Humans ; Aldosterone ; Hyperaldosteronism/diagnosis* ; Adrenal Gland Neoplasms/complications* ; Adenoma/diagnosis*

Aldosterone ; blood ; Humans ; Hyperaldosteronism ; classification ; diagnosis ; Hypertension ; complications ; Mass Screening ; Renin ; blood ; Renin-Angiotensin System

The metabolic alterations caused by hyperaldosteronism are being increasingly recognized and have generated considerable interest among the medical fraternity. Hyperaldosteronism is suspected to have a pivotal role in the patho-physiology of congestive cardiac failure where it has been studied extensively. But its effects on calcium metabolism, parathyroid metabolism and renal handling of calcium are less well described. Recent experimental models have shed light into the roles played by previously unknown mechanisms in causing these metabolic alterations. We hereby report a case of primary hyperaldosteronism due to adrenal adenoma (Conn's syndrome) who presented with a myriad of clinical features including symptomatic hypocalcemia, significant weight loss along with uncontrolled hypertension for a prolonged period before eventually detected to have primary hyperaldosteronism. Surgical removal of the causative tumor resulted in prompt disappearance of all the symptoms and signs and regain of lost weight.
Adrenal Cortex Neoplasms/*complications/diagnosis/pathology/surgery ; Adrenocortical Adenoma/*complications/diagnosis/pathology/surgery ; Adult ; Female ; Humans ; *Hyperaldosteronism/complications/etiology/physiopathology ; Hypocalcemia/*etiology ; Pregnancy ; Treatment Outcome

The coexistence of myelolipoma within adrenal cortical adenoma is extremely rare, for both tumors present usually as separate entities. There are only 16 such cases reported worldwide. To the best of our knowledge, the case we reported here is the first one of myxoid adrenal cortical adenoma associated with myelolipoma reported. A 32-year-old Chinese woman with 4-year history of hypertension was presented in our study. Computed tomography (CT) of the abdomen showed a large heterogeneously-enhancing mass (4.5 cm in diameter) in the left suprarenal region. Clinical history and laboratory results suggest a metabolic disorder as Conn's syndrome. The patient underwent a left adrenalectomy, and a histopathological study confirmed the mass to be a myxoid adrenal cortical adenoma containing myelolipoma. The patient was postoperatively well and discharged uneventfully. In the present case report, we also discuss the etiology of simultaneous myelolipoma and adrenal adenoma associated with Conn's syndrome, and the methods of the diagnosis and differential diagnosis.
Adrenal Cortex Neoplasms ; complications ; diagnosis ; pathology ; Adrenocortical Adenoma ; complications ; diagnosis ; pathology ; Adult ; Biomarkers, Tumor ; metabolism ; Female ; Humans ; Hyperaldosteronism ; complications ; Inhibins ; metabolism ; Myelolipoma ; complications ; diagnosis ; pathology ; Neoplasms, Multiple Primary ; complications ; diagnosis ; pathology ; Synaptophysin ; metabolism ; Tomography, X-Ray Computed ; Vimentin ; metabolism

No abstract available.
Adrenal Cortex Neoplasms/*complications/diagnosis/surgery ; Adrenalectomy ; Adrenocortical Adenoma/*complications/diagnosis/surgery ; Adult ; Biopsy ; Coronary Angiography ; Drug-Eluting Stents ; Humans ; Hyperaldosteronism/diagnosis/*etiology ; Male ; Myocardial Infarction/diagnosis/*etiology/therapy ; Percutaneous Coronary Intervention/instrumentation ; Tomography, X-Ray Computed ; Treatment Outcome

