Adrenal Artery Research Articles

Ultrasound visualization and blood flow velocity measurements of the adrenal arteries in the fetus.

Detection and surveillance of fetal growth restriction (FGR) is well established, but there is still room for improvement. Animal studies indicate that compromised fetuses increase adrenal blood flow. Modern ultrasound equipment allows us to measure vascular impedance in the fetal adrenal arteries despite their modest size. However, extensive anatomical variance is a challenge to standardizing measurements. We set out to improve this. We included 75 low-risk pregnant women in a prospective cross-sectional study aiming to develop a reliable technique to visualize and measure flow velocity in human fetal adrenal arteries. We used commercially available ultrasound equipment: a GE Voluson 10 2019 with a C2-9 probe (GE Healthcare, Zipf, Austria), and a Philips Epiq Elite with a V9-2 probe (Philips Medical Systems International B.V., Best, The Netherlands), exploiting the modern sensitive power Doppler modes in both scanners to visualize small vessels. Among 72 fetuses, the inferior adrenal artery was the most consistently visualized and measured artery to the gland. Doppler velocimetry was achieved in 66 (92%) participants. We found the anatomical variation described previously but were able to develop visualization strategies to identify the common arteries and use a consistent Doppler technique for the second half of pregnancy. It is possible to visualize and measure flow velocity in the adrenal arteries of human fetuses. The success rate was highest for the inferior adrenal artery making this vessel a candidate for clinical studies.

7392 Unilateral Adrenal Embolization In Cushing Disease-A Lifesaving Emergent Procedure

Abstract Disclosure: M. Sadiq: None. B. Irshad: None. A. Haider: None. Case presentation: A 59-year-old female was diagnosed with Cushing Disease (CD) thirteen years ago with symptomatic hypercortisolism. Hypokalemia and elevated 24-hour urine cortisol (392 ug/24 hr, n 0-50 ug/24 hr) were noted at the time of diagnosis. Following LDDST, morning cortisol was 30.5 ug/dl, and HDDST showed greater than 50% suppression. A pituitary macroadenoma with bilateral cavernous sinus extension was noted on MRI Sella. Due to cavernous sinus invasion, she was not considered a surgical candidate and underwent Gamma knife radiation. 24-hour urine cortisol decreased significantly (20 ug/24 hours). Two years follow-up MRI brain showed an empty Sella and AM cortisol was noted to be normal at 12.2 ug/ dl with no evidence of AI. She was lost to follow-up and reestablished almost ten years after her initial gamma knife and was symptomatic from hypercortisolism. 24-hour urine cortisol at 85.4 mcg/24 hr, abnormal salivary cortisol x 2 (0.24 and 0.20 mcg/dl n < 0.09 mcg/dl) confirming hypercortisolism. MRI of Sella showed recurrent adenoma with bilateral sellar masses. She was referred to Neurosurgery and was started on Ketoconazole and Paseriotide once-monthly injections. She developed new onset diastolic heart failure & upper GI bleeding, requiring hospitalization. High ACTH level of 668 pg/ml (n. 6.6- 65 pg/ ml). 8 am cortisol was 107.6 ug/dl which was suppressed to 16.1 after 8 mg overnight Decadron. Repeat Gamma knife was planned but due to her decline, it was decided to do unilateral adrenal artery embolization to reduce hypercortisolism. IR-guided adrenal artery embolization of the left middle & inferior adrenal arteries was performed. She required stress dosing of HC post-embolization which was tapered off while monitoring 8 am cortisol which started to rise & 24-hour cortisol levels were noted to be normal (51.2 mcg/24 H) on post-embolization day eight. Gamma knife radiation treatment was performed a month later after which she was noted to have GWS and required Hydrocortisone 15/10 mg twice daily, which she has been taking to date. 24-hour urine cortisol remains normal at 11.8 mcg/24 h. Discussion: Treatment for CD is primarily surgical. Radiotherapy is a second-line alternative in tumors that are non-amenable to surgery. Radiotherapy takes time to achieve its full effect. Cushing Disease patients with significant hypercortisolism and resultant complications require urgent treatment. Unilateral Adrenalectomy is described in literature to curb the cortisol burden . Similarly Unilateral Adrenal artery embolization offers less invasive approach to treat patients considered unfit for surgery. Conclusion: Unilateral adrenal artery embolization can be considered a bridging treatment in CD to reduce cortisol burden and improve the metabolic profile following which a more definitive treatment such as repeat surgery or radiotherapy can lead to long-term remission. Presentation: 6/1/2024

