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Percutaneous adrenalectomy

Satoshi Yoshiji, Kimitaka Shibue, Toshihito Fujii, Takeshi Usui, Keisho Hirota, Daisuke Taura, Mayumi Inoue, Masakatsu Sone, Akihiro Yasoda, Nobuya Inagaki
RATIONALE: Unilateral adrenalectomy as part of surgical resection of renal cell carcinoma (RCC) is not thought to increase the risk of chronic adrenal insufficiency, as the contralateral adrenal gland is assumed to be capable of compensating for the lost function of the resected gland. However, recent studies have indicated that adrenalectomy might cause irreversible impairment of the adrenocortical reserve. We describe a case of chronic primary adrenal insufficiency in a 68-year-old man who previously underwent unilateral adrenonephrectomy, which was complicated by severe postoperative adrenal stress that involved cardiopulmonary disturbance and systemic infection...
December 2017: Medicine (Baltimore)
Chrystal Chan, James Mark Roberts
Ectopic adrenocorticotropic hormone (ACTH)-related Cushing's syndrome can lead to multiple complications including severe immunosuppression. If the ACTH-secreting tumour cannot be found, definitive treatment is surgical adrenalectomy, typically followed by glucocorticoid replacement. Here, we present a case of fulminant respiratory failure secondary to coinfection with Pneumocystis jirovecii and cytomegalovirus in a patient with ectopic ACTH-dependent Cushing's syndrome with occult primary. Due to significant deconditioning, she was unable to undergo definitive adrenalectomy and instead underwent percutaneous microwave ablation of the adrenal glands...
November 14, 2017: BMJ Case Reports
S Y Liu, C M Chu, A P Kong, S K Wong, P W Chiu, F C Chow, E K Ng
BACKGROUND: Radiofrequency ablation (RFA) is an emerging treatment for primary aldosteronism owing to aldosterone-producing adenoma. Whether RFA could be an alternative treatment to laparoscopic adrenalectomy is unknown. METHODS: This was a retrospective comparative study in patients with aldosterone-producing adenoma undergoing either laparoscopic adrenalectomy or CT-guided percutaneous RFA between 2004 and 2012. Short-term outcomes and long-term resolution rates of primary aldosteronism (normalized aldosterone to renin ratio), hypokalaemia and hypertension (BP lower than 140/90 mmHg without antihypertensive medical therapy) were evaluated...
October 2016: British Journal of Surgery
Min-Hsin Yang, Yeu-Sheng Tyan, Yu-Hui Huang, Shao-Chuan Wang, Sung-Lang Chen
PURPOSE: To retrospectively compare the safety and efficacy of radiofrequency ablation (RFA) with laparoscopic adrenalectomy (LA) in treating aldosterone-producing adenoma (APA) of the adrenal gland. MATERIALS AND METHODS: From September 2009 to September 2013, seven patients, diagnosed with unilateral adrenal APA and underwent computed tomography (CT)-guided percutaneous RFA, were recruited in this retrospective study. Eighteen unilateral adrenal APA with the same tumor size (<25 mm) who underwent LA during the same interval were enrolled as control group...
October 2016: La Radiologia Medica
Ammar Sarwar, Olga R Brook, Anand Vaidya, Ari C Sacks, Barry A Sacks, S Nahum Goldberg, Muneeb Ahmed, Salomao Faintuch
PURPOSE: To compare adrenal radiofrequency (RF) ablation with adrenalectomy in treating unilateral aldosterone-producing adenoma (APA). MATERIALS AND METHODS: Between April 2008 and September 2013, 44 patients with adrenal venous sampling-confirmed (lateralization index ≥ 4) unilateral APA underwent adrenal RF ablation (12/44 [27%]) or adrenalectomy (32/44 [73%]). Outcomes of adrenal RF ablation (patient age, 51 y ± 11; 4/12 men) were compared with adrenalectomy (patient age, 50 y ± 11; 19/32 men)...
July 2016: Journal of Vascular and Interventional Radiology: JVIR
Harish Venugopal, Katherine Griffin, Saima Amer
UNLABELLED: Resection of primary tumour is the management of choice in patients with ectopic ACTH syndrome. However, tumours may remain unidentified or occult in spite of extensive efforts at trying to locate them. This can, therefore, pose a major management issue as uncontrolled hypercortisolaemia can lead to life-threatening infections. We present the case of a 66-year-old gentleman with ectopic ACTH syndrome from an occult primary tumour with multiple significant complications from hypercortisolaemia...
