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Hormone and Metabolic Research =... Nov 2014The majority of benign adrenal cortex lesions leading to Cushing syndrome are associated to one or another abnormality of the cAMP/cGMP-phosphodiesterase signaling... (Review)
Review
The majority of benign adrenal cortex lesions leading to Cushing syndrome are associated to one or another abnormality of the cAMP/cGMP-phosphodiesterase signaling pathway. Phosphodiesterases (PDEs) are key regulatory enzymes of intracellular cAMP/cGMP levels. These second messengers play important regulatory roles in controlling steroidogenesis in the adrenal. Disruption of PDEs has been associated with a number of adrenal diseases. Specifically, genetic mutations have been associated with benign adrenal lesions, leading to Cushing syndrome and/or related adrenal hyperplasias. A Genome Wide Association study, in 2006, led to the identification of mutations in 2 PDE genes: PDE8B and PDE11A; mutations in these 2 genes modulate steroidogenesis. Further human studies have identified PDE2 as also directly regulating steroidogenesis. PDE2 decreases aldosterone production. This review focuses on the most recent knowledge we have gained on PDEs and their association with adrenal steroidogenesis and altered function, through analysis of patient cohorts and what we have learned from mouse studies.
Topics: Adrenal Gland Neoplasms; Adrenal Glands; Animals; Cushing Syndrome; Humans; Hyperplasia; Mice; Phosphoric Diester Hydrolases; Signal Transduction
PubMed: 25232906
DOI: 10.1055/s-0034-1389916 -
Journal of Medical Case Reports Dec 2017Adrenal gland trauma is a rare condition that typically stems from blunt force trauma, and is associated with multiple organ injuries. Alternatively, isolated adrenal... (Review)
Review
BACKGROUND
Adrenal gland trauma is a rare condition that typically stems from blunt force trauma, and is associated with multiple organ injuries. Alternatively, isolated adrenal gland trauma is extremely rare, accounting for only 1.5 to 4% of all adrenal trauma cases. While isolated adrenal trauma is a mostly self-limiting condition, it is potentially life-threatening, representing a significant cause of bleeding, and/or hypotension due to adrenal insufficiency and adrenal crisis. Due to its rare occurrence, there are no reported guidelines for monitoring and observing isolated adrenal trauma.
CASE PRESENTATION
Here we report on an isolated adrenal hemorrhage from a blunt trauma without associated injuries. A 53-year-old white man presented with abdominal pain after a high-speed motor vehicle accident. An initial evaluation revealed minimal abdominal pain and negative focused assessment with sonography for trauma examination; computed tomography imaging revealed a significant fluid collection consistent with adrenal hemorrhage. He was observed in our intensive care unit for 24 hours, and had stable hemoglobin and vital signs, after which he was discharged. At 1-month follow-up, he reported persistent intermittent abdominal pain, which was completely resolved by the 4-month follow-up.
CONCLUSIONS
This case report demonstrates isolated adrenal gland injury resulting from significant blunt trauma to the abdomen. There are no current guidelines for monitoring isolated adrenal hemorrhage. Recognizing possible adrenal injury in blunt trauma cases is important due to potentially severe adrenal hemorrhage; therefore, we recommend follow-up with serial abdominal computed tomography until the resolution of hemorrhage and symptoms.
Topics: Abdominal Injuries; Accidents, Traffic; Adrenal Gland Diseases; Adrenal Glands; Critical Care; Hemorrhage; Humans; Male; Middle Aged; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography; Wounds, Nonpenetrating
PubMed: 29277157
DOI: 10.1186/s13256-017-1506-x -
BMJ Case Reports Aug 2015Pheochromocytoma and paraganglioma are rare neuroendocrine tumours in paediatric ages. We report a case of a 14-year-old girl referred to our oncology centre due to an...
Pheochromocytoma and paraganglioma are rare neuroendocrine tumours in paediatric ages. We report a case of a 14-year-old girl referred to our oncology centre due to an abdominal mass. She had an 11-month history of paroxysmal episodes of headache, nausea, dizziness, palpitations and visual disturbances. Imaging studies showed a left paravertebral mass measuring 5.8 × 4.6 × 3.5 cm. Metaiodobenzylguanidine scintigraphy revealed an abnormal hyperfixation on the left upper quadrant. Chromogranin A was elevated, as well as normetanephrine. The patient was submitted to surgery during which a connection between this mass and the adrenal gland was found. A diagnosis of pheochromocytoma was performed.
Topics: 3-Iodobenzylguanidine; Abdomen; Adolescent; Adrenal Gland Neoplasms; Adrenal Glands; Anxiety; Chromogranin A; Diagnosis, Differential; Female; Humans; Normetanephrine; Paraganglioma; Pheochromocytoma; Tomography, X-Ray Computed
PubMed: 26245288
DOI: 10.1136/bcr-2015-211393 -
The Journal of Physiology Feb 19771. The dynamics of the adrenocortical response to adrenocorticotrophic hormone (ACTH) was studied in anaesthetized, acutely hypophysectomized male rats. 2. ACTH...
