Pathology Of Adrenal Glands Research Articles

What's new in adrenal gland pathology: WHO 5th edition for adrenal cortex.

The 5th edition of WHO Classification of Endocrine and Neuroendocrine Tumors (2022) introduced many significant changes relevant to endocrine daily practice. In this newsletter, we summarize the notable changes to the adrenal cortex based on the 5th edition of the WHO classification [1].

Automated Adrenal Gland Disease Classes Using Patch-Based Center Symmetric Local Binary Pattern Technique with CT Images.

Incidental adrenal masses are seen in 5% of abdominal computed tomography (CT) examinations. Accurate discrimination of the possible differential diagnoses has important therapeutic and prognostic significance. A new handcrafted machine learning method has been developed for the automated and accurate classification of adrenal gland CT images. A new dataset comprising 759 adrenal gland CT image slices from 96 subjects were analyzed. Experts had labeled the collected images into four classes: normal, pheochromocytoma, lipid-poor adenoma, and metastasis. The images were preprocessed, resized, and the image features were extracted using the center symmetric local binary pattern (CS-LBP) method. CT images were next divided into 16 × 16 fixed-size patches, and further feature extraction using CS-LBP was performed on these patches. Next, extracted features were selected using neighborhood component analysis (NCA) to obtain the most meaningful ones for downstream classification. Finally, the selected features were classified using k-nearest neighbor (kNN), support vector machine (SVM), and neural network (NN) classifiers to obtain the optimum performing model. Our proposed method obtained an accuracy of 99.87%, 99.21%, and 98.81% with kNN, SVM, and NN classifiers, respectively. Hence, the kNN classifier yielded the highest classification results with no pathological image misclassified as normal. Our developed fixed patch CS-LBP-based automatic classification of adrenal gland pathologies on CT images is highly accurate and has low time complexity [Formula: see text]. It has the potential to be used for screening of adrenal gland disease classes with CT images.

Multimodality imaging of adrenal gland pathologies: A comprehensive pictorial review.

The assessment of acute abdominal and pelvic emergencies typically involves a multimodal approach consisting of plain radiographs, ultrasound, computed tomography (CT), and rarely magnetic resonance imaging (MRI). Although MRI is not traditionally employed in acute care settings, there are several instances in which MRI provides superior functional and prognostic information. In this manuscript, we highlight multimodal findings of adrenal gland emergencies: Hemorrhage, infarction, and infection. The purpose of our study is to highlight significant findings in various modalities, including CT, MRI, ultrasound, and PET/CT. Due to the scarcity of published data and limited clinical use, primary ultrasound findings are limited in our multimodal review. In conclusion, we find that synergistic use of CT, MRI, and functional imaging provides an effective tool for evaluation and management of adrenal pathology.

Robotic Adrenalectomy: An Initial Experience in a Turkish Regional Hospital.

BackgroundDue to the technical advantages and the convenience it provides to surgeons, “robotic adrenalectomy” is a widely used procedure for adrenal surgeries. In this study, we aim to evaluate our robotic adrenalectomy experience and delineate the factors that have a substantial impact on surgical outcomes.MethodsSuccessive 0 transperitoneal robotic operations using the daVinci SI® platform were grouped according to the surgery side, malignant or benign pathologies, for adenoma or non-adenoma lesions, tumor size of less than 4 cm or above, body mass index below or above 30 kg/m2, and with or without laparotomy history. Groups were compared in terms of duration of the operations, amount of bleeding, and the duration of hospitalization.ResultsMorbidity developed in 5 patients (16.6%), and no mortality was observed. We had only one conversion to perform open surgery (3.3%). Operations performed for adenoma significantly last longer when compared with the non-adenoma group (p < 0.05). In the malignant group, the amount of bleeding during surgery was found to be significantly higher (p < 0.05). The blood loss during the surgery was also found to be higher in the adenoma group than in the non-adenoma match (p < 0.05). Phenomenally, operative blood loss was found to be lesser in the bigger tumor size group (>4 cm) than in the smaller size group (p < 0.05).ConclusionOur results corroborate that robotic adrenalectomy may be more challenging for malignant pathologies and adenomas, but we can claim that it is an effective and safe option for all adrenal gland pathologies.

