Adrenal Artery Research Articles

Application value of preoperative embolization in primary retroperitoneal tumor

To evaluate the value of angiography in clarifying the origin of the feeding arteries of primary retroperitoneal tumors and to explore the application of embolization therapy in the treating of primary retroperitoneal tumor. 68 patients with primary retroperitoneal tumor were randomized into conventional tumor resection group (n = 35) and the preoperative embolization group (n = 33). Some clinical data were compared between the preoperative embolization group and the routine operation group, including blood loss, blood transfusion, operation time and adverse reactions after embolization. All the diagnoses were pathologically confirmed. The origins of the tumor-feeding arteries were analyzed. The clinical value of embolization in assisting the surgery as well as in making prognosis was assessed. According to their location and size, primary retroperitoneal tumors had feeding arteries from different origins. In this series of cases the tumor blood supply originated from the lumbar artery (81.8%), internal iliac artery (45.5%) and adrenal artery (27.3%). In the preoperative embolization group and conventional surgery group, the blood loss was 912 ml vs. 2 500 ml (P < 0.001), the blood transfusion was 1 000 ml vs. 2 600 ml (P < 0.001), the operation time was 4.1 h vs. 5.9 h (P < 0.001), and the length of hospital stay was 12.5 d vs. 19.8 d (P < 0.001). The origins of the feeding arteries in primary retroperitoneal tumors are very complex. Preoperative embolization therapy may effectively reduce the intraoperative blood loss, postoperative adverse events, length of hospital stay, and facilitate the patients' recovery.

A very unusual case of spontaneous adrenal artery rupture

A very unusual case of spontaneous adrenal artery rupture

Incidentally Found Retroperitoneal Ganglioneuroma in an Adult

The ganglioneuroma is a very rare tumor arising from sympathetic nerve system. An asymptomatic retroperitoneal ganglioneuroma was found incidentally in a 35-year-old woman. Ultrasonography, computed tomography, and magnetic resonance imaging showed a retroperitoneal mass extending to the left adrenal gland, and surrounding abdominal aorta, celiac axis, left renal and adrenal arteries, and veins. The tumor was resected and histologic examination showed ganglioneuroma.

Endothelial Metabolism of Angiotensin II to Angiotensin III, not Angiotensin (1–7), Augments the Vasorelaxation Response in Adrenal Cortical Arteries

Hyperaldosteronism is linked to the development and progression of several different cardiovascular diseases. Angiotensin (Ang) II increases aldosterone secretion and adrenal blood flow. Ang II peptide fragments are produced by various peptidases, and these Angs have diverse and vital physiologic roles. Due to the uncharacteristic vasorelaxation of adrenal arteries by Ang II, we tested the hypothesis that Ang II metabolism contributes to its relaxant activity in adrenal arteries. Metabolism of Angs by bovine adrenal cortical arteries and isolated bovine adrenal vascular cells was measured by liquid chromatography-mass spectrometry. The primary Ang metabolites of adrenal arteries are Ang III and Ang (1-7), with Ang IV produced to a lesser extent. Bovine microvascular endothelial cells produced a similar metabolic profile to adrenal arteries, whereas bovine adrenal artery smooth muscle cells exhibited less metabolism. In preconstricted adrenal arteries, Ang II caused relaxation in picomolar concentrations and constrictions at 10nM. Ang-converting enzyme 2 inhibition augmented this relaxation response, whereas aminopeptidase inhibition did not. Ang III was equipotent to Ang II in relaxing adrenal arteries. Ang IV did not cause relaxation. Nitric oxide synthase inhibition enhanced Ang II-induced constriction of adrenal arteries. Aminopeptidase inhibition increased the concentration range for Ang II-induced constriction of adrenal arteries. Ang III and Ang IV did not change the basal tone but caused constriction of adrenal arteries with nitric oxide synthase inhibition. These data indicate that Ang II metabolism modulates the vascular effects of Ang II in the adrenal vasculature.