Bilateral adrenal artery embolization for the treatment of idiopathic hyperaldosteronism: A proof-of-principle single center study.

Unilateral adrenal artery embolization (AAE) has emerged as an alternative treatment for patients with primary aldosteronism due to aldosterone-producing adenomas or idiopathic hyperaldosteronism with bilateral adrenal hyperplasia. This study aimed to investigate the effectiveness and safety of bilateral AAE in idiopathic hyperaldosteronism. We enrolled a total of 58 patients with idiopathic hyperaldosteronism who underwent successful bilateral AAE, and 55 of them completed 6-month follow-up. Bilateral AAE significantly lowered blood pressure of patients with IHA at 1, 3, and 6 months (all P < 0.01). Six months after the procedure, office, home, and 24-hour ambulatory blood pressure decreased by 20.3/13.5, 18.4/12.6, and 13.7/9.9 mmHg, respectively. Among them, 92.7%, 90.9%, and 89.1% had significant or moderate improvement in blood pressure control at 1, 3, and 6 months after the procedure. Bilateral AAE substantially decreased plasma aldosterone levels, reversed plasma renin suppression, decreased aldosterone-to-renin ratio, and corrected hypokalemia. Importantly, the procedure did not significantly change serum cortisol and plasma adrenocorticotropic hormone (ACTH) levels, and the cortisol and ACTH circadian rhythms remained intact three months after the procedure. Additionally, 16 patients underwent ACTH stimulation tests three months post-procedure and all of them had normal results except for one with a decreased response due to exogenous steroid therapy. Flank pain was the most common side effect which happened in 96.4% of the patients and resolved within 48 h. There were no long-term side effects in the 6 months. The present study provides evidence that bilateral AAE is an effective and safe alternative treatment for patients with IHA. Changes in office and 24h ambulatory blood pressure at 1, 3, and 6 months after bilateral adrenal artery embolization in patients with idiopathic hyperaldosteronism.

Bilateral superselective adrenal artery embolization for bilateral primary aldosteronism: a novel approach in an efficacy and safety proof-of-principle trial.

Superselective adrenal artery embolization (SAAE) offers a novel approach for treating primary aldosteronism (PA). In this study, we aimed to assess the efficacy and safety of SAAE for the treatment of PA based on the lateralization results obtained from adrenal vein sampling (AVS).In this prospective study, we enrolled 40 patients with PA who underwent SAAE. The patients were categorized into two groups, unilateral PA and bilateral PA, based on AVS results. Clinical parameters and biochemical markers were assessed at 3 and 12 months postoperatively. The primary outcomes were changes in blood pressure and defined daily dose (DDD) of antihypertensive medications compared to baseline. Thirty-eight patients achieved technical success, with favorable clinical and biochemical efficacy rates. At three months postoperatively, the clinical efficacy rates were 79.2% and 78.6% for the UPA and BPA groups, respectively. At 12 months, the rates were 83.3% and 71.4%, respectively. Both groups exhibited a significant decrease in average blood pressure at 3 and 12 months compared with baseline (P < 0.001), and there was also a notable reduction in DDD (P < 0.05). At three months, the biochemical efficacy rates were 61.9% and 58.3% in the UPA and BPA groups, respectively. Due to loss to follow-up, biochemical indicators were not assessed at 12 months postoperatively. No severe adverse reactions occurred during or after SAAE. Patients with both UPA and BPA can benefit from SAAE. The superiority of bilateral adrenal artery embolization in the treatment of BPA over unilateral adrenal artery embolization requires further investigation.