2015: Endocrinology, Diabetes & Metabolism Case Reports
Asha Sarma, Paul B Shyn, Mark A Vivian, Ju-Mei Ng, Kemal Tuncali, Jorchen H Lorch, Sarah N Zaheer, Michael S Gordon, Stuart G Silverman
Bilateral adrenalectomy is currently the only available treatment for adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome (ectopic ACTH syndrome) that is refractory to pharmacologic therapy. We describe two patients with refractory ectopic ACTH syndrome who were treated with CT-guided percutaneous microwave ablation of both hyperplastic adrenal glands in a single session: O ne was not a surgical candidate, and the other had undergone unsuccessful surgery. Following the procedure, both patients achieved substantial decreases in serum cortisol, symptomatic improvement, and decreased anti-hypertensive medication requirements...
October 2015: Cardiovascular and Interventional Radiology
Hassan Shawa, Mandeep Bajaj, Glenn R Cunningham
Pheochromocytoma should be considered in young patients who have acute cardiac decompensation, even if they have no history of hypertension. Atrioventricular node ablation and pacemaker placement should be considered for stabilizing pheochromocytoma patients with cardiogenic shock due to atrial tachyarrhythmias. A 38-year-old black woman presented with cardiogenic shock (left ventricular ejection fraction, <0.15) that did not respond to the placement of an intra-aortic balloon pump. A TandemHeart(®) Percutaneous Ventricular Assist Device was inserted emergently...
December 2014: Texas Heart Institute Journal
Koichiro Yamakado
Although laparoscopic adrenalectomy has remained the standard of care for the treatment for adrenal tumors, percutaneous image-guided ablation therapy, such as chemical ablation, radiofrequency ablation, cryoablation, and microwave ablation, has been shown to be clinically useful in many nonsurgical candidates. Ablation therapy has been used to treat both functioning adenomas and malignant tumors, including primary adrenal carcinoma and metastasis. For patients with functioning adenomas, biochemical and symptomatic improvement is achieved in 96 to 100% after ablation; for patients with malignant adrenal neoplasms, however, the survival benefit from ablation therapy remains unclear, though good initial results have been reported...
June 2014: Seminars in Interventional Radiology
Ashray Gunjur, Cuong Duong, David Ball, Shankar Siva
BACKGROUND: We systematically reviewed the literature on the use of surgery, stereotactic ablative body radiotherapy (SABR) and percutaneous catheter ablation (PCA) techniques for the treatment of adrenal metastases to develop evidence-based recommendations. METHODS: A systematic review of the MEDLINE database was performed using structured search terms following PRISMA guidelines. Eligible publications were those published from 1990 to 2012, written in English, had at least five patients treated for adrenal metastasis and reported on patient clinical outcomes (local control, survival and treatment related complications/toxicity)...
August 2014: Cancer Treatment Reviews
Tomohide Hori, Kentaro Yamagiwa, Tadataka Hayashi, Shintaro Yagi, Taku Iida, Kentaro Taniguchi, Yoshifumi Kawarada, Shinji Uemoto
Malignant pheochromocytoma accounts for approximately 10% of pheochromocytoma cases. The main site of distant metastasis is the liver. Hypertensive crisis due to catecholamine oversecretion is potentially fatal. We present a case of malignant pheochromocytoma with multiple liver metastases. A 60-year-old female with repeated hypertensive episodes was diagnosed with malignant pheochromocytoma. She underwent a left adrenalectomy and partial hepatectomy with resection of segment 6. Catecholamine levels remained high after surgery and she received repeated cycles of chemotherapy...
November 27, 2013: World Journal of Gastrointestinal Surgery
P Sèbe, J Rigaud, C Avancès, L Brunaud, C Caillard, P Camparo, B Carnaille, X Durand, A Fléchon, T Murez, M Mathonnet, F Triponez, E Mirallié, P Coloby, M Soulié
INTRODUCTION: Malignant tumours of the adrenal gland are adrenocortical carcinomas (ACC), malignant phaeochromocytomas (MPC) or metastatic tumours. The objective of this article is to propose guidelines for the management of these tumours. MATERIAL AND METHODS: A review of the literature was performed by selecting articles on malignant tumours of the adrenal gland published in PUBMED. RESULTS: Abdominal computed tomography is the reference first-line examination...
November 2013: Progrès en Urologie
W Zachary Stone, David C Wymer, Benjamin K Canales
BACKGROUND AND PURPOSE: Positron-emission tomography/computed tomography (PET/CT) with fluorine-18 fluorodeoxyglucose (FDG) is used as first-line staging for patients with newly diagnosed non-small cell lung cancer (NSCLC). Our purpose was to review the accuracy of FDG-PET/CT to predict adrenal gland metastasis, explain the causes for false-positive PET, and provide a diagnostic algorithm. PATIENTS AND METHODS: Two patients with incidentally discovered lung masses were found to have hypermetabolic adrenal activity by FDG-PET/CT with maximal standard uptake value (SUV) of 4...
