Cases reported "Adrenal Gland Neoplasms"

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11/635. 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.
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12/635. A case of aldosterone-producing adenoma with severe postoperative hyperkalemia.

    It is known that some patients with primary aldosteronism show postoperative hyperkalemia, which is due to inability of the adrenal gland to secrete sufficient amounts of aldosterone. However, hyperkalemia is generally neither severe nor prolonged, in which replacement therapy with mineralocorticoid is seldom necessary. We report a case of a 46-year-old woman with an aldosterone-producing adenoma associated with severe postoperative hyperkalemia. After unilateral adrenalectomy, the patient showed episodes of severe hyperkalemia for four months, which required not only cation-exchange resin, but also mineralocorticoid replacement. plasma aldosterone concentration (PAC) was low, although PAC was increased after rapid ACTH test. Histological examination indicated the presence of adrenocortical tumor and paradoxical hyperplasia of zona glomerulosa in the adjacent adrenal. immunohistochemistry demonstrated that the enzymes involved in aldosterone synthesis, such as cholesterol side chain cleavage (P-450scc), 3beta-hydroxysteroid dehydrogenase (3beta-HSD), and 21-hydroxylase (P-450c21), or the enzyme involved in glucocorticoid synthesis, 11beta-hydroxylase (P-450c11beta), were expressed in the tumor, but they were completely absent in zona glomerulosa of the adjacent adrenal. These findings were consistent with the patterns of primary aldosteronism. serum potassium level was gradually decreased with concomitant increase in PAC. These results suggest that severe postoperative hyperkalemia of the present case was attributable to severe suppression of aldosterone synthesis in the adjacent and contralateral adrenal, which resulted in slow recovery of aldosterone secretion. It is plausible that aldosterone synthesis of adjacent and contralateral adrenal glands is severely impaired in some cases with primary aldosteronism, as glucocorticoid synthesis in cushing syndrome.
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13/635. Primary bilateral adrenal lymphoma.

    Primary adrenal lymphoma is a rare primary neoplastic disease of the adrenal glands, with up to 65 cases reported in the literature over the past 40 years. The increasing use and sophistication of medical diagnostic imaging has allowed this disease to be diagnosed more frequently premortem, presenting more opportunity for treatment. The true incidence of these neoplasms is not known, nor is it clear why historical autopsy series have not reported this neoplasm more frequently, and why its existence has been documented more recently with advanced diagnostic imaging. This review has presented our new case, and reviewed 5 more in the literature, bringing the total number of cases to over 70. Accumulation of more cases and the experience treating these cases is needed to develop a better picture of diagnostic procedures and treatment regimens that have maximum efficacy.
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14/635. Malignant pheochromocytoma with multiple hepatic metastases treated by chemotherapy and transcatheter arterial embolization.

    A 62-year-old Japanese male developed multiple hepatic metastases two years after resection of pheochromocytoma of the right adrenal gland. Transcatheter arterial embolization (TAE) was performed for the purpose of the treatment of hepatic metastases resistant to 27 cycles of combined chemotherapy consisting of cyclophosphamide, vincristine, and dacarbazine. After TAE, the hepatic metastatic lesions decreased in size and hypertension passed its crisis. The present case suggests the utility of TAE for multiple hepatic metastases under careful blood pressure monitoring.
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15/635. Radiotherapy for adrenal gland metastasis from lung cancer: report of three cases.

    Adrenal gland metastasis is often observed during the clinical course of patients with lung cancer. However, treatment of adrenal gland metastasis is seldom considered because of the systemic spread of the disease. Treatment with curative intent is very rare, but palliative treatment may sometimes be considered when symptoms such as flank pain are observed. Three cases of adrenal gland metastasis were reported. Two of them received surgery for lung cancer and developed a sole metastasis of the adrenal gland. Case 1 developed a sole left adrenal gland metastasis with left flank pain 14 months after surgery for large cell carcinoma of the lung. Curative radiotherapy after intra-arterial chemotherapy was given. A good response was obtained, and he has been alive for 2 years and 9 months. Case 2 developed a right adrenal gland metastasis after radiotherapy for brain metastasis, after having received right upper lobectomy because of SCLC. The increase in the size of the right adrenal gland led us to treat the lesion before symptoms developed. Radiotherapy was given on an outpatient basis. Case 3, who was previously treated with chemoradiotherapy for SCLC, developed brain, liver, and bilateral adrenal gland metastasis. Huge adrenal gland metastases displaced the pancreas and caused severe pain with the increase in serum amylase level. Concurrent radiotherapy with systemic chemotherapy was given and remarkable shrinkage of the adrenal gland metastases was obtained together with pain relief. Cases 2 and 3 died after 8 and 4 months, respectively. In some cases, radiotherapy for adrenal gland metastasis is a good palliative therapy even in the advanced stage patients. Radiotherapy can sometimes curatively treat adrenal metastasis from NSCLC, as in our Case 1, in which adrenalectomy appeared difficult at the time of recurrence.
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16/635. Bilateral smooth-muscle tumors of the adrenals in a child with AIDS.