Safety and efficacy of bilateral superselective adrenal arterial embolization for treatment of idiopathic hyperaldosteronism: a prospective single-center study

ObjectiveThis study aimed to assess the efficacy and safety of bilateral superselective adrenal arterial embolization (SAAE) in patients with bilateral idiopathic hyperaldosteronism (IHA), a subtype of PA.MethodsNinety-eight patients with bilateral IHA underwent bilateral SAAE between August 2022 and August 2023. Sixty-eight patients were followed up for up to 12 months. The study outcomes were evaluated using the criteria provided by the Primary Aldosteronism Surgical Outcome (PASO) guidelines.ResultsThe mean reductions in systolic and diastolic blood pressure were 27.4 ± 21.3 mmHg and 23.1 ± 17.4 mmHg, respectively (p < 0.001). The rates of clinical success and biochemical success after adrenal artery ablation were 63.2% (43/68) and 39.7% (27/68), respectively. Overall, there were significant reductions in daily defined doses (DDD), aldosterone/renin ratio (ARR), and plasma aldosterone levels (p < 0.001). Plasma renin levels increased by a mean value of 10.4 ± 39.0 pg/mL (p = 0.049), and potassium levels increased by 0.40 ± 0.63 mmol/L (p < 0.001). No significant adverse events were reported during SAAE or the follow-up period of up to one year. Additionally, no abnormalities were detected by adrenal 68Ga-Pentixafor PET/CT scans before or after SAAE.ConclusionBilateral SAAE appears to lead to sustained improvements in blood pressure and biochemical parameters in patients with bilateral PA, with minimal adverse effects. This suggests that bilateral SAAE could serve as an effective alternative approach for treating bilateral IHA, potentially curing this condition.

Comparative evaluation of imaging quality of the adrenal artery in experimental animals

Comparative evaluation of imaging quality of the adrenal artery in experimental animals

Efficacy and safety of adrenal arterial embolization for primary aldosteronism: a systematic review and meta-analysis.

Primary aldosteronism (PA) is related with resistant hypertension and cardiovascular events. Adrenal artery embolization (AAE) is a choice for patients who refused surgery and medical therapy. However, whether AAE can effectively and safely treat PA is unclear. We performed this meta-analysis to determine the efficacy and safety of AAE for patients with PA. Databases including Cochrane Library, Embase, PubMed and Web of Science were used to obtain relevant articles published before July 30, 2023. The primary outcome was blood pressure before and after AAE. The second outcomes included changes in plasma aldosterone level, serum potassium level, and plasma cortisol level. Finally, 7 prospective studies with 222 patients were included. The results showed that systolic and diastolic blood pressure was reduced by 21.68 mmHg (P<0.001) and 10.54 mmHg (P=0.007) respectively after AAE. The change in plasma aldosterone and serum potassium level was -11.52 ng/dL and 0.61 mmol/L respectively (P<0.001), whereas the reduction in cortisol level was not apparent. Moreover, AAE is a relatively safe procedure which only causes some minor complications such as back pain and fever. This meta-analysis indicated that AAE could effectively and safely treat PA. It is a good choice for patients that are not suitable for adrenalectomy or drug therapy.

Establishment of a scoring model for predicting clinical outcomes in patients with unilateral primary aldosteronism after superselective adrenal artery embolization.