January 2014: Journal of Endourology
Sunil Kumar Kota, Siva Krishna Kota, Lalit Kumar Meher, Sruti Jammula, Sandip Panda, Kirtikumar D Modi
BACKGROUND: Pheochromocytoma/paragangliomas have been described to be associated with rare vascular abnormalities like renal artery stenosis. Coexistence of physiologically significant renal artery lesions is a compounding factor that alters management and prognosis of pheochromocytoma patients. Apart from individual case reports, data on such association in Indian population is not available. The aim of this study is to find the nature and prevalence of associated vascular abnormalities...
November 2012: Indian Journal of Endocrinology and Metabolism
Akira Sasaki, Shigeaki Baba, Toru Obuchi, Akira Umemura, Masaru Mizuno, Go Wakabayashi
INTRODUCTION: Single-port laparoscopic adrenalectomy is one of the most interesting surgical advances. Here, we evaluate the safety and feasibility of single-port laparoscopic adrenalectomy as treatment for a right-sided aldosterone-producing adenoma. CASE PRESENTATION: A 39-year-old Japanese woman presented with hypertension and hypokalemia. Abdominal computed tomography and an endocrinological workup revealed a 19mm right adrenal tumor with primary aldosteronism...
2012: Journal of Medical Case Reports
Fan-Chi Chang, Kao-Lang Liu, Kuo-How Huang, Vin-Cent Wu, Yen-Hung Lin, Yung-Ming Chen, Kwan-Dun Wu
Adrenalectomy is the definite treatment for aldosterone-producing adenoma (APA). Percutaneous ethanol or acetic acid injection with computed tomography (CT) guidance has been described as a safe, noninvasive, and effective alternative treatment modality in patients with high surgical risk. We report on a man who was 49 years of age and presented with treatment-resistant hypertension and was later diagnosed with APA. CT-guided percutaneous ethanol injection (PEI) was performed for this high surgical risk patient...
March 2012: Journal of the Formosan Medical Association, Taiwan Yi Zhi
Ziyad Alguraan, Orhan Agcaoglu, Kevin El-Hayek, Amir H Hamrahian, Allan Siperstein, Eren Berber
OBJECTIVE: To report 10 cases of neoplasms that were initially thought to be primarily adrenal-derived masses but were later confirmed as tumors of a different origin. METHODS: Between 2000 and 2011, a total of 229 patients underwent adrenalectomy at our institution. Of this overall group, 10 patients had retroperitoneal pathologic conditions mimicking adrenal tumors. Using an institutional review board-approved database, we reviewed the clinical, biochemical, and radiologic characteristics of these 10 patients...
May 2012: Endocrine Practice
Yoshiyuki Nakajima, Naoki Masaoka, Masako Sodeyama, Yoko Tsuduki, Masato Sakai
We report a rare case of pheochromocytoma-related cardiomyopathy during the preterm period. The patient was a 33-year-old woman who was referred to our hospital at 34 weeks' gestation. Her pulse was 130 beats/min, blood pressure of 186/90 mmHg and oxygen saturation was 30-40%. Fetal bradycardia prompted an emergency cesarean section and, nine minutes after admission, a boy weighing 2774 g was delivered with Apgar scores of 2 at 1 min and 5 at 5 min. A preoperative echocardiogram showed reduced fractional shortening of 19%...
July 2011: Journal of Obstetrics and Gynaecology Research
Shirley Yuk-Wah Liu, Enders Kwok-Wai Ng, Paul Sing-Fun Lee, Simon Kin-Hung Wong, Philip Wai-Yan Chiu, Wilfred Lik-Man Mui, Wing-Yee So, Francis Chun-Chung Chow
OBJECTIVE: To evaluate the safety and efficacy of radiofrequency ablation (RFA) in treating primary aldosteronism (PA) due to aldosterone-producing adenoma (APA). BACKGROUND: Radiofrequency ablation is an established technique for treating malignant solid organ neoplasm. Its application on benign functional adrenal adenoma has never been prospectively described. METHODS: We prospectively evaluated a patient cohort with computed tomography (CT)-guided percutaneous RFA performed on functional APA of size 4 cm or less...
December 2010: Annals of Surgery
Michael Nguyen Quang, Bernd Krüger, Christopher D Krüger, Andreas Walberer, Bernhard Schenck, Klaus Kisters, Martin Wenning, Bernhard K Krämer
BACKGROUND: Secondary hypertension can rarely be caused by different disorders as shown in the present case with simultaneous occurrence of two possible causes. CASE REPORT: Magnetic resonance imaging findings of a 58-year-old patient showed an eccentric left renal artery stenosis of 60-70% and an inhomogeneous tumor of the left adrenal gland. After percutaneous transluminal angioplasty, elevated plasma aldosterone concentrations persisted. Adrenal vein sampling in the authors' hospital confirmed a primary hyperaldosteronism due to unilateral adenoma...
April 2010: Medizinische Klinik
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