Unravelling the sex-specific diversity and functions of adrenal gland macrophages.

SummaryDespite the ubiquitous function of macrophages across the body, the diversity, origin, and function of adrenal gland macrophages remain largely unknown. We define the heterogeneity of adrenal gland immune cells using single-cell RNA sequencing and use genetic models to explore the developmental mechanisms yielding macrophage diversity. We define populations of monocyte-derived and embryonically seeded adrenal gland macrophages and identify a female-specific subset with low major histocompatibility complex (MHC) class II expression. In adulthood, monocyte recruitment dominates adrenal gland macrophage maintenance in female mice. Adrenal gland macrophage sub-tissular distribution follows a sex-dimorphic pattern, with MHC class IIlow macrophages located at the cortico-medullary junction. Macrophage sex dimorphism depends on the presence of the cortical X-zone. Adrenal gland macrophage depletion results in altered tissue homeostasis, modulated lipid metabolism, and decreased local aldosterone production during stress exposure. Overall, these data reveal the heterogeneity of adrenal gland macrophages and point toward sex-restricted distribution and functions of these cells.

Genetic Alterations in Benign Adrenal Tumors

The genetic basis of most types of adrenal adenomas has been elucidated over the past decade, leading to the association of adrenal gland pathologies with specific molecular defects. Various genetic studies have established links between variants affecting the protein kinase A (PKA) signaling pathway and benign cortisol-producing adrenal lesions. Specifically, genetic alterations in GNAS, PRKAR1A, PRKACA, PRKACB, PDE11A, and PDE8B have been identified. The PKA signaling pathway was initially implicated in the pathogenesis of Cushing syndrome in studies aiming to understand the underlying genetic defects of the rare tumor predisposition syndromes, Carney complex, and McCune-Albright syndrome, both affected by the same pathway. In addition, germline variants in ARMC5 have been identified as a cause of primary bilateral macronodular adrenal hyperplasia. On the other hand, primary aldosteronism can be subclassified into aldosterone-producing adenomas and bilateral idiopathic hyperaldosteronism. Various genes have been reported as causative for benign aldosterone-producing adrenal lesions, including KCNJ5, CACNA1D, CACNA1H, CLCN2, ATP1A1, and ATP2B3. The majority of them encode ion channels or pumps, and genetic alterations lead to ion transport impairment and cell membrane depolarization which further increase aldosterone synthase transcription and aldosterone overproduction though activation of voltage-gated calcium channels and intracellular calcium signaling. In this work, we provide an overview of the genetic causes of benign adrenal tumors.

Single-port retroperitoneoscopic adrenalectomy: Initial experience and standardization of the technique

Introduction and objectiveThe minimally invasive surgical approach to adrenal gland pathology is the most widely used nowadays, and retroperitoneoscopy occupies a relevant place. However, the evolution of these techniques towards even less invasive surgery through single-port access is anecdotal. The aim of this work is to describe our initial experience in single-port retroperitoneoscopic surgery (SPORS) of the adrenal gland focusing on perioperative data and postoperative pain. Material and methodsWe collected and analyzed the demographic and operative data of a series of patients undergoing adrenalectomy through SPORS. All procedures were performed through a single 3−4 cm subcostal incision with a multichannel port. Surgical data such as operative time, bleeding, length of stay and presence of complications were collected. We used the visual analog scale (VAS) for postoperative pain assessment. ResultsFrom December 2018 to August 2020, 6 patients with different types of adrenal pathology underwent consecutive surgeries in our Department by the same surgeon using SPORS. All surgeries were performed without requiring accessory trocar placement or reconversion to open surgery. The mean operative time was 91.6 ± 16.3 min, with <150 mL bleeding, mean length of stay of 35.8 ± 13.3 h and postoperative pain of VAS ≤3 (median 0.5). The mean size of specimens was 57.8 ± 18 mm. No complications were reported according to the Clavien-Dindo scale. ConclusionsEven in initially adverse cases, SPORS adrenalectomy is a feasible and safe technique with good cosmetic and perioperative results.