Superselective adrenal arterial embolization (SAAE) is a potential alternative treatment for patients with unilateral primary aldosteronism (PA) who refuse unilateral adrenalectomy. Therefore, we aimed to establish a scoring model to differentiate between hypertensive remission after SAAE. This prospective cohort study involved 240 patients who underwent SAAE for unilateral PA. Patients were randomly divided into a model training set and a validation set at a ratio of 7:3. The clinical outcome was a response to hypertension remission, defined as complete, partial, or absent success at 6 months after SAAE. Multivariate logistic regression was performed to identify independent parameters and develop a nomogram to predict clinical outcomes after SAAE. The discrimination, calibration efficacy, and clinical utility of the predictive model were assessed. Five independent predictors were identified: female sex, duration of hypertension, defined daily dose of antihypertensive medication, diabetes, and target organ damage. The above five independent predictors were put into a predictive model that was presented as a nomogram. Using bootstrapping for internal validation, the C-statistic for the predictive model was 0.866 (95% confidence interval [CI]: 0.834 to 0.898). In the validation cohort, the area under the curve (AUC) of the nomogram for predicting hypertension remission after SAAE was 0.809. The present model is the first nomogram-based score that specifically predicts hypertension remission after SAAE in patients with unilateral PA using conventional parameters. This is an effective risk stratification tool that can be used by clinicians for timely and tailored preoperative risk discussions.

Unusual Case of Adrenal Artery Aneurysm: Diagnosis and Management

Unusual Case of Adrenal Artery Aneurysm: Diagnosis and Management

Transcatheter arterial embolization of the left inferior adrenal artery hemorrhage

A 64-year-old man was brought to the Emergency Department aftera sudden onset of severe left back pain. His medical history revealed human immunodeficiency virus (HIV) and pneumocystis pneumonia (PCP). Abdominal echocardiography and contrast-enhanced computed tomography (CT) scan showed adrenal hemorrhage, and an emergency interventional radiology (IVR) was performed. IVR images are shown in Figure 1. Bleeding from the left inferior adrenal artery was shown and hemostasis by transcatheter arterial embolization (TAE) (Figure 2) was performed. The cause of the hemorrhage was unknown, various culture results were negative, and the CT showed no neoplastic lesion. His serology was negative for pheochromocytoma and coagulation studies were normal and with no history of trauma. He progressed stably postoperatively and was discharged on the 14th day of hospitalization.

Combination of intrahepatic TARE and extrahepatic TACE to treat HCC patients with extrahepatic artery supply: A case series

PurposeThe aim of this study was to report the safety and tumor response rate of combined transarterial radioembolization (TARE) through the intrahepatic arteries and transarterial chemoembolization (TACE) through the extrahepatic feeding arteries (EHFA) in patients with hepatocellular carcinoma (HCC). MethodsPatients with HCC, who had both intrahepatic and extrahepatic arterial supply visible on preinterventional multiphase CT and were treated between 2016 and 2021 with a combination of TACE and TARE on the same nodule, were retrospectively included. Epidemiological, clinical, biological, and radiological characteristics were recorded. Safety and tumor response were assessed at 6 months. ResultsNine patients (8 men, median age 62 years [IQR: 54–72 years]) were included. Seven patients had previous treatments on the target nodule (TARE: 5; TACE: 2). The median longest axis (LA) of the lesion was 70 mm (IQR: 60–79 mm). Three patients had portal vein invasion (VP3). The EHFA originated from the right diaphragmatic artery (n = 6), the right adrenal artery (n = 2), and the left gastric artery (n = 1). The LA of the tumor portion treated with TACE was 47 mm (range: 35–64 mm). The ratio between the LA of the entire lesion and the LA treated with TACE was 1.44 (range: 1.27–1.7). One major complication occurred: acute on chronic liver failure. Median follow-up was 23 months (range: 16–29 months). Seven patients underwent further treatment: on the same lesion (n = 2), on newly appeared nodules (n = 2), and systemic treatment (n = 3). At 6-month follow-up, seven patients showed a local objective response. Time-to-progression was 13 (3.5–19) months. ConclusionThe combination of TARE and extrahepatic TACE for HCC with both intrahepatic and extrahepatic arterial supplies seems feasible and safe. Further studies are needed to validate the effectiveness of these preliminary results.