    We report a case of bilateral smooth muscle tumors (SMT) involving the adrenal glands in an 11-year-old female with acquired immunodeficiency syndrome (AIDS). The SMT of the right adrenal gland extended into the inferior vena cava, producing a tumor thrombus.
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17/635. Recurrent adrenocortical carcinoma in a child.

    An 8-month-old girl presented with clitoromegaly, cushingoid features and a large abdominal tumour. ultrasonography (US) and computed tomography (CT) of the abdomen revealed a tumour of the left suprarenal gland, 12x11x7 cm in size. serum levels of cortisol, testosterone and DHEA-S, and urinary extretion of 17-ketosteroids and 17-hydroxycorticoids were increased. Complete removal of the tumour was accomplished through a transabdominal approach. The diagnosis of adrenocortical carcinoma was confirmed histologically. Three months after the first operation, a recurrent tumour of the left renal hilus, 23x15 mm in size, was identified by US and verified by aspiration biopsy. The tumour was removed by the transabdominal route. In this report, we discuss the diagnosis and the treatment of this rare disease.
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18/635. Hazards of laparoscopic adrenalectomy for Conn's adenoma. When enthusiasm turns to tragedy.

    A 74-year-old man with primary aldosteronism had a small tumor (27 x 23 mm) of his right adrenal gland successfully removed by a transperitoneal laparoscopy. Despite absence of malignancy in the resected tumor and complete relief of all symptoms in the immediate postoperative period, recurrence occurred 6 months later. The tumor behaved as a carcinoma spread in the peritoneal cavity, and the patient eventually died with peritoneal carcinomatosis. We suggest that the laparoscopic technique coupled with pneumoperitoneum may have favored this recurrence.
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19/635. A case of primary bilateral adrenal lymphoma with partial adrenal insufficiency.

    Unilateral or bilateral non-Hodgkin's lymphomas arising primarily in the adrenal glands are extremely rare. These lymphomas are usually present with large, bilateral adrenal masses with or without lymphadenopathy, and may be accompanied by adrenal insufficiency in some cases. A review of the literature indicates that patients with primary lymphoma of the adrenal glands usually do not have disease elsewhere, and if present, it is frequently extranodal. We report here an unusual case of primary bilateral adrenal lymphoma with partial adrenal insufficiency.
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20/635. teratoma in the region of adrenal gland: a unique entity masquerading as lipomatous adrenal tumor.

    BACKGROUND: The aim of this study was to establish the clinical and pathologic aspects of 3 atypical lipomatous lesions in the region of the adrenal gland. methods: Three young Chinese patients (ages 18, 18, and 37 years) were seen for nonspecific back pain. Radiologic examination revealed a lipomatous lesion in the region of the adrenal gland, and hormonal assessment was normal. Calcification was noted in 2 of the 3 lesions. adrenalectomy was performed because of the size (diameter 7.5, 10, 11 cm) of the tumors with suspected local symptoms. RESULTS: On gross examination 2 tumors were cystic and 1 was solid. In all 3 patients the diagnosis was mature teratomas. The tumors were composed of mature tissues arising from more than 1 germinal layer. There was no evidence of immature elements or malignancy. adipose tissue was the predominant component in the tumors. There was no evidence of recurrent diseases in all these patients during follow-up. CONCLUSIONS: To our knowledge, this is the first report of teratomas occurring in the adrenal region. teratoma should clinically and radiologically be included in the differential diagnoses of lipomatous adrenal lesions. Excision of the teratoma is advocated.
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