1. The dynamics of the adrenocortical response to adrenocorticotrophic hormone (ACTH) was studied in anaesthetized, acutely hypophysectomized male rats. 2. ACTH test-signals were applied either in a jugular vein ('intact infused preparation') or in the aorta through the coeliac artery with the aorta ligated below this artery ('isolated in situ perfused preparation'). The adrenocortical responses were measured directly in samples serially taken from the left adrenal vein. 3. Tested ACTH signals were either impulses (injections of 0-05--1-2 mu. ACTH) or step functions (constant infusions of 0-025--1-6 mu. ACTH/min). 4. All responses showed a 3-6 min delay, larger delays corresponding to smaller input signals. The step responses reached steady-state level without overshoot. 5. The impulse responses of the isolated perfused and of the intact infused glands, as well as their step responses, were similar as to dynamic form. 6. It is concluded that there is an inherent delay in the responses of both the isolated perfused and of the intact infused rat adrenal gland. Further, unlike what has been reported for the canine adrenal gland, the intact rat adrenal gland does not appear to be appreciably 'faster' in its response than the isolated gland. Finally, the amplification factor from ACTH to corticosterone could be estimated for both preparations in the case of ACTH injections; a value of 1-3 X 10(6) (one ACTH molecule activates synthesis and release of 1-3 million corticosterone molecules) was found.
Topics: Adrenal Cortex; Adrenal Glands; Adrenocorticotropic Hormone; Animals; Corticosterone; In Vitro Techniques; Male; Rats; Regional Blood Flow
PubMed: 191596
DOI: 10.1113/jphysiol.1977.sp011708 -
International Journal of Molecular... May 2024Gap junctions (GJs) are important in the regulation of cell growth, morphology, differentiation and migration. However, recently, more attention has been paid to their... (Review)
Review
Gap junctions (GJs) are important in the regulation of cell growth, morphology, differentiation and migration. However, recently, more attention has been paid to their role in the pathogenesis of different diseases as well as tumorigenesis, invasion and metastases. The expression pattern and possible role of connexins (Cxs), as major GJ proteins, under both physiological and pathological conditions in the adrenal gland, were evaluated in this review. The databases Web of Science, PubMed and Scopus were searched. Studies were evaluated if they provided data regarding the connexin expression pattern in the adrenal gland, despite current knowledge of this topic not being widely investigated. Connexin expression in the adrenal gland differs according to different parts of the gland and depends on ACTH release. Cx43 is the most studied connexin expressed in the adrenal gland cortex. In addition, Cx26, Cx32 and Cx50 were also investigated in the human adrenal gland. Cx50 as the most widespread connexin, along with Cx26, Cx29, Cx32, Cx36 and Cx43, has been expressed in the adrenal medulla with distinct cellular distribution. Considerable effort has recently been directed toward connexins as therapeutically targeted molecules. At present, there exist several viable strategies in the development of potential connexin-based therapeutics. The differential and hormone-dependent distribution of gap junctions within adrenal glands, the relatively large gap junction within this gland and the increase in the gap junction size and number following hormonal treatment would indicate that gap junctions play a pivotal role in cell functioning in the adrenal gland.
Topics: Humans; Connexins; Gap Junctions; Adrenal Gland Neoplasms; Carcinogenesis; Adrenal Glands; Animals; Gene Expression Regulation, Neoplastic
PubMed: 38791437
DOI: 10.3390/ijms25105399 -
Surgery Jul 2024Although uncommon, adrenal hemorrhage has multiple etiologies. Because clinical characteristics, management, and outcomes of patients with adrenal hemorrhage are...
BACKGROUND
Although uncommon, adrenal hemorrhage has multiple etiologies. Because clinical characteristics, management, and outcomes of patients with adrenal hemorrhage are inadequately described, we examined the underlying etiology, need for intervention, evolution of imaging characteristics, and adequacy of subsequent evaluation.
METHODS
We performed a retrospective review of patients diagnosed with adrenal hemorrhage (radiologist-confirmed density consistent with hemorrhage on computed tomography) from 2005 to 2021 at a university-based institution. Demographic characteristics, hemorrhage etiology, and subsequent follow-up were analyzed.
RESULTS
Of 193 adrenal hemorrhage patients, the mean age was 49.2 ± 18.3 years, and 35% were female. Clinical presentations included trauma (47%), abdominal or flank pain (28%), incidental findings on imaging acquired for other reasons (12%), postoperative complication (8%), or shock (3%). Hemorrhage outside of the gland was present in 62% of patients. Unilateral hemorrhage was more frequent (93%) than bilateral (7%). A total of 12% of patients had nodules, but only 70% of these were identified on initial imaging, and only 43% had hormonal evaluation. Of 7 patients who had adrenalectomy or biopsy, pathology was either benign (57%) or nonadrenal malignancy (43%). No adrenocortical carcinomas were identified. Follow-up imaging was performed in 56% of patients and revealed decreased, stable, resolved, or increased adrenal hemorrhage size in 39%, 19%, 30%, and 12% of patients, respectively.