Arterial Vascularization and Morphological Characteristics of Adrenal Glands in the Pampas Deer (Ozotoceros bezoarticus, Linnaeus 1758)

This research presents morphological characteristics of adrenal glands and a demonstration of arterial vascularization in the Pampas deer, which is considered to be in extreme danger of extinction. A total of ten deer constituted the material of the study. Vascularization of organs was investigated by using latex injection technique. Left adrenal glands were basically supplied by coeliac, cranial mesenteric, renal and lumbal arteries. The arterial vascularization of the left adrenal glands was very complex in comparison with right adrenal glands. In two examples, branch of the lumbal artery was divided into phrenic caudal artery and cranial adrenal artery. In six examples, it was observed that the caudomedial and ventral regions of the left adrenal glands were also supplied by thinner branches that stemmed from second left lumbal artery. Besides, coeliac and cranial mesenteric arteries also gave off shorter branches supplying the cranial region of the left adrenal glands in five examples. It was determined that two branches originated from abdominal aorta directly for supplying left adrenal glands in only two examples. In four examples, two caudal adrenal arteries stemmed separately from left renal artery in a short distance. Arterial vascularization of right adrenal glands was more constant and supplied by lumbal and renal arteries. The adrenal glands were generally oval or round shaped. In only two examples, left adrenal glands were 'V-' or heart-shaped. There was no significant difference (P>0.05) in sizes between right and left adrenal glands.

Unconventional Extrahepatic Neovascularization After Transplant Hepatic Artery Thrombosis: A Case Report

Liver neovascularization preserves hepatic function and improves survival in the setting of post-transplant hepatic artery thrombosis (HAT). In this report, we have presented a unique case of a neovascularized liver after subclinical HAT in a 46-year-old liver transplant patient in whom a collateral supply was recruited from three unconventional sources: The right colic, right intercostal, and right inferior adrenal arteries. We propose systematic angiographic evaluation of all potential sources of collateral vessel formation for patients with HAT to accurately assess patient risk and determine the need for further intervention or revascularization.

Adrenal Artery Embolization: Anatomy, Indications, and Technical Considerations

The purpose of this review is to describe adrenal arterial anatomy and to discuss the indications, outcomes, and technical considerations of adrenal artery embolization. Adrenal artery embolization can be used for management of adrenal tumors (palliative for pain relief, debulking, or hormone suppression) and treatment of acute bleeding from ruptured adrenal tumors, traumatic adrenal injury, and aneurysms. Variant arterial supplies, options for embolic agents, and potential complications are important considerations.

Adrenal artery pseudoaneurysm in pheochromocytoma presenting with catastrophic retroperitoneal hemorrhage

Spontaneous rupture of adrenal pheochromocytoma is an extremely rare condition which presents as an abdominal catastrophe. Unrecognized, this transformation can rapidly lead to death. We report a case of a 63-year-old male who presented with hemorrhagic shock secondary to ruptured adrenal pheochromocytoma. The clinical course is notable for immediate transarterial catheter embolization for control of bleeding, followed by optimization and elective adrenalectomy. High mortality is associated with an operative intervention in the face of an unrecognized pheochromocytoma. This reinforces the need for maintaining a high index of suspicion in the setting of a suprarenal mass despite hypotension.

Spontaneous Rupture of the Adrenal Artery Successfully Treated Using the Endovascular Approach

Adrenal artery rupture is a rare cause of retroperitoneal hemorrhage. We describe 2 cases of spontaneous rupture of the adrenal artery successfully treated using endovascular coil embolization. Two patients presented with sudden onset abdominal pain and hemodynamic compromise. In both the cases computed tomography (CT) showed a large retroperitoneal hemorrhage. Aortography confirmed bleeding from the right inferior adrenal artery in the first patient and the left inferior adrenal artery in the second patient. Both patients were treated with endovascular coil embolization. Subsequent CT scans demonstrated a reduction in the size of the retroperitoneal hematoma with no active bleeding. Endovascular treatment of a ruptured adrenal artery is effective, safe, and permits organ preservation.

両側副腎出血を契機に発見された肺癌副腎転移の1例

A 58-year-old man presented with nausea and left flank pain. The patient was referred to our hospital based on clear detection of anemia and computed tomography findings of bilateral adrenal tumors with hemorrhage and a mass in the apex of the left lung. Right adrenal artery embolization had no effect on enlargement of the right adrenal hematoma or advanced anemia. Right adrenalectomy was then performed in an attempt to control hemorrhaging and make a definitive diagnosis, and the patient's anemia improved following the operation. Histopathological diagnosis suggested adrenal metastasis of lung adenocarcinoma, which was subsequently diagnosed given similarities in transbronchial biopsy findings to those in the right adrenal gland. Adrenal hemorrhage due to metastasis of lung cancer is an extremely rare condition; indeed, to our knowledge, the present case is only the 26th reported worldwide. However, prognosis for this mortal condition may be improved should patients receive adrenalectomy followed by an appropriate treatment regimen.