Primary hyperaldosteronism: the choice in favor of conservative surgery

Primary hyperaldosteronism (PHA) is the most common cause of secondary arterial hypertension among endocrine disorders. Given that patients with this pathology are at a higher risk of developing fatal and non-fatal cardiovascular events, early diagnosis and timely treatment are of great importance. Currently, the two main forms of PHA are aldosterone-producing adenoma and bilateral adrenal hyperplasia, which are treated with laparoscopic adrenalectomy or pharmacotherapy with mineralocorticoid receptor antagonists. Although most patients experience restoration of their functional and metabolic status after surgical intervention, some may develop postoperative adrenal insuffi ciency, which requires long-term hormone replacement therapy. This review examines the options for organ-preserving surgeries, such as partial adrenalectomy and selective embolization of the adrenal artery.

Efficacy and feasibility of catheter-based adrenal ablation on Cushing's syndrome associated hypertension

Objective: To explore the value of catheter-based adrenal ablation in treating Cushing's syndrome (CS)-associated hypertension. Methods: A clinical study was conducted in patients with CS, who received catheter-based adrenal ablation between March 2018 and July 2023 in Daping Hospital. Parameters monitored were blood pressure (outpatient and 24-hour ambulatory), body weight, clinical characteristics, serum cortisol and adrenocorticotropic hormone (ACTH) at 8 am, 24-hour urinary free cortisol (24 h UFC), fasting blood glucose and postoperative complications. Procedure effectiveness was defined as blood pressure returning to normal levels (systolic blood pressure<140 mmHg (1 mmHg=0.133 kPa) and diastolic blood pressure<90 mmHg), cortisol and 24 h UFC returning to normal and improvement of clinical characteristics. The parameters were monitored during follow up in the outpatient department at 1, 3, 6, and 12 months after catheter-based adrenal ablation. Results: A total of 12 patients (aged (40.0±13.2) years) were reviewed. There were 5 males, with 5 cases of adenoma and 7 with hyperplasia from imaging studies. Catheter-based adrenal ablation was successful in all without interruption or surgical conversion. No postoperative complication including bleeding, puncture site infection, adrenal artery rupture or adrenal bleeding was observed. The mean follow up was 28 months. Compared to baseline values, body weight declined to (59.48±11.65) kg from (64.81±10.75) kg (P=0.008), fasting blood glucose declined to (4.54±0.83) mmol from (5.53±0.99) mmol (P=0.044), outpatient systolic blood pressure declined to (128±21) mmHg from (140±19) mmHg (P=0.005), diastolic blood pressure declined to (78±10) mmHg from (86±11) mmHg (P=0.041), and the mean ambulatory daytime diastolic blood pressure declined to (79±12) mmHg from (89±8) mmHg (P=0.034). Catheter-based adrenal ablation in 8 patients was defined as effective with their 24 h UFC significantly reduced after the procedure (1 338.41±448.06) mmol/L from (633.66±315.94) mmol/L, P=0.011). The change of 24 h UFC between the effective treatment group and ineffective group was statistically significant (P=0.020). The postoperative systolic blood pressure in the treated adenoma group was significantly lower than those of hyperplasia group (112±13) mmHg vs. (139±20) mmHg, P=0.026). Conclusions: For patients with CS-associated hypertension who are unwilling or unable to undergo surgical treatment, catheter-based adrenal ablation could improve the blood pressure and cortisol level. Catheter-based adrenal ablation could be a safe, effective, and minimally invasive therapy. However, our results still need to be validated in further large-scale studies.

The impact of superselective adrenal artery embolization on renal function in patients with primary aldosteronism: a prospective cohort study.

