) showed abdominal discomfort and pain. 4. For initial diagnosis of the adrenal tumors, USG, CT, MRI and angiography are reliable but IVP was reliable in large adrenal tumor 5. The surgical approaches were transperitoneal in 18 patients and retroperitoneal in 2 patients and postoperative surgical complication occurred in 3 patients of transperitoneal approaches that were prolonged ileus, spleen injury and pancreatic injury with pleural effusion.6. The tumor masses were 12gm to 4,000gm in weight (mean: 616gm). The adrenal benign and malignant tumor were significantly different in weight ( 120gm : 1817gm).
Adrenocortical Adenoma ; Adrenocortical Carcinoma ; Angiography ; Diagnosis ; Female ; Humans ; Ileus ; Incidence ; Magnetic Resonance Imaging ; Male ; Neuroblastoma ; Pheochromocytoma ; Spleen

Adrenal Cortex Neoplasms ; diagnosis ; pathology ; Adrenocortical Adenoma ; diagnosis ; pathology ; Aged ; Humans ; Immunohistochemistry ; Male ; Myxoma ; diagnosis ; pathology

OBJECTIVETo investigate the expression of chromogranin A (CgA) and synaptophysin (Syn) for differential diagnosis of different kinds of adrenal gland tumors.

METHODSThe samples of 69 adrenal gland tumors and 4 normal adrenal glands were immunohistochemically analyzed for the expression of chromogranin A and synaptophysin. The statistical analysis of the data was performed using chi-square test.

RESULTSIn the normal adrenal gland, CgA and Syn was exclusively detected in the medulla. CgA was detected in all pheochromocytomas 25/25 (100%), and gave less or no expression in adrenocortical tumors. Syn was detected in adrenocortical adenomas 27/28 (96.4%), adrenocortical carcinoma 7/8 (87.5%), pheochromocytoma 24/25 (96.0%) and adrenal metastatic carcinoma 6/8 (75.0%), respectively.

CONCLUSIONThere is statistically significant difference of CgA expression between adrenalcortical and adrenal medullary tumors, and also between benign and malignant pheochromocytomas. CgA and Syn are immunohistochemically reliable markers in the differential diagnosis of various kinds of adrenal gland tumors.

Adrenal Gland Neoplasms ; diagnosis ; metabolism ; Adrenocortical Adenoma ; diagnosis ; metabolism ; Adrenocortical Carcinoma ; diagnosis ; metabolism ; Chromogranin A ; biosynthesis ; genetics ; Diagnosis, Differential ; Female ; Humans ; Male ; Pheochromocytoma ; diagnosis ; metabolism ; Synaptophysin ; biosynthesis ; genetics

The adrenocartical carcinoma is a rare tumor with an estimated incidence of 1 case per 1,700,000 population. Despite its rarity, a large number of investigators have studied this neoplasm for the following two reasons. The First is the occasional difficulty of differentiation between careinoma and adenoma at the time of initial surgery, even by histopathologic examination. The other is its unique feature of corticosteroidogenesis. Steroid metabolism of adrenocortieal carcinoma is characterized by its low efficiency of steroid production due to deficiency of steroidogenic enzyme. The deficieney of 11 B-hydroxylase has been indieated in case of adrenoeortical carcinoma by several investigators. In this study, the serum level of cortisol was within normal range, but the serum level of 11-deoxycortisol was 50 times higher than normal. After the removal of tumor, the serum level of ll-deoxycortisol was markedly decm. In conclusion, the results from the this case suggest that measurement of serum 11-deoxy- cortisol may be a useful tool in the diagnosis and follow-up of adrenocortical carcinoma.
Adenoma ; Adrenocortical Carcinoma* ; Cortodoxone ; Diagnosis ; Follow-Up Studies ; Humans ; Hydrocortisone ; Incidence ; Metabolism ; Reference Values ; Research Personnel

This is a case report of virilizing adrenal cortical adenoma in 22 month old male patient who was diagnosed by clinical features, endocrinological studies, radiologic studies and pathologic findings. During surgery, a 40gm well-encapsulated tumor was removed from the right adrenal gland. Histologic examination revealed no capsulr invasion and a diagnosis of adrenocortical adenoma was made. He is in well condition without the clinical or laboratory evidence of recurrence at 2 years of follow up.
Adrenal Glands ; Adrenocortical Adenoma* ; Diagnosis ; Follow-Up Studies ; Humans ; Infant ; Male ; Recurrence

OBJECTIVETo investigate the clinical features of adrenocortical adenoma's diagnosis and treatment in patients aged 60 years or above.

METHODSA retrospective study was performed with a total of 249 patients aged 60 years or above who suffered from adrenocortical adenoma and treated in Peking Union Medical College Hospital from January 2004 to January 2014.The clinical features, treatments and prognosis of the 249 patients aged 60 years or above were compared with another 249 patients which were randomly selected during the same period aged from 30 to 50 years.t-test or χ(2) test was used to analyze the data between the two groups.

RESULTSEndocrine examinations were performed in all 249 patients aged 60 years or above.There were 144 patients diagnosed as non-functional adrenocortical adenoma, 94 cases as aldosterone-producing adenoma and 11 cases as Cushing adenoma.For the patients aged 60 years or above, the rate of cardio-cerebral vascular incident in non-functional adrenocortical adenoma group was 26.4%(38/144), which was significantly lower than that of the aldosterone-producing adenoma and Cushing adenoma group(54.3%, 57/105)(χ(2)=20.027, P=0.000). There were 91.5%(65/71) of the patients aged 60 years or above who got a relief in low blood potassium symptoms after the operation.Forty-nine point one percent(53/108) of the non-functional adrenocortical adenoma patients aged 60 years or above had a better control of their blood pressure level, while functional adrenocortical adenoma group were 64.0%(48/75) which indicated that the functional adrenocortical adenoma patients have a better control of their blood pressure then the non-functional adrenocortical adenoma patients after the operation(χ(2)=3.987, P=0.046). There were 37.1% of the patients aged 60 years or above whose fasting blood-glucose was higher than 7.1 mmol/L, while the patients aged from 30 to 50 years was 14.1%(χ(2)=22.02, P=0.000). The differences in plasma aldosterone and blood potassium between the patients aged 60 years or above and the patients aged from 30 to 50 years had statistical significance(t=10.48, -2.58; P=0.00, 0.01).