Spontaneous Rupture of a Rare Adrenal Artery Aneurysm Mimicking a Ruptured Abdominal Aortic Aneurysm

Spontaneous adrenal artery aneurysm rupture is an exceedingly rare but life-threatening condition that requires emergent treatment. We report on an 80-year-old male who underwent an emergent exploratory laparotomy and repair of a ruptured adrenal artery aneurysm and highlight the role of both vascular surgery and interventional radiology in the management of this scenario.

Anti‐mouse renin expression in the rat kidney

The causes of toxemia of pregnancy are not fully understood. This project examines rat kidneys to determine if a mouse anti‐renin antibody will cross‐react rat renin‐producing cells in the rat. This will allow further study female reproductive tissues in the rat to examine for renin production. Renin is known as hormone produced by the juxtaglomerular cells of the afferent arteriole of the kidney in response low blood pressure. Also, renin is an immediate downstream target of Class I Hox gene regulation, important in embryonic development. In mice, renin is expressed in embryonic renal, adrenal and gonadal arteries, the adrenal glands, and tissue associated with embryonic pronephric and mesonephric kidneys. Using a renin/GFP reporter in transgenic mice, renin is expressed in placental giant trophoblast cells and uterine/ovarian artery cells of the tunica adventitia. In RCS rats, renin antibody stain that used anti‐rat renin and peroxidase labeled placental giant trophoblast cells and cells of the tunica adventitia of the uterine/ovarian artery. This project examines rat kidney tissue labeled by indirect immuno‐fluorescence with anti‐mouse renin antibody and fluorescent conjugate. Cells in the juxtaglomerular region of the kidney were renin positive. This demonstrates that anti‐mouse renin antibody can dependably label regions in the rat kidney that are known for renin production. This will allow for further studies to determine renin location in rat female reproductive tissues. Dr. Craig Jones of Roswell Park Cancer Institute generously donated mouse renin antibody and lab space for stain procedures. D'Youville College Faculty Council and Department of Math &amp; Natural Sciences supported work.

Abstract No. 327: Adrenal artery embolization: anatomy, indications, and technical considerations

Abstract No. 327: Adrenal artery embolization: anatomy, indications, and technical considerations

Spontaneous rupture of an adrenal artery in pregnancy: a case report.

A spontaneous rupture of an adrenal artery is a rare cause of abdominal pain in pregnancy. We present a case of a pregnant woman who needed to be operated on because of a rupture of the right adrenal artery associated with a fetal bradycardia. An immediate caesarean section was performed. The intra-abdominal palpation identified an extensive retroperitoneal mass near the right kidney and a postoperative computer tomography confirmed an active bleeding near the kidney. For this reason our interventional radiology team, using a right femoral artery approach, performed a flush aortogram and identified the source of bleeding in the right adrenal artery. After two attempts, a coiling of the artery stopped the haemorrhage. The pathogenesis of arterial haemorrhage is still poorly understood although a possible cause could be the excess of hormones during pregnancy, which can lead to a significant arterial wall degeneration. In case of a retroperitoneal bleeding and if the patient is still haemodynamically stable, a transcatheter embolization using microcoils must be considered. This technique is nowadays safe and effective and can be performed within a short time with a lower risk of complications.

Anatomical variations of the right renal and spermatic arteries: a case report

Knowledge of the anatomy of renal vessels and their anatomical variations (diverse branching from abdominal aorta) represents an indispensable moment for planning and performing surgical operations in this area. Renal arteries originate from abdominal aorta at L1-L2 level. Normally the right renal artery passes behind inferior vena cava and right renal vein, the left one is shorter and passes behind left renal vein. Each renal artery gives inferior adrenal gland arteries and divides in four or five branches close to the hilum. Usually, shortly below the right renal artery, right gonadic artery arises and runs in front of the inferior vena cava. In our Department, during a routine gross anatomy dissection of a 98-year-old Caucasian male cadaver for undergraduated, postgraduated students and residents, we observed that right renal artery exhibit an early bifurcation. The two arteries have a peculiar running, in spite of the more frequent behavior. They cross each other at the middle of the path between abdominal aorta and renal hilum forming a sort of knot. The lower branch goes up looking like a superior polar artery, from which stems a short retropielic artery. Right gonadic artery originates from right renal artery in spite of its more frequent origin from abdominal aorta at L3 level. These monolateral variations are of course unusual but not responsible for any hemodynamic impairment. Probably as concerning the right renal artery variation it looks like that it is due to a non complete fusion of the primitive segmental arteries at the first steps of formation of right dorsalis aorta. This impinges on the fact that also the right gonadic artery stays close to the upper part of dorsalis aorta and therefore originates eventually from the right renal artery.

