Adrenal Medullary Tumors Research Articles

Changes in WHO classification of adrenal tumors and new ideas for multi-dimensional diagnosis and treatment

In 2022, WHO updated the classification and concept of adrenal cortical and medullary tumors. In terms of adrenal cortical tumors, the WHO classification further standardizes the nomenclature of nodular adrenal cortical disease and refines the pathological classification of primary aldosteronism. In terms of adrenal medullary tumors, the WHO classification unifies the concepts of pheochromocytoma and paraganglioma, and reclassifies various concepts, including paraganglioma-like neuroendocrine tumors. The new standards not only cover the clinical manifestations of the disease, but also include other multiple aspects such as the histological origin of the disease, immunohistochemical manifestations, physiological mechanisms of the disease, hereditary susceptibility and prognostic factors. This article intends to explore how to improve the diagnostic and therapeutic level of adrenal tumors.

NF-κB1 deficiency promotes macrophage-derived adrenal tumors but decreases neurofibromas in HTLV-I LTR-Tax transgenic mice.

Human T-cell leukemia virus type I (HTLV-I) is an oncogenic virus whose infection can cause diverse diseases, most notably adult T-cell leukemia/lymphoma (ATL or ATLL), an aggressive and fatal malignancy of CD4 T cells. The oncogenic ability of HTLV-I is mostly attributed to the viral transcriptional transactivator Tax. Tax alone is sufficient to induce specific tumors in mice depending on the promotor used to drive Tax expression, thereby being used to understand HTLV-I tumorigenesis and model the tumor types developed in Tax transgenic mice. Tax exerts its oncogenic role predominantly by activating the cellular transcription factor NF-κB. Here, we report that genetic deletion of NF-κB1, the prototypic member of the NF-κB family, promotes adrenal medullary tumors but suppresses neurofibromas in mice with transgenic Tax driven by the HTLV-I Long Terminal Repeat (LTR) promoter. The adrenal tumors are derived from macrophages. Neoplastic macrophages also infiltrate the spleen and lymph nodes, causing splenomegaly and lymphadenopathy in mice. Nevertheless, the findings could be human relevant, because macrophages are important target cells of HTLV-I infection and serve as a virus reservoir in vivo. Moreover, the spleen, lymph nodes and adrenal glands are the most common sites of tumor cell infiltration in HTLV-I-infected patients. These data provide new mechanistic insights into the complex interaction between Tax and NF-κB, therefore improving our understanding of HTLV-I oncogenic pathogenesis. They also expand our knowledge and establish a new animal model of macrophage neoplasms and adrenal tumors.

Cystic pheochromocytoma: a rare variant of adrenal gland tumor case report

Abstract Introduction/Objective Pheochromocytoma is the primary adrenal medullary tumor in adults. Patients usually present with sustained or sporadic hypertension. The tumors are almost always solid. Cystic pheochromocytoma (CP) is extremely rare with only a few cases reported in the literature. Patients with CP may be asymptomatic and normotensive and be diagnosed incidentally on imaging or intraoperatively. Methods/Case Report We report a case of an 82-year-old male with a large CP who presented with back pain. The patient was hypertensive preoperatively (140/85 mmHg). Imaging showed a 5.4 cm complex right adrenal mass that could not be further classified. Labs showed markedly increased 24hr urine normetanephrine (1342 ug/24hr). The patient was presumed to have a pheochromocytoma and was preoperatively treated with an alpha-blocker. At surgery an 8.0 cm multiloculated cystic adrenal mass was removed, and grossly the specimen consisted of a brown, multicystic mass filled with brown liquid. Histology revealed the septa to contain nests of polygonal cells with vacuolated to basophilic granular cytoplasm with moderate nuclear pleomorphism . Immunohistochemical staining was positive for synaptophysin, chromogranin and S-100, which confirmed the diagnosis of CP. Patient’s postoperative blood pressure was 130/60 mmHg. Results (if a Case Study enter NA) NA Conclusion Cystic pheochromocytoma has to be in the differential for a retroperitoneal cystic mass in order that clinicians, radiologists as well as pathologists undertake proper patient management and diagnosis.

