1/149. Posttraumatic hypertension secondary to adrenal hemorrhage mimicking pheochromocytoma: case report.We report the case of a 68-year-old man who presented with a mass 3 x 4 cm in size located in the right adrenal gland together with extreme hypertension, tripled urine levels for normetanephrine, and normal plasmatic levels of metanephrines. The patient had suffered a fall from a height of 2.5 meters before hospitalization. [123I]MIBG-scan was repeatedly positive in the area of the right adrenal gland. At laparotomy under alpha-adrenergic blocking agents, the suspected pheochromocytoma was histologically confirmed as hematoma. After resection of the adrenal gland, blood pressure returned to normal without drug therapy as did metanephrine levels in urine. Although adrenal insufficiency after distension of the gland caused by hemorrhage has been reported, there are no data available regarding the mimicking of a hormonally active pheochromocytoma. We conclude that intra-adrenal pressure rise caused by hematoma may cause partial ischemic necrosis to the gland but may also induce reactive hyperplasia with periodic excessive secretion of catecholamines. This interpretation is consistent with the finding that plasma levels of catecholamines were normal in contrast to the urinary normetanephrines in the presented case. It might be worthwhile to investigate patients with intra-adrenal hemorrhage immediately after sustaining multiple injuries and in the posttraumatic course of several months up to 1 or more years together with verification of abnormal urinary excretion of metanephrines as a sign of impaired adrenal function.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
2/149. Multicentric warfarin-induced skin necrosis complicating heparin-induced thrombocytopenia.Two patients developed catastrophic multicentric skin necrosis while receiving warfarin to treat venous thromboembolism complicated by immune-mediated heparin-induced thrombocytopenia (HIT). Patient 1 developed skin necrosis involving the breasts, thighs, and face, as well as venous limb gangrene and bilateral hemorrhagic necrosis of the adrenal glands, resulting in death. The second patient developed bilateral mammary necrosis necessitating mastectomies, as well as skin necrosis involving the thigh. Neither patient had an identifiable hypercoagulable syndrome, other than HIT. HIT may represent a risk factor for the development of multicentric warfarin-induced skin necrosis (WISN).- - - - - - - - - - ranking = 0.2keywords = gland (Clic here for more details about this article) |
3/149. Haemorrhage into non-functioning adrenal cysts--report of two cases and review of the literature.Adrenal cysts are a rare condition and are usually non-functioning and asymptomatic. Most of the reported cases were incidental findings or discovered at autopsy. However, large cysts have a tendency to develop complications such as intracystic haemorrhage and rupture, which can present as an acute surgical emergency. We report two cases of adrenal cysts with intracystic haemorrhage. One patient presented with persistent non-specific upper abdominal pain, investigations with ultrasound (US) scan and computed tomographic (CT) scan revealed a left adrenal cyst and gallstones. Simultaneous cholecystectomy and adrenalectomy was performed with resultant relief of symptoms. The second patient presented with acute abdominal pain simulating acute surgical abdomen. Preoperative CT scan showed a large cystic lesion in the region of the tail of the pancreas with radiological evidence of haemorrhage but was unable to confirm its origin. The cyst was found to have arisen from the left adrenal gland at laparotomy; left adrenalectomy with complete excision of the cyst was done. histology showed pseudocyst with haemorrhage in both cases. Pseudocyst is the commonest histological type encountered clinically. We believe the second case is related to pregnancy and childbirth as the patient presented during puerperium and the cyst, even though very large in size (25 x 15 x 15 cm), was not noted during antenatal screening with US scan.- - - - - - - - - - ranking = 0.2keywords = gland (Clic here for more details about this article) |
4/149. Acute adrenal crisis in a patient treated with intraarticular steroid therapy.Intraarticular therapy with corticosteroids can cause systemic effects such as decreased concentration of plasma cortisol, but whether this might place a patient at risk from stress induced acute adrenal failure is not known. We describe a patient who presented with lethargy, hyponatremia, and then with acute abdomen. The diagnosis of acute adrenal crisis was related to suppression of the hypothalamic-pituitary-adrenal axis by intraarticular use of corticosteroid. This was confirmed by a low basal cortisol concentration and by a short Synacthen test that elicited an increase in plasma cortisol concentration from 36 to 481 nmol/l. Within 24 h of receiving 37.5 mg of hydrocortisone, the patient rapidly improved.- - - - - - - - - - ranking = 0.0015913907711564keywords = pituitary (Clic here for more details about this article) |
5/149. The incidentally discovered asymptomatic adrenal tuberculous mass mimicking malignancy.Tuberculous adrenal mass without any tuberculous changes in other sites is a rare entity. In this study we describe such a case. A male patient of 47 years with 6 months history of anorexia and weakness was presented. ultrasonography and computed tomography revealed a mass in the right adrenal gland. It was mistaken as a malignant neoplasm and the diagnosis was confirmed by surgical exploration.- - - - - - - - - - ranking = 0.2keywords = gland (Clic here for more details about this article) |