Traumatic injury causing intraperitoneal hemorrhage of an occult pheochromocytoma.

Pheochromocytoma is a rare catecholamine-secreting tumor derived from chromaffin cells. The diagnosis is usually suggested by classic history in a symptomatic patient, presence of a strong family history in a patient, or discovery of an incidental mass on imaging in an asymptomatic patient. Traumatic hemorrhage into an occult pheochromocytoma presenting as hypovolemic shock is a rare presentation of pheochromocytoma. We report a case of a 48-year-old female, who presented in hypovolemic shock due to unilateral adrenal hemorrhage secondary to a fall from horse. Computed tomographic imaging revealed that the source of the hypovolemic shock was hemorrhagic right adrenal mass with active extravasation. The patient underwent emergent selective arterial embolization of right superior adrenal artery and a small adrenal branch from the right renal artery to control the hemorrhage. The patient subsequently progressed to sepsis and MODS, needing multiple surgical procedures and a protracted recovery in the ICU. In the ICU, the patient suffered from rapid cyclic fluctuation of her systolic blood pressure and was subsequently diagnosed with pheochromocytoma secondary to traumatic hemorrhage. We discuss this rare case along with the presentation and diagnostic workup of this critically ill patient with a previously undiagnosed pheochromocytoma.

Clinical anatomy of adrenal blood supply in different aged groups

Renal blood supply sources of adrenals in the norm are studied in the work as well as blood supply peculiarities of unilateral adrenal and kidney in renal artery stenosis are revealed. It is concluded that including the study of adrenal arteries into angiographic algorithm in case of renal artery stenosis is of necessity.

Spontaneous adrenal pheochromocytoma rupture complicated by intraperitoneal hemorrhage and shock

MEN2A is a hereditary syndrome characterized by medullary thyroid carcinoma, hyperparathyroidism, and pheochromocytoma. Classically patients with a pheochromocytoma initially present with the triad of paroxysmal headaches, palpitations, and diaphoresis accompanied by marked hypertension. However, although reported as a rare presentation, spontaneous hemorrhage within a pheochromocytoma can present as an abdominal catastrophe. Unrecognized, this transformation can rapidly result in death. We report the only documented case of a thirty eight year old gentleman with MEN2A who presented to a community hospital with hemorrhagic shock and peritonitis secondary to an unrecognized hemorrhagic pheochromocytoma. The clinical course is notable for an inability to localize the source of hemorrhage during an initial damage control laparotomy that stabilized the patient sufficiently to allow emergent transfer to our facility, re-exploration for continued hemorrhage and abdominal compartment syndrome, and ultimately angiographic embolization of the left adrenal artery for control of the bleeding. Following recovery from his critical illness and appropriate medical management for pheochromocytoma, he returned for interval bilateral adrenal gland resection, from which his recovery was unremarkable. Our review of the literature highlights the high mortality associated with the undertaking of an operative intervention in the face of an unrecognized functional pheochromocytoma. This reinforces the need for maintaining a high index of suspicion for pheochromocytoma in similar cases. Our case also demonstrates the need for a mutimodal treatment approach that will often be required in these cases.

Blood supply of adrenals in renal artery stenosis

«Renal» blood supply sources of adrenals in the norm are studied in the work as well as blood supply peculiarities of unilateral adrenal and kidney in renal artery stenosis are revealed. It is concluded that including the study of adrenal arteries into angiographic algorithm in case of renal artery stenosis is of necessity.

Adrenal artery aneurysm encountered during laparoscopic adrenalectomy for pheochromocytoma

Adrenal artery aneurysms are an extremely rare clinical entity. Only six previous case reports of adrenal artery aneurysms exist, all of which were discovered after rupture. Herein, we describe the discovery of an unruptured adrenal artery aneurysm found during laparoscopic adrenalectomy for pheochromocytoma.