Superselective adrenal artery embolization (SAAE) is an effective treatment for patients with primary aldosteronism (PA). However, the impact of SAAE on renal function in the PA population remains uncertain. We investigated the estimated glomerular filtration rate (eGFR) and age, sex, body mass index, and diabetes-specific percentiles of eGFR residuals in 182 PA patients treated with SAAE in a prospective cohort from Nanchang SAAE in treating PA registry study. Data suggest that SAAE caused a significant decrease in eGFR from 91.9 ± 26.1 to 88.7 ± 24.1 ml/min/1.73 m2 (p < 0.05) after a median follow-up of 8 months in PA patients. Patients experienced a significant decrease in eGFR from 110.6 ± 18.9 to 103.8 ± 18.2 ml/min/1.73 m2 (p < 0.001) and a very slight increase from 71.1 ± 14.8 to 71.8 ± 17.8 ml/min/1.73 m2 (p = 0.770) with baseline eGFR ≥90 and <90 ml/min/1.73 m2, respectively. Patients with high eGFR residuals (glomerular hyperfiltration) experienced a significant decrease in their eGFR levels from 123.1 ± 22.6 to 105.0 ± 18.6 ml/min/1.73 m2 (p < 0.001). In contrast, there was no significant impact of SAAE on the eGFR of patients with normal or low eGFR residuals. The very early eGFR changes (24 h after SAAE) best predicted the effect of SAAE on eGFR changes after median of eight months in PA patients. On the whole, SAAE seems to have a beneficial impact on renal function in patients with PA, the results of which vary depending on the patient's baseline eGFR and glomerular hyperfiltration status.

FRI240 Aspirin Induced Adrenal Hemorrhage: Rare Side Effect Of A Common Medication!

Abstract Disclosure: H.A. Qadeer: None. R. Samkutty: None. V. Singh: None. Introduction: Adrenal hemorrhage is a heterogeneous disorder with various clinical presentations. Bilateral adrenal hemorrhage can result in acute adrenal insufficiency that can be fatal. With the increasing use of DOAC, cases of anticoagulation therapy induced adrenal hemorrhage have been reported. We present a rare case of unilateral adrenal hemorrhage in a patient with pre-existing adrenal myelolipoma after using Aspirin. Based on our literature search, previously only two cases of Aspirin Induced adrenal hemorrhage in a stable adrenal mass have been reported. Case Presentation: 55-year-old male with history of stable 6.2 cm right adrenal gland myelolipoma, fatty liver disease and hypertension, recent use of 2 doses 81 mg Aspirin after receiving right shoulder replacement surgery presented to emergency department with acute onset right sided flank pain, constant, radiating to the back and right upper quadrant associated with an episode of vomiting. He was hemodynamically stable. Blood work showed normal electrolytes, liver function and renal function at baseline. Hemoglobin was stable around 10g/dL. CT scan abdomen/pelvis with contrast showed increase in the size of a previously stable adrenal myelolipoma to 12.9 x 15.6 cm with mass effect upon the liver. Acute hemorrhage was suspected with the blood extending beyond the margins of the mass into the right retroperitoneal space, displacing the right kidney. On admission, aspirin was discontinued. With absence of hemodynamic instability, normal electrolytes, and normal AM cortisol level of 11.9 mcg/dL, adrenal insufficiency was ruled out. Hormonal work up for hyperfunctioning adrenal tumor was performed that ruled out pheochromocytoma, Cushing syndrome and Primary Aldosteronism. With symptomatic improvement, absence of progression of adrenal hemorrhage on repeat CT scan of the abdomen/pelvis, patient was discharged home. He received IR guided embolization of the right superior adrenal artery and middle adrenal artery in the outpatient setting. Discussion: Spontaneous adrenal gland hemorrhage is a rare event. Bilateral adrenal hemorrhage is associated with acute adrenal insufficiency that can be fatal. Major risk factors for adrenal hemorrhage include anticoagulant therapy, heparin Induced thrombocytopenia, hypercoagulable state, trauma and sever sepsis. Here we have reported a rare case of adrenal gland hemorrhage with therapeutic dose of aspirin used after orthopedic surgery. Aspirin is a very commonly used medication and high index of suspicion is required to avoid this side effect as Immediate discontinuation of the medication is necessary to prevent progression of the disease. Conclusion: Aspirin use can be associated with progression of stable benign adrenal tumors by causing spontaneous hemorrhage. A high index of clinical suspicion is required for timely recognition of this side effect. Presentation: Friday, June 16, 2023

Abdominal aortic branches of red-rumped agouti (Dasyprocta leporina Linnaeus, 1758).