Suprarrenalectomía retroperitoneoscópica por puerto único: experiencia inicial y estandarización de la técnica

Introduction and objectiveThe minimally invasive surgical approach to adrenal gland pathology is the most widely used nowadays, and retroperitoneoscopy occupies a relevant place. However, the evolution of these techniques towards even less invasive surgery through single-port access is anecdotal. The aim of this work is to describe our initial experience in single-port retroperitoneoscopic surgery (SPORS) of the adrenal gland focusing on perioperative data and postoperative pain. Material and methodsWe collected and analyzed the demographic and operative data of a series of patients undergoing adrenalectomy through SPORS. All procedures were performed through a single 3-4cm subcostal incision with a multichannel port. Surgical data such as operative time, bleeding, length of stay and presence of complications were collected. We used the visual analog scale (VAS) for postoperative pain assessment. ResultsFrom December 2018 to August 2020, 6 patients with different types of adrenal pathology underwent consecutive surgeries in our Department by the same surgeon using SPORS. All surgeries were performed without requiring accessory trocar placement or reconversion to open surgery. The mean operative time was 91.6±16.3minutes, with <150mL bleeding, mean length of stay of 35.8±13.3hours and postoperative pain of VAS ≤3 (median 0.5). The mean size of specimens was 57.8±18mm. No complications were reported according to the Clavien-Dindo scale. ConclusionsEven in initially adverse cases, SPORS adrenalectomy is a feasible and safe technique with good cosmetic and perioperative results.

A Rare Case of Rapidly Enlarging Myelolipoma in Sickle Cell Disease

Adrenal myelolipoma (AM) is a benign tumor composed of mature fat cells and hemopoietic elements. Most AMs are incidental findings on imaging and clinically asymptomatic. The purpose of this case report is to describe a rare case of AM and explore its clinical manifestations, imaging features, and treatment. In this study, we report a case of a rapidly growing right AM in a patient with uncontrolled hemoglobin sickle cell disease. A 38-year-old male presented to our institution's endocrine surgery clinic for evaluation of an enlarging right adrenal mass. This mass was incidentally found during an abdominal ultrasound performed for transaminitis and thrombocytopenia. Patient was asymptomatic without any abdominal discomfort, back pain, nausea, or vomiting. Patient was lost to follow up until 2018. Follow-up computed tomography scan in 2018 showed the right adrenal mass measuring 12.3 cm in greatest dimension with significant macroscopic fat. Given the imaging features, AM was the presumed diagnosis. However, with a medical history of uncontrolled sickle cell disease, extra-medullary hematopoiesis and rapidly growing liposarcoma could not be ruled out. Surgical excision was performed due to size and significant tumor growth. Diagnosis was confirmed with histopathology and revealed myelolipoma. Image characteristics can be helpful in diagnosis of AM; however, the appearance of this lesion on computed tomography can be similar to other adrenal gland pathologies such as liposarcoma and mass-forming extramedullary hematopoiesis. Percutaneous needle biopsy may be indicated if the diagnosis remains unclear.

Collision and composition tumors: rare conditions to remember in differential diagnosis of adrenal glands lesions.

We have read with interest a recently published article entitled “ CT and MRI of adrenal gland pathologies ” by Wang et al . (1). The article provides a wide overview focused on the typical computed tomography (CT) and magnetic resonance imaging (MRI) features related to several pathological conditions that can involve the adrenal glands, with particular attention to the ones associated to hormones secretion and endocrine syndromes.