CONCLUSIONSMost of the adrenocortical adenoma in patients aged 60 years or above is non-functional adrenocortical adenoma.Among who, patients with aldosterone-producing adenoma tend to have lower plasma aldosterone concentration and higher blood potassium level then the patients aged from 30 to 50 years.The patients aged 60 years or above with functional adrenocortical adenoma are tend to have severe cardio-cerebral vascular incidence.A few of non-functional adrenocortical adenoma patients who combine with hypertension can benefit for the operation.

Adrenocortical Adenoma ; diagnosis ; therapy ; Adult ; Aldosterone ; metabolism ; Blood Pressure ; Humans ; Hypertension ; Middle Aged ; Prognosis ; Retrospective Studies

Our experience of surgical management with 21 adrenal tumors between September 1980 and February 1993 is presented. The patients comprised 17 functioning adrenal tumors (5 primary aldosteronisms, 4 Cushing's syndromes, 6 pheochromocytomas and 2 neuroblastomas) and 4 nonfunctioning adrenal tumors (1 adrenal cyst, 1 adrenal cortical carcinoma, 1 adrenal adenoma and 1 metastatic adrenal carcinoma). The 21 patients in these series included 3 men and 18 women. Age was ranged from 11 years to 68 years at the time of presentation (average 35.8 years). Nine tumors occurred in the left adrenal gland, eleven in right and one in bilateral. Surgical approaches to the adrenal gland were transperitoneal in 11 cases and extraperitoneal in 10 cases. Among 17 functioning adrenal tumors, 13 cases underwent unilateral adrenalectomy, and 3 cases underwent unilateral adrenalectomy with nephrectomy. One case of pheochromocytoma underwent bilateral adrenalectomy. Among 4 non-functioning adrenal tumors, one case underwent unilateral adrenalectomy and 3 cases underwent unilateral adrenalectomy with nephrectomy. Operative complications occurred in 2 cases. One case with pneumothorax and the other case with electrolyte abnormality. The use of advanced radiographic and laboratory procedures results in the refinement of diagnosis and localization of tumors, enabling better surgical management of adrenal tumors. But some of underlying diseases should be differentiated by pathologic confirmation.
Adenoma ; Adrenal Glands ; Adrenalectomy ; Adrenocortical Carcinoma ; Diagnosis ; Female ; Humans ; Male ; Nephrectomy ; Pheochromocytoma ; Pneumothorax

Cushings syndrome in pregnancy is rare. This is explained by the syndromes association with amencerhea, infertility and abortions. Matemal and fetal risks increase markedly when pregnancy does occur in woman with hypercortisolism. Since pregnant women without Cushings syndrome develop some features of Cushings syndrome, such as hypertension, hyperglycemia and striae, a high index of clinical suspician must be maintained to prevent delay in diagnosis. The physiologic changes in adrenocorticostemid metabolism during pregnancy further complieate the diagnosis. We describe a case of Cushings syndmme in pregnancy secondary to an adrenal cortical adenoma which was diagnosed immediately after a preterm delivery in 24-year-old woman with preeclampsia.
Adenoma* ; Adrenocortical Adenoma ; Cushing Syndrome* ; Diagnosis ; Female ; Humans ; Hyperglycemia ; Hypertension ; Infertility ; Metabolism ; Pre-Eclampsia ; Pregnancy* ; Pregnant Women ; Young Adult

We report a case of a 74-year-old female with myxoid adrenocortical adenoma which showed different magnetic resonance imaging findings compared to those of a typical adrenocortical adenoma. The myxoid change in the adrenocortical adenoma is a rare form of degeneration. It presents a considerable diagnostic challenge to both radiologists and clinicians because it can mimic other adrenal tumor types on imaging. The MRI findings of the presented case included a high signal intensity on T2-weighted images similar to that of fluid and delayed progressive enhancement.
Adenoma/*diagnosis/pathology ; Adrenal Gland Neoplasms/*diagnosis/pathology ; Adrenocortical Adenoma/*diagnosis/pathology ; Aged ; Diagnosis, Differential ; Female ; Humans ; Magnetic Resonance Imaging ; Rare Diseases/*diagnosis/pathology

To investigate the diagnosis and surgical treatment of adrenocortical oncocytoma. The clinical data from three cases of adrenocortical oncocytomas (ACOs) were retrospectively analyzed and discussed in light of the relevant literature. In these three cases, one presented with virilization, while the other two cases had no typical clinical features. The tumor was completely encapsulated and was non-invasive. Microscopically, the tumor cells showed neither mitosis nor necrosis, with abundant eosinophilic cytoplasm. No recurrence or metastasis was discovered after close follow-up observation for 12-24 months. Adrenocortical ACOs are rather rare, and most of them are benign. It was hard to make a confirmed diagnosis of ACOs before surgery. Resection of tumor is the best choice, and close follow-up observation is essential.
Adenoma, Oxyphilic ; diagnosis ; pathology ; surgery ; Adrenal Cortex Neoplasms ; diagnosis ; pathology ; surgery ; Adrenocortical Adenoma ; diagnosis ; pathology ; surgery ; Child ; Female ; Humans ; Middle Aged