Understanding the cardiovascular system is fundamental in diagnosing pathologies and interpreting exams, such as contrast radiographs. In this context, the present study describes the collateral abdominal aorta artery branches of red-rumped agouti. Ten red-rumped agoutis, six males and four females, were assessed. The vascular system was perfused with Neoprene 450 latex coloured with a yellow pigment, dissected and analysed. Three euthanized animals were perfused with a barium sulfate solution (1 g mL-1 ) associated with latex Neoprene 450 at a 1:3 ratio to obtain contrast-enhanced radiographs. The abdominal aorta emitted the celiac artery, which in turn originated the left gastric, hepatic and splenic arteries. The second collateral branch comprised the cranial mesenteric artery, followed by the renal arteries, which emitted the adrenal arteries, with the caudal emergence of the gonadal arteries. The caudal mesenteric artery appeared in a caudal direction. The abdominal aorta divided after reaching the pelvic cavity entrance, originating the right and left common iliac arteries. Before its bifurcation, the abdominal aorta dorsocaudally emitted its last collateral branch, the median sacral artery. The collateral branches of the aorta, therefore, resemble previously described rodent patterns, with few variations.

Evaluation of fetal adrenal artery Doppler velocimetry and fetal adrenal gland size in pregnancies after recovery from COVID-19.

Assessment of the fetal adrenal gland (FAG) size and middle adrenal artery (MAA) Doppler parameters in pregnancy recovered from Coronavirus Disease (COVID-19) and comparison of the values with the healthy control group. Thirty-eight pregnant women who had recovered from COVID-19 infection and 76 healthy control group between 33 and 35 weeks of gestation were involved in this case-control study. Fetuses were examined for fetal biometry, fetal well-being, adrenal gland dimensions, and Doppler parameters 4-6 weeks after the diagnosis of COVID 19 infection. FAG dimensions were measured in two planes and MAA blood flow velocity was evaluated with pulsed Doppler. Pregnant women with COVID-19 infection were grouped according to the National Institutes of Health for the severity of the disease, and those with mild and moderate infections were examined in the study. The total adrenal gland (TAG) height, fetal zone (FZ) length and width, and MAA-Peak Systolic Velocity (MAA-PSV) were significantly higher, and the MAA-Pulsatility Index (MAA-PI) was significantly lower in the COVID-19 group (p < 0.05). The lower in MAA-PI and the higher in MAA-PSV, the width of the FZ, and width of the TAG were found to be significant in the moderate group compared to the mild groups (p < 0.05). COVID-19 pregnancies might cause early maturation of the FAG and its vasculature depends on the intrauterine stress due to the hyper-inflammation, so fetuses exposed to maternal COVID-19 suggested to have an increase in blood flow to the adrenal gland and fetal adrenal size.

Sjúkratilfelli Skyndileg aftanskinublæðing

A 50-year old male presented to our emergency department with sudden abdominal pain. Upon arrival he was diaphoretic, pale and tachycardic. A CT showed retroperitoneal hemorrhage with suspected tumor at the left adrenal gland. He was quickly stabilized with intravenous fluids and blood transfusion. Rebleed occurs roughly a week after discharge and a new CT showed a visceral pseudoaneurysm from the left middle adrenal artery. The pseudoaneurysm was embolized and the patient discharged in good condition. Follow-up MRI depicted reabsorption of the hematoma and no adrenal tumor. Thus, the etiology of the previous retroperitonal hemorrhage is considered spontaneous.

Aortic branches and rete mirabile of the limbs of two-toed sloth (Choloepus didactylus).

Choloepus didactylus has reduced metabolism and difficulty in thermoregulation owing to its low body mass, and there are few studies related to the vascularization of abdominal and thoracic organs in this species. Therefore, we macroscopically described the arteries that comprise the aortic arch, thoracic aorta, and abdominal aorta. Six specimens were used, and their arterial systems filled with red latex before fixation in 10% formaldehyde, and fragments of the rete mirabile were processed for histological analysis using light and scanning electron microscopy. In these species, the aortic arch had two branches: the brachiocephalic trunk and left subclavian artery. The initial portion of the abdominal aorta presented four different ramifications, besides to the peculiarities of the adrenal, renal, and iliac arteries. Microscopy of the rete mirabile revealed a muscular artery surrounded by smaller muscular arteries, veins, nerves, and lymphatic tissue joined by connective tissue. Thus, the data obtained have clinical and surgical importance, with applicability in procedures involving vascularization of the thoracic and abdominal organs. We suggest that the rete mirabile is an efficient thermoregulatory structure because it allows the accumulation of blood and the countercurrent heat exchange, as there is no blood mixing.