Roentgenoendovascular destruction of adrenal glands in the management of primary aldosteronism

Background. In the XXI century, interventional radiology is developing rapidly in the surgical treatment for endocrine pathology of adrenal glands. Until the introduction of aldosterone to renin ratio calculation as a screening test by K. Hiramatsu in 1981, primary aldosteronism was thought to be a rare pathology. Further study of the disease obtained new data on its prevalence – from 5 to 10 % among patients with hypertension and more than 20 % of patients with refractory hypertension. In Ukraine, the prevalence of primary aldosteronism among patients with refractory arterial hypertension is 1.2 %. The aim of the study was to evaluate the effectiveness of roentgenoendovascular destruction of adrenal glands (REDAG) in patients with primary aldosteronism (PA). Materials and methods. During the period from 2014 to July2018, a total of 132 patients with adrenal pathology were examined and treated at the Clinic of Hospital Surgery of ZSMU. Operative treatment for primary aldosteronism was performed in 38 patients, including 15 patients who underwent REDAG. There were 10 (66.7 %) women and 5 (33.3 %) men. The average age was 49.4 ± 14.9 years. According to CT (MRT), anatomy of adrenal neoplasms had the following localization: left-sided – in 11 (73.3 %) patients, right-sided – in 1 (6.7 %), bilateral – in 3 (20 %). The mean volume of adrenal neoplasms was 9.0 (6.3–10.0) mm. Diagnostics was performed according to the clinical practical recommendations for the diagnosis and treatment of PA (Clinical Practical Guideline – The Management of Primary Aldosteronism, 2016). Roentgenoendovascular surgery in patients with PA included destruction of the right adrenal gland in 3 (20 %) cases, of the left – in 12 (80 %). The results of the operative treatment were evaluated according to the standard criteria and clinical biochemical criteria of PASO (Primary Aldosteronism Surgical Outcomes) including the echocardiographic data. Results. The duration of the REDAG was 36.6 ± 6 minutes. Conversions, postoperative complications, lethal outcomes were avoided. The length of hospital stay was 9 (7–12) days. Comparative analysis of surgical treatment results showed a statistically significant decrease in systolic and diastolic blood pressure, aldosterone levels (P < 0.05). The control CT performed after treatment identified adrenal adenomas in the contralateral glands in 2 (13.3 %) patients. However, the follow-up clinical and laboratory diagnostics did not reveal its hormonal activity. According to PASO criteria, the complete biochemical effect was achieved in 73.3 %, complete clinical - in 66.7 %, partial biochemical effect – in 20 %, partial clinical effect – in 26.6 % of patients, failure of biochemical and clinical effects – in 6.7 %. Conclusions. Interventional methods of surgical treatment for adrenal pathology represent a complete alternative to endoscopic methods of surgical treatment in case i f it is clinically indicated. REDAG for primary aldosteronism demonstrates the statistically significant efficacy of symptomatic arterial hypertension treatment: complete biochemical effect in 73.3 %, complete clinical – 66.7%, partial biochemical effect – 20 %, partial clinical effect – 26.6 % of patients.