PSAT006 Two Cases of Pheochromocytoma Associated Takotsubo Syndrome- Importance of Early Recognition and Treatment

Abstract Introduction Pheochromocytoma is a rare catecholamine producing adrenal medullary tumor that classically presents with hypertension. Takutsubo cardiomyopathy (TC) is a rare but increasingly recognized presentation of pheochromocytoma. We present two cases of TC likely caused by pheochromocytoma. Case 1 A 60 y/o male who presented with acute onset nausea, vomiting and abdominal pain. Systolic BP was 150-160 mm Hg, and diastolic BP was 100 mmHg. Troponin was elevated (4.15 ng/ml; nl = 0-0.04). An echocardiogram showed a reduced left ventricular ejection fraction (LVEF) of 15-20% (nl = 50-75%), a mildly dilated left ventricle, and apical ballooning suggestive of TC. Coronary arteries were normal on cardiac catheterization. CT scan identified a 5.3×5.6×5.7 cm adrenal mass of 50 HU pre-contrast. Further evaluation revealed markedly elevated plasma metanephrine concentration of 858 pg/ml (nl<57) and normetanpehrine concentration of 1729 pg/ml (<148). His presentation was strongly suggestive of pheochromocytoma associated TC. He was prepared for surgery with doxazosin 2 mg twice daily followed by metoprolol succinate and metyrosine up to 500 mg/d. Final pathology revealed a 5.3 cm left pheochromocytoma with negative surgical margins. Germline genetic testing was negative for pheochromocytoma/paraganglioma pathogenic gene mutations, and an MIBG scan did not reveal metastatic disease. Echocardiogram one month after adrenalectomy showed a marked improvement in LVEF to 55-60% with no regional wall motion abnormalities, and plasma metanephrine concentrations normalized. Case 2 A 61 y/o female smoker with type 2 diabetes mellitus, hypertension, Graves disease and obesity presented with sudden onset of nausea followed by chest discomfort, bilateral shoulder discomfort and shortness of breath. Troponin was 0.6 ng/ml (nl = 0-0.04), EKG showed ST elevations in leads I, 2, V5 V6 with hyperacute T waves. Coronary arteries were normal on catheterization. She required intubation, and systolic BP ranged from 110 to 200 mm Hg. On echocardiogram the LVEF was 35% to 40% (nl = 50-75), and there was diffuse hypokinesis of the mid to apical LV myocardium with hypercontractility of the LV base, suggestive of TC. The plasma metanephrine concentration was 3.31 nmol/l (nl= 0-0.49), and normetanephrine concentration was 5.02 nmol/l (nl= 0-0.89). CT imaging revealed a 2.9 cm left adrenal mass. She underwent successful left adrenalectomy after preparation with alpha, beta blockade and metyrosine. Germline genetic testing was negative for pheochromocytoma/paraganglioma pathogenic gene mutations . Echocardiogram nine months post-adrenalectomy showed normal EF of 50-55% and resolution of apical hypokinesis. Discussion We present two pheochromocytoma patients presenting with TC that reversed following appropriate pheochromocytoma management. Few case series report the association of pheochromocytoma and TC. These patients usually present acutely without prodromal stressors commonly found with classic TC. Conclusion In the setting of TC, pheochromocytoma should be considered. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

P.636 Intracerebroventricular injection of the cardiotonic steroid digoxin, but not bufalin, causes mania-like behavior in C57Black/6 mice