PD03-09 WHAT ARE THE PREOPERATIVE RISK FACTORS OF HEMODYNAMIC INSTABILITY DURING ADRENALECTOMY FOR PHEOCHROMOCYTOMA?

You have accessJournal of UrologyCME1 Apr 2023PD03-09 WHAT ARE THE PREOPERATIVE RISK FACTORS OF HEMODYNAMIC INSTABILITY DURING ADRENALECTOMY FOR PHEOCHROMOCYTOMA? Mokhtar Bibi, Yassine Ouanes, Kays Chaker, Mohamed Anouer Madani, Yosri Messoudi, Boutheina Mosbahi, Selma Trabelsi, Kheireddine Mourad Dali, Moez Rahoui, and yassine Nouira Mokhtar BibiMokhtar Bibi More articles by this author , Yassine OuanesYassine Ouanes More articles by this author , Kays ChakerKays Chaker More articles by this author , Mohamed Anouer MadaniMohamed Anouer Madani More articles by this author , Yosri MessoudiYosri Messoudi More articles by this author , Boutheina MosbahiBoutheina Mosbahi More articles by this author , Selma TrabelsiSelma Trabelsi More articles by this author , Kheireddine Mourad DaliKheireddine Mourad Dali More articles by this author , Moez RahouiMoez Rahoui More articles by this author , and yassine Nouira yassine Nouira More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003220.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Adrenalectomy for pheochromocytoma is considered to be a challenging procedure because of the risk of hemodynamic instability (HI), which is poorly defined and unpredictable. Our study aimed to determine the predictive factors for perioperative HI in patients undergoing unilateral adrenalectomy for pheochromocytoma. METHODS: Between January 2005 and December 2021, 45 patients underwent unilateral adrenalectomy for pheochromocytoma in department of urology La Rabta Hospital. HI was defined as an occurrence of intraoperative episodes of systolic blood pressure above 200 mmHg, mean arteral pressure under 60 mmHg or vasoactive drug administration. Patients were divided into 2 groups depending on presence or absence of intraoperative HI. Patient demographics, tumor characteristics and perioperative hemodynamics were noted. A multivariable logistic regression analysis was performed to determine the independent preoperative risk factors for HI. RESULTS: There was no postoperative mortality, and HI was noted 71.1% (32 patients). Open and laparoscopic adrenalectomy were performed in 36 and 9 patients respectively. Mean tumor size was 54.52 mm. Univariate analysis showed that gender, tumor size, tumoral necroses, B blockers treatment were significantly associated with Hi (p=0.019, p=0.00 01, p=0.0001, p=0.01, respectively). IH was correlated with Systolic blood pressure at incision, adrenal artery clamping and tumour removal (p=0.018, p=0.001, p=0.046, p=0.048, respectively). The multivariate logistic regression analysis showed that tumor size was an independent risk factors for intraoperative hemodynamic instability (OR 2.79, 95% CI: 1-61.8, p=0.008). CONCLUSIONS: Tumour size was the independant predictive factor with hemodynamic instability during adrenalectomy for pheochromocytoma. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e78 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mokhtar Bibi More articles by this author Yassine Ouanes More articles by this author Kays Chaker More articles by this author Mohamed Anouer Madani More articles by this author Yosri Messoudi More articles by this author Boutheina Mosbahi More articles by this author Selma Trabelsi More articles by this author Kheireddine Mourad Dali More articles by this author Moez Rahoui More articles by this author yassine Nouira More articles by this author Expand All Advertisement PDF downloadLoading ...