PURPOSE: We present a single surgeon experience of 52 cases of transperitoneal laparoscopic adrenalectomy for various adrenal diseases. MATERIALS AND METHODS: Transperitoneal laparoscopic adrenalectomy (n= 52) for various adrenal diseases was performed by a single surgeon from February 1998 to December 2004. Clinical diagnosis of the subjects included 17 cases of primary aldosteronism, 11 of adrenal adenoma causing Cushing's syndrome, 3 of pheochromocytoma and 21 of nonfunctioning adenoma. The 52 patients were divided into 3 groups according to the time when operations were performed: early group of 18 patients, intermediate group of 17 patients, and late group of 17 patients. The mean operative time, mean estimated blood loss (EBL) and complication of each group were investigated to analyze the single surgeon's learning curve. RESULTS: All laparoscopic adrenalectomies were successfully completed in all 52 patients. The mean operative time, mean EBL, mean tumor size, and mean postoperative hospital stay were 124 minutes (60-360), 56cc (30-300), 2.7cm (1-4.7), and 3.8 days (3-8), respectively. The mean time to solid diet and ambulation were 1.5 days and 1 day, respectively. There was no serious intraoperative or postoperative complication. Statistically, the mean operative time and estimated blood loss showed a significant reduction in the intermediate and late group compared with the early group. CONCLUSIONS: Our results showed that transperitoneal laparoscopic adrenalectomy is a safe and effective surgical treatment modality in adrenal diseases.
Adenoma ; Adrenal Gland Diseases ; Adrenalectomy* ; Cushing Syndrome ; Diagnosis ; Diet ; Humans ; Hyperaldosteronism ; Laparoscopy ; Learning Curve ; Length of Stay ; Operative Time ; Pheochromocytoma ; Postoperative Complications ; Walking

OBJECTIVETo investigate the experience on diagnosis and treatment of multiple adrenal aldosterone-producing adenomas (APA).

METHODSEighteen cases of multiple adrenal APA were analyzed retrospectively, which were admitted from October 1992 to April 2006.

RESULTSAdrenalectomy was performed for 4 cases of unilateral synchronous multiple APA, which were discovered with three adenomas by 3D-CT; bilateral tumor resection was performed for 6 cases of bilateral synchronous multiple APA. There were 8 cases of bilateral metachronous multiple APA, including 2 cases of ipsilateral recurrent adrenal APA after adrenal tumor removal, which underwent tumor resection. Another 6 cases were contralateral APA following adrenalectomy due to adrenal APA, and underwent tumor resection. After operation, the adrenal function seemed to be normal, and no recurrence had been found on follow-up.

CONCLUSIONSUnilateral multiple synchronous APA require adrenalectomy. Tumor resection should be performed for bilateral or asynchronous APA, and it is very important to preserve healthy adrenal tissue as much as possible. 3D-CT has much value on diagnosis of small APA, unilateral multiple synchronous APA and ipsilateral recurrent adrenal APA.

Adenoma ; complications ; diagnosis ; surgery ; Adrenal Gland Neoplasms ; complications ; diagnosis ; surgery ; Adrenalectomy ; Adult ; Aldosterone ; blood ; Female ; Follow-Up Studies ; Humans ; Hyperaldosteronism ; blood ; etiology ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed

Multiple endocrine neoplasia type 1 (MEN1) syndrome includes varying combinations of endocrine and non-endocrine tumors. There are also a considerable number of atypical MEN1 syndrome. In this case, a 68-yr-old woman was referred to the Department of Endocrinology for hypercalcemia. Five years ago, she had diagnosed as primary hyperaldosteronism and now newly diagnosed as parathyroid hyperplasia with laboratory and pathologic findings. Hurthle-cell thyroid cancer was also resected during the parathyroid exploration and small meningioma was found on brain MRI. Her general condition has markedly improved and her adrenal mass and meningioma are being closely observed now. We could find the loss of heterozygosity of the MEN1 locus in parathyroid glands, suggesting a MEN1-related tumor, but not a germline mutation. Considering a variety of phenotypic expression and a limitation of current molecular analysis, periodic follow up will be needed in patients with a MEN1-like phenotype.
Aged ; Base Sequence ; Brain/radionuclide imaging ; Female ; Humans ; Hyperaldosteronism/complications/*diagnosis ; Hyperparathyroidism, Primary/*diagnosis/etiology/pathology ; Loss of Heterozygosity ; Magnetic Resonance Imaging ; Meningeal Neoplasms/complications/*diagnosis/radionuclide imaging ; Meningioma/complications/*diagnosis/radionuclide imaging ; Mutation ; Parathyroid Glands/pathology ; Proto-Oncogene Proteins/genetics/metabolism ; Sequence Analysis, DNA ; Thyroid Neoplasms/complications/*diagnosis/pathology ; Tomography, X-Ray Computed