CONCLUSION
Adrenal hemorrhage is secondary to multiple etiologies, most commonly trauma. In the setting of adrenal hemorrhage, many adrenal nodules were not identified on initial imaging. Only a minority of patients with nodules underwent "complete" biochemical evaluation. Follow-up imaging may improve the identification of underlying nodules needing hormonal evaluation.
Topics: Humans; Female; Middle Aged; Male; Retrospective Studies; Hemorrhage; Adult; Adrenal Gland Diseases; Aged; Tomography, X-Ray Computed; Adrenalectomy; Adrenal Glands
PubMed: 38594100
DOI: 10.1016/j.surg.2024.03.004 -
American Journal of Hypertension Jun 2022Normal-appearing adrenal glands on cross-sectional imaging may still be the source of aldosterone production in primary aldosteronism (PA).
BACKGROUND
Normal-appearing adrenal glands on cross-sectional imaging may still be the source of aldosterone production in primary aldosteronism (PA).
METHODS
We evaluated the prevalence of aldosterone production among morphologically normal-appearing adrenal glands and the impact of this phenomenon on interpretations of localization studies and treatment decisions. We performed a retrospective cohort study of PA patients with at least 1 normal adrenal gland and reanalyzed contemporary studies to assess interpretations of imaging and adrenal venous sampling (AVS) at the individual patient and adrenal levels.
RESULTS
Among 243 patients, 43 (18%) had bilateral normal-appearing adrenals and 200 (82%) had a unilateral normal-appearing adrenal, for a total of 286 normal-appearing adrenal glands. 38% of these normal-appearing adrenal glands were a source of aldosteronism on AVS, resulting in discordance between imaging and AVS findings in 31% of patients. Most patients with lateralizing PA underwent curative unilateral treatment (80%); however, curative treatment was pursued in 92% of patients who had concordant imaging-AVS results but in only 38% who had discordant results (P < 0.05). In young patients, imaging-AVS discordance was detected in 32% of those under 45 years and 21% of those under 35 years. Among 20 contemporary studies (including 4,904 patients and 6,934 normal-appearing adrenal glands), up to 64% of normal-appearing adrenals were a source of aldosteronism resulting in 31% of patients having discordant results.
CONCLUSIONS
Morphologically normal-appearing adrenal glands are commonly the source of aldosterone production in PA, even among young patients. The lack of awareness of this issue may result in inappropriate treatment recommendations.
Topics: Adrenal Glands; Adrenalectomy; Aldosterone; Humans; Hyperaldosteronism; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 34883509
DOI: 10.1093/ajh/hpab189 -
Journal of Feline Medicine and Surgery Jan 2021Abdominal ultrasound plays a vital role in the diagnostic work-up of many cats presenting to general and specialist practitioners. Ultrasound examination of the adrenal... (Review)
Review
PRACTICAL RELEVANCE
Abdominal ultrasound plays a vital role in the diagnostic work-up of many cats presenting to general and specialist practitioners. Ultrasound examination of the adrenal glands can provide important information pertaining to several conditions including hyperaldosteronism and hyperadrenocorticism.
CLINICAL CHALLENGES
Despite ultrasonography being a commonly used modality, many practitioners are not comfortable performing an ultrasound examination or interpreting the resulting images. Even for the experienced ultrasonographer, differentiating between incidental findings, such as adrenal mineralisation, and clinically significant pathological changes can be challenging.
AIM
This review, part of an occasional series on feline abdominal ultrasonography, discusses the ultrasonographic examination of the normal and diseased adrenal glands. Aimed at general practitioners who wish to improve their knowledge of and confidence in feline abdominal ultrasound, this review is accompanied by high-resolution images and videos available online as supplementary material.
EQUIPMENT
Ultrasound facilities are readily available to most practitioners, although the use of ultrasonography as a diagnostic tool is highly dependent on operator experience.
EVIDENCE BASE
Information provided in this article is drawn from the published literature and the author's own clinical experience.
Topics: Adrenal Gland Diseases; Adrenal Glands; Animals; Cat Diseases; Cats; Ultrasonography
PubMed: 33403910
DOI: 10.1177/1098612X20979509 -
Schweizer Archiv Fur Tierheilkunde Sep 2017
Topics: Adrenal Glands; Age Factors; Animals; Body Weight; Cattle; Cattle Diseases; Female; Hair; Hydrocortisone; Organ Size
PubMed: 28952959
DOI: 10.17236/sat00128 -
The Journal of Thoracic and... Aug 2018
Topics: Adrenal Cortex; Adrenal Glands; Animals; Cardiopulmonary Bypass; Dogs
PubMed: 29691046
DOI: 10.1016/j.jtcvs.2018.03.131