Pheochromocytoma is an adrenal medullary tumor of the chromaffin cells first described in 1886, remains an entity not fully discovered that case reports keep showing its diversity in clinical presentation, diagnosis methods treatment and follow up challenges.We report the case of a 47 year old woman with complaining from abdominal pain and major weightless with a 09 cm tumor of the body of the pancreas viewed in imaging with no hormonal secretion but high levels of chromogranine A open surgery conducted that revealed the tumor to be located between the adrenal medulla and the Aorta misleading the team between an adrenal tumor or a zuckerkandl body tumor. The hemodynamic changes after manipulation of the tumor and the histopathology confirming the diagnosis of pheochromocytoma. Our main surprise was the aspect of the tumor bombing in the peritoneal cavity firstly thought to be mesenteric tumor; and the stability of the patient with no premedication until the tumor had been manipulated, enlarging the hypothesis about catecholamine secretion of these tumor.The diagnosis is basically simple when the tumor expresses its catecholamines by biomarkers testing, an imaging. Functional imaging should be used to locate the tumor or its metastasis, the sequence of testing or imaging can vary either it’s a symptomatic tumor or an incidentaloma. Preoperative measures should be taken so no major preoperative complications and the main treatment is the tumor complete resectionThe malignancy of the pheochromocytoma is no near to be reliably identified which imposes a lifetime follow up of these patients as for metastasis were described even after 40 years after diagnosis.

First proof of association between autoimmune polyglandular syndrome and multiple endocrine neoplasia in humans.

Autoimmune Addison's disease (AAD) is a rare condition occurring either in isolation or associated with other autoimmune diseases as part of an autoimmune polyglandular syndrome (APS) type 1, 2 or 4. Multiple endocrine neoplasia (MEN) type 1, 2 or 4 is a hereditary autosomal dominant cancer syndrome. Medullary thyroid carcinoma and pheochromocytoma are neoplasms common to MEN-2a and MEN-2b. We describe a unique, complex case of a man resulted affected by both APS-2 and MEN-2a. The patient developed Hashimoto's thyroiditis, diabetes mellitus type 1 and AAD, despite testing negative for adrenal cortex autoantibodies (ACA) and steroid 21-hydroxylase autoantibodies (21-OHAb). Moreover, he had also a family history for MEN-2a and he first developed medullay thyroid cancer, then bilateral pheochromocytoma on the adrenal substrate of an AAD. On adrenal histology we found complete bilateral cortical atrophy in the presence of a lymphocytic infiltration and fibrosis, confirming an ACA and 21-OHAb-negative AAD. This datum is the first documented in a living individual and confirms that the absence of autoantibodies is not incompatible with an autoimmune disease and confirms that AAD is a cell-mediated autoimmune disease limited to the adrenal cortex and sparing medullary. In the light of a literature review concerning the association between APS and MEN, this is the first proven case to be reported in humans. Finally, our findings suggest that adrenal medullary tumor can develop even on an adrenal gland with cortical atrophy due to autoimmune adrenalitis.

Retrospective analysis of variant venous anatomy in 303 laparoscopic adrenalectomies and its clinical implications.

To clarify the correlation of variant venous anatomy with adrenal tumor phenotype and surgical outcomes. This retrospective study included 303 consecutive minimally invasive adrenalectomies from 301 patients. All adrenal veins were identified. We compared the preoperative, intraoperative, and postoperative data between patients with and without variant adrenal venous anatomy. We also explored the factors associated with venous variants. We found variant venous anatomy in 62 of 303 adrenalectomies (20.5%). Compared with patients with normal anatomy, those with variant anatomy were associated with larger tumor size, larger adrenal veins, more adrenal medullary tumors, longer operation time, more estimated intraoperative blood loss, longer length of hospitalization, and more transfusion. Computed tomography (CT) images may improve the identification of venous anatomy. Tumor size and diagnosis of pheochromocytoma were independently related to variant venous anatomy, whereas sex, tumor size, and venous variant influenced hemorrhage. For pheochromocytoma with variant venous anatomy operated on by a single surgeon, robot-assisted laparoscopic adrenalectomy was associated with shorter postoperative hospitalization. Adrenal vein variants are associated with worse outcomes in adrenal tumors and an optimized surgery strategy should be applied to this group of patients.

Correlation between CT features of adrenocortical and adrenal medullary tumors and expression of miR-96 in serum.