Pathological Findings in the Adrenal Glands of 80 Dogs

Background: The adrenal glands development important endocrine functions and can be affected by primary or secondary diseases. These adrenal gland pathologies may induce clinical syndromes resulting from abnormalities in the production and secretion of hormones. Data about pathological changes in dogs are scarce. Therefore, the aim of the present study was to identify and evaluate the histopathological and epidemiological features of adrenal changes in dogs submitted to necropsy examination from 2005 to 2016 in a Veterinary Teaching Hospital, Londrina, Paraná, Brazil.Material, Methods &amp; Results: During this period, 80 animals presented alterations of adrenal gland, representing 5.5% of all necropsied dogs. The pure breed dogs representing 58.6% and mixed breed 41.4%; 53.4% were female and 46.6% were male. The non-neoplastic adrenal lesions were more frequently (57.5%) compared to the neoplastic changes (42.5%). Most of the adrenal glands lesions occurred in older dogs (60%), following by the middle aged (31.25%) and young dogs (8.75%). The main non-neoplastic lesions observed in the adrenal glands were of hyperplastic (69.5%) and circulatory (26%) origin, among the earlier, 68.8% were diffuse hyperplasia and 31.2% nodular hyperplasia. The nodular hyperplasia was classified as micronodular multifocal in 40% of the glands with nodular hyperplasia, macronodular multifocal in 30%, micronodular diffuse in 20%, and micronodular focal in 10%. The neoplasms observed were adrenocortical adenoma (ACA) in 44.1%, pheochromocytomas in 23.5% and adrenocortical carcinomas (ACC) in 11.7% of the dogs with adrenal tumors. Metastasis from other primary tumors were observed in 20.6%.Discussion: The data in veterinary literature about the frequency of changes in adrenal gland of dogs are scarce and focus features of diagnosis by ultrasound examination. Most of the adrenal changes observed in the present study were incidental findings observed during the necropsy examination and no specific clinical signs were observed. Non-neoplastic adrenal lesions, mainly of hyperplastic origin, were more frequently observed compared to the neoplastic changes. Differing from previous studies, the diffuse hyperplasia was the most common non neoplastic finding in the adrenal glands. Considering the subclassification of nodular hyperplasia, the multifocal micronodular and macronodular multifocal pattern were the most frequent. In veterinary literature, there are no data about frequency of nodular hyperplastic subtypes. However, in humans the subclassification of nodular hyperplasia is associated to development of endocrine disorders. Previous studies reported lower incidence of neoplastic changes in adrenal gland of dogs compared to the present results. The adrenocortical adenoma was the most common primary tumor, followed by the adrenocortical carcinoma, pheochromocytoma and adrenocortical carcinoma. Congestion and hemorrhage were common findings observed in the adrenal gland primary tumors. On the other hand, necrosis and inflammatory infiltrate were observed only in the adrenocortical carcinomas. These histopathological features may be used as tool in the differential diagnosis between well differentiated adrenocortical carcinoma and adenoma. The histopathological examination was fundamental to differential and definitive diagnosis of all canine adrenal gland disorders observed.

Perubahan Patologi Seluler Kelenjar Adrenal Tikus Hipertensi dengan Terapi Sel Punca Mesenkimal Sumsum Tulang (CELLULER STUDY OF ADRENAL GLAND IN HYPERTENSIVE RATS WITH IMPACT OF BONE MARROW MESENCHYMAL STEM CELLS THERAPY)

The purpose of this study was to investigate changes in cellular pathology of adrenal gland as impact of bone marrow mesenchymal stem cells (BMMSC) therapy in hypertensive rats. The research used ten male wistar rats with age ± 10-12 weeks with body weight ± 200-250 grams which is devided into two different groups ie BMMSc(-) hyprtention and BMMSc(+) hypertension. Rats are conditioned with hypertention using Hasbinoto et al method. Right nephrectomy and left carotid communic artery ligation are performed on all rats. Rats are injected with deoxycorticosterone acetate (DOCA), then 0.12 % of âaminopropionitrile fumarate (BAPN) is added into drinking water. 1% NaCl solution was administered as drinking water during the study. Rats were evaluated for particular indicator ie blood pressure then were euthanized for adrenal organs collections. The data that obtained then analysed using qualitative descriptive. The result of the study indicate hypertention therapy using BMMSC can repair cell damaged of the adrenal gland such as hyperplasia, nodules, cysts and cytoplasm vacuolization.

CT and MRI of adrenal gland pathologies.

Besides ultrasound and nuclear medicine techniques, computed tomography (CT) and magnetic resonance imaging (MRI) are commonly used to examine adrenal lesions in both symptomatic and asymptomatic patients. Some adrenal lesions have characteristic radiological features. If an adrenal nodule is discovered incidentally, determining whether the lesion is benign or malignant is of great importance. According to their biological behavior, lesions can be divided into benign (mainly: adenoma, hyperplasia, pheochromocytoma, cyst, hemorrhage, cystic lymphangioma, myelolipoma, hemangioma, ganglioneuroma, teratoma) and malignant (mainly: metastases, adrenal cortical carcinoma, neuroblastoma, lymphoma) conditions. In this paper, we review CT/MRI findings of common adrenal gland lesions.