Secondary hypertension occurs in a significant proportion of adult patients (~10%). In young patients, renal causes (glomerulonephritis) and coarctation of the aorta should be considered. In older patients, primary aldosteronism, obstructive sleep apnoea and renal artery stenosis are more prevalent than previously thought. Primary aldosteronism can be screened by taking morning aldosterone and renin levels, and should be considered in patients with severe, resistant or hypokalaemia-associated hypertension. Symptoms of obstructive sleep apnoea should be sought. Worsening of renal function after starting an angiotensin-converting enzyme inhibitor suggests the possibility of renal artery stenosis. Recognition, diagnosis and treatment of secondary causes of hypertension lead to good clinical outcomes and the possible reversal of end-organ damage, in addition to blood pressure control. As most patients with hypertension are managed at the primary care level, it is important for primary care physicians to recognise these conditions and refer patients appropriately.
Aldosterone ; blood ; Angiotensin-Converting Enzyme Inhibitors ; therapeutic use ; Aortic Coarctation ; complications ; diagnosis ; Blood Pressure ; Glomerulonephritis ; complications ; diagnosis ; Humans ; Hyperaldosteronism ; diagnosis ; Hypertension ; complications ; diagnosis ; therapy ; Primary Health Care ; methods ; Referral and Consultation ; Renal Artery Obstruction ; drug therapy ; Renin ; blood ; Sleep Apnea, Obstructive ; complications

OBJECTIVEIn recent years, the assessment of the plasma aldosterone-to-renin ratio (ARR) has become a most effectively and commonly used method for screening primary aldosteronism from hypertensive patients. It is known that there is a large variance in ARR value between races and ARR is affected by many factors, such as drugs, posture and serum potassium etc. The objective of this study is to establish the threshold of ARR for screening primary aldosteronism in Chinese hypertensive patients.

METHODSA total of 110 hypertensive patients were recruited and divided into essential hypertension group (n=65) and adenoma/hyperplasia group (n=45) according to the adrenal contrast CT scan. Antihypertensive drugs which can affect ARR such as beta-blockers, dihydropyridine calcium channel blockers (CCBs), ACE inhibitors (ACEIs), angiotensin II receptor blockers (ARBs) and clonidine, were withdrawn for at least 2 weeks. Washout period for diuretics including spironolactone were 4 weeks. Non-dihydropyridine calcium channel blockers (slow released verapamil) and/or alpha-blocker (terazosin) are allowed for controlling blood pressure when needed. If the serum potassium value<3.6 mmol/L, an oral potassium supplement was prescribed. After keeping upright position for 2 hours, blood samples were drawn for PRA and PAC measurement between 9:00AM-10:00AM.

RESULTSARR was 100.00+/-48.65 (14.19-285.16) pg/ml vs ngxml-1xh-1 in patients with essential hypertension and 699.33+/-213.33 (185.8-2150) pg/ml vs ngxml-1xh-1 in patients with adenoma/hyperplasia. ARR value was greater than 240 in 42 out of 45 patients (93.3%) with adenoma/hyperplasia and was less than 240 in 59 out of 65 (90.7%) patients with essential hypertension. We used ARR 240 as the cut-off threshold for screening primary aldosteronism in another 178 hypertensive patients and ARR was greater than 240 in all 15 patients with confirmed primary aldosteronism.

CONCLUSIONIt is suitable to use upright ARR 240 as a cut-off threshold for screening primary aldosteronism in Chinese hypertensive patients.

Adult ; Aged ; Aldosterone ; blood ; China ; epidemiology ; Clinical Chemistry Tests ; statistics & numerical data ; Female ; Humans ; Hyperaldosteronism ; diagnosis ; epidemiology ; Hypertension ; complications ; epidemiology ; Male ; Mass Screening ; Middle Aged ; Potassium ; blood ; Reference Values ; Renin ; blood ; Renin-Angiotensin System