6/149. Traumatic adrenal injury in children.BACKGROUND: Multiple organ injury in children is an increasingly frequent phenomenon in the modern emergency room. Adrenal hemorrhage associated with this type of trauma has received little attention in the past. OBJECTIVES: Using computed tomography, we sought to determine the rate and nature of adrenal gland injury in children following blunt abdominal trauma due to motor vehicular accident. methods: A total of 121 children with blunt abdominal trauma were examined and total body CT was performed in cases of multi-organ trauma or severe neurological injury. RESULTS: Of all the children who presented with blunt abdominal trauma over a 51 month period, 6 (4.95%) had adrenal hemorrhage. In all cases only the right adrenal gland was affected. Coincidental injury to the chest and other abdominal organs was noted in 66.7% and 50% of patients, respectively. CONCLUSIONS: Traumatic adrenal injury in the pediatric population may be more common than previously suspected. Widespread application of the more sophisticated imaging modalities available today will improve the detection of damage to the smaller organs in major collision injuries and will help in directing attention to the mechanism of trauma.- - - - - - - - - - ranking = 0.4keywords = gland (Clic here for more details about this article) |
7/149. Delayed posttraumatic adrenal hematoma.Posttraumatic adrenal hemorrhage is a frequent finding after severe abdominal trauma and can have important clinical implications if it is bilateral. With the increased use of helical CT in the evaluation of trauma patients, posttraumatic adrenal hematoma is more frequently diagnosed. We present the CT findings of a unilateral posttraumatic adrenal hemorrhage where the diagnostic findings only appeared in the follow-up study. We think that mild enlargement of the adrenal gland in a trauma patient can be an early sign of an impending adrenal hemorrhage.- - - - - - - - - - ranking = 0.2keywords = gland (Clic here for more details about this article) |
8/149. An unusual cause of Cushing's syndrome: primary pigmented nodular adrenal dysplasia.We report a case of Cushing's syndrome due to primary pigmented nodular adrenal dysplasia (PPNAD) and discuss the diagnostic process and management of this rare case. The diagnosis of PPNAD is discussed in the context of other causes of Cushing's syndrome. Eighty-five per cent of cases of Cushing's syndrome are due to a pituitary corticotrophic tumour (Cushing's disease). Rarer causes include cortisol secreting adrenal adenoma and ectopic ACTH secretion. In the routine investigation of Cushing's disease it is not unusual to find bilateral adrenal nodules on the CT scan. We present a case of Cushing's syndrome in which this radiographic finding was present and yet the biochemical diagnosis was one of ACTH independent disease. histology revealed PPNAD.- - - - - - - - - - ranking = 0.0015913907711564keywords = pituitary (Clic here for more details about this article) |
9/149. Isolated hydatid cyst of the adrenal gland.Hydatide disease of the adrenal gland is extremely rare, even in disseminated disease. Isolated cyst of the gland is even more rare. Only 9 of such cases seem to have been described so far. We present a 49 year old woman in whom a hydatide cyst of the right gland was found during the investigation for the dull pain in the area. She was successfully operated. Hydatide etiology was confirmed at operation and by histology. She had an uneventful recovery. The preoperative pain disappeared postoperatively.- - - - - - - - - - ranking = 1.4keywords = gland (Clic here for more details about this article) |
10/149. Apparently normal ovarian differentiation in a prepubertal girl with transcriptionally inactive steroidogenic factor 1 (NR5A1/SF-1) and adrenocortical insufficiency.steroidogenic factor 1 (NR5A1/SF-1) plays an essential role in the development of the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-gonadal axes, controlling expression of their many important genes. The recent description of a 46,XY patient bearing a mutation in the NR5A1 gene, causing male pseudohermaphroditism and adrenal failure, demonstrated the crucial role of SF-1 in male gonadal differentiation. The role of SF-1 in human ovarian development was, until now, unknown. We describe a phenotypically and genotypically normal girl, with signs and symptoms of adrenal insufficiency and no apparent defect in ovarian maturation, bearing a heterozygote G-->T transversion in exon 4 of the NR5A1 gene that leads to the missense R255L in the SF-1 protein. The exchange does not interfere with protein translation and stability. Consistent with the clinical picture, R255L is transcriptionally inactive and has no dominant-negative activity. The inability of the mutant (MUT) NR5A1/SF-1 to bind canonical dna sequences might offer a possible explanation for the failure of the mutant protein to transactivate target genes. This is the first report of a mutation in the NR5A1 gene in a genotypically female patient, and it suggests that NR5A1/SF-1 is not necessary for female gonadal development, confirming the crucial role of NR5A1/SF-1 in adrenal gland formation in both sexes.- - - - - - - - - - ranking = 0.20318278154231keywords = gland, pituitary (Clic here for more details about this article) |
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