Appearance of Adrenal Myelolipomas on 2-deoxy-2-(18F) fluoro-D-glucose Positron Emission Tomography-Computed Tomography.

With the widespread use of 2-deoxy-2-(18F) fluoro-D-glucose positron emission tomography-computed tomography (FDG PET/CT) in oncologic imaging, it has become increasingly important for physicians who interpret FDG PET/CT scans to confidently recognize the spectrum of incidentally encountered benign and malignant findings. The adrenal glands represent an interesting nexus of multiple rare and common benign intrinsic tumors as well as metastases from a variety of primary malignancies. Given the breadth of adrenal gland pathology, careful description of the FDG PET/CT appearance of these pathologies is of value to help reduce misinterpretation. In this manuscript, we retrospectively and systematically review the FDG PET/CT imaging characteristics of benign adrenal myelolipomas in a small consecutive patient series. The myelolipomas in this series demonstrated differing degrees of macroscopic fat visible on CT, with generally mild FDG uptake fusing to the nonfatty portions of the lesions. At imaging follow-up, all of the myelolipomas in this series remained unchanged in appearance, helping to confirm their benign nature. The typical appearance of a myelolipoma on FDG PET/CT is a fat-containing adrenal mass with low-level FDG uptake in the nonfatty aspects of the mass, and such a lesion requires no further imaging workup.

Adrenal glands transabdominal ultrasonography - pictorial essay.

Adrenal gland ultrasonography is one of the corner stones of the abdominal ultrasonography examination for many medical specialties. The adrenal areas can be easily overlooked though adrenal gland pathology is diverse. We present the normal aspects and various transabdominal ultrasonography findings of the adrenal glands, both common and rare. Even though ultrasound examination is operator and patient dependent, we consider the examination of the adrenal glands very important, due to relatively frequent incidental detection of an adrenal mass.

Laparoscopic adrenalectomy: institutional Czech experience after almost 300 operations

Laparoscopic adrenalectomy is nowadays the method of choice for surgical treatment of adrenal gland pathologies. A retrospective analysis of the results of adrenalectomy procedures performed at the First Clinic of Surgery during the period from 2006 to 2015. Of the total number of 285 adrenalectomy procedures, 271 (95.1 %) were performed laparoscopically. Laparoscopic surgery was used for 2 bilateral adrenalectomies, 17 partial adrenalectomies and 12 laparoscopic removals of benign adrenal tumours greater than 10 cm. Malignant adrenal tumour was treated with open surgery 7 times, and metastasis of other cancers to the adrenal gland was removed laparoscopically 4 times. Laparoscopy can be used for complete or partial adrenalectomy. Neither tumour size of more than 10 cm nor metastatic involvement of the adrenal gland is regarded as contraindications to laparoscopy.

A Rare Case of Cushing Syndrome Caused by an Adrenocorticotropic Hormone-Producing Pulmonary Carcinoid Tumor

We present a rare of case of a carcinoid tumor-causing Cushing syndrome. Cushing syndrome, if left untreated, can result in severe morbidity and even mortality. Common causes of endogenous Cushing include pituitary gland adenomas and excess cortisol produced from various adrenal gland pathologies. Rarely, tumors such as pulmonary neuroendocrine tumors can produce adrenocorticotropic hormone (ACTH) and cause …

Anatomy and Pathology of Adrenal Glands for Understanding Primary Aldosteronism

Anatomy and Pathology of Adrenal Glands for Understanding Primary Aldosteronism

Adrenal Masses of Varied Etiology

A wide spectrum of benign and malignant diseases can present as an adrenal mass. Combined PET-CT is useful for evaluation of adrenocortical and adrenomedullary masses. F-FDG has been extensively used as PET radiotracer for this purpose. F-FDOPA PET, Ga-DOTA peptide (Ga-DOTANOC/TATE) PET, and C-HED PET have also been used for imaging of adrenal medullary lesions, whereas C-MTO PET has been used for adrenocortical imaging. We provide a review of imaging characteristics of adrenal gland pathologies on PET-CT using different tracers.