Correlation between CT features of adrenocortical and adrenal medullary tumors and the expression of miR-96 in serum were investigated. A total of 230 patients with adrenocortical tumors and 194 patients with adrenal medullary tumors were selected in Dongying People's Hospital from August 2013 to August 2017. The two groups of patients underwent CT examination, and the signs and symptoms were recorded. The expression of miR-96 in the serum of the two groups was detected by RT-PCR, and the correlation between the expression of serum miR-96 and CT features was analyzed. In patients with adrenocortical tumor, serum miR-96 expression levels were significantly higher in patients with tumor diameter ≥5 cm than those with tumor diameter <5 cm (p<0.001). In patients with adrenal medullary tumor, serum miR-96 expression levels were significantly higher in patients with tumor diameter ≥3 cm than those with tumor diameter <3 cm (p<0.001). In patients with adrenocortical or adrenal medullary tumor, serum miR-96 expression levels were significantly higher in patients with peripheral infiltration than those without peripheral infiltration (p<0.001), and serum miR-96 expression levels were also significantly higher in patients with distant metastasis than those without distant metastasis (p<0.001). Serum levels of miR-96 in patients with benign adrenocortical and adrenal medullary tumors were significantly lower than those with malignant tumors in the same group (p<0.001). miR-96 may have oncogenic functions in patients with adrenocortical or adrenal medullary tumors. Increased expression level of miR-96 may promote proliferation, invasion and metastasis of tumors, and serum levels of miR-96 provide references for the diagnosis of adrenocortical and adrenal medullary tumors.

Renal tubular and adrenal medullary tumors in the 2-year rat study with canagliflozin confirmed to be secondary to carbohydrate (glucose) malabsorption in the 15-month mechanistic rat study

During preclinical development of canagliflozin, an SGLT2 inhibitor, treatment-related pheochromocytomas, renal tubular tumors (RTT), and testicular Leydig cell tumors were reported in the 2-year rat toxicology study.In a previous 6-month rat mechanistic study, feeding a glucose free diet prevented canagliflozin effects on carbohydrate malabsorption as well as the increase in cell proliferation in adrenal medulla and kidneys, implicating carbohydrate malabsorption as the mechanism for tumor formation.In this chronic study male Sprague-Dawley rats were dosed orally with canagliflozin at high dose-levels (65 or 100 mg/kg/day) for 15 months and received either a standard diet or a glucose-free diet. Canagliflozin-dosed rats on standard diet showed presence of basophilic renal tubular tumors (6/90) and an increased incidence of adrenal medullary hyperplasia (35/90), which was fully prevented by feeding a glucose-free diet (no RTT's; adrenal medullary hyperplasia in ≤5/90).These data further confirm that kidney and adrenal medullary tumors in the 2-year rat study were secondary to carbohydrate (glucose) malabsorption and were not due to a direct effect of canagliflozin on these target tissues.

Evaluation and treatment of inherited pheochromocytoma in pregnancy

Pheochromocytomas represent a rare, but potentially devastating, cause of hypertension among pregnant patients. Inherited predisposition to these tumors requires vigilant screening, especially in women of child-bearing age. We present an illustrative case of a multiple endocrine neoplasia type 2A patient who was successfully surgically treated for a pheochromocytoma during pregnancy. A review of the existing, English-language literature and screening guidelines was undertaken. Pheochromocytomas presenting during pregnancy, can be safely and effectively treated with laparoscopic surgery, allowing the maintenance of a normal pregnancy. Screening of patients with inherited endocrinopathies that predispose to adrenal medullary tumors must be adapted to maximize the opportunity to detect a pheochromocytoma in the pregravid state. More frequent testing and a lower threshold for biochemical or radiologic investigation are suggested for women in their reproductive years.

Adrenal Tumors in Children - Clinicopathological Experience

Abstract Objective To document general baseline data on the patterns of childhood adrenal tumors. Design, setting, and participants This is a retrospective analysis of 10 cases of pediatric adrenal tumors (age group 0–12 years) in surgical pathology encountered over a period of 5 years. Results In the adrenal gland, adrenal medullary tumors were more common than adrenal cortex with neuroblastoma as common individual tumor. Two were tumors of adrenal cortex and 8 were of adrenal medulla with ratio of medullary to cortical adrenal neoplasms as 4:1. Conclusion Different types of tumors were seen in the adrenal gland. A high index of suspicion should be maintained with an aim of surgical treatment. Histological type is important for understanding etiology and progression of disease.

Pediatric Genitourinary Tumors-Clinicopathological Experience

Objective: To document general baseline data on the patterns of childhood genitourinary tu- mors. Design, Setting and Participants: This is a retrospective analysis of 28 cases of pediatric geni- tourinary tumors (Age group 0-12 years) in surgical pathology in a tertiary care hospital en- countered over a period of 5 years. Results: In the genitourinary system tumors of the kidney, bladder, prostate, testis, and adrenal were included. A total of 3149 pediatric surgical specimen presented over a five years. Of this, 28 were diagnosed with genitourinary tumors. In the renal tumors only Wilm's tumors (WTs) (9 cases) was seen, with classical triphasic tumors were more common. The mean age of presenta- tion is 3 year with commonest age group of presentation (8 cases out of 9) in the age group 1-5 years. Three of them had showed unfavorable histology. Among the gonadal germ cell tumors, there were noted four mature teratoma, one immature teratoma, two yolk sac tumors of ovary & one yolk sac tumour in testis was seen. In the adrenal gland, adrenal medullary tumors were more common than adrenal cortex with neuroblastoma (4 of 10 cases) as common individual tumor. Conclusion: Different types of genitourinary tumors seen in the childhood. A high index of suspicion should be maintained with an aim of surgical treatment to avoid the poor manage- ment. Histological type is important for understanding etiology and progression of disease. The likelihood of a given type of tumor being present in a particular age or sex group or particular site may heighten the index of suspicion and ultimately influences etiology, biology, and natural history, relative incidence and distribution frequency, clinical presentation and manifestations, and response to therapy and outcome.

Development of pheochromocytoma in ceramide synthase 2 null mice.

Pheochromocytoma (PCC) and paraganglioma are rare neuroendocrine tumors of the adrenal medulla and sympathetic and parasympathetic paraganglia, for which mutations in ∼15 disease-associated genes have been identified. We now document the role of an additional gene in mice, the ceramide synthase 2 (CerS2) gene. CerS2, one of six mammalian CerS, synthesizes ceramides with very-long (C22-C24) chains. The CerS2 null mouse has been well characterized and displays lesions in several organs including the liver, lung and the brain. We now demonstrate that changes in the sphingolipid acyl chain profile of the adrenal gland lead to the generation of adrenal medullary tumors. Histological analyses revealed that about half of the CerS2 null mice developed PCC by ∼13 months, and the rest showed signs of medullary hyperplasia. Norepinephrine and normetanephrine levels in the urine were elevated at 7 months of age consistent with the morphological abnormalities found at later ages. Accumulation of ceroid in the X-zone was observed as early as 2 months of age and as a consequence, older mice displayed elevated levels of lysosomal cathepsins, reduced proteasome activity and reduced activity of mitochondrial complex IV by 6 months of age. Together, these findings implicate an additional pathway that can lead to PCC formation, which involves alterations in the sphingolipid acyl chain length. Analysis of the role of sphingolipids in PCC may lead to further understanding of the mechanism by which PCC develops, and might implicate the sphingolipid pathway as a possible novel therapeutic target for this rare tumor.

Three Cases of ACTH-Producing Pheochromocytoma – Full Hormonal Workup in Patients With an Adrenal Mass May Be Crucial For Correct Management

ABSTRACT Objective: In rare cases, adrenal medullary tumors secrete adrenocorticotropic hormone (ACTH) in addition to catecholamines. Methods: We present 3 cases of ACTH-producing pheochromocytomas, highlighting the diagnostic challenges, clinical severity, and phenotypic diversity of this rare phenomenon. Results: Two of the patients (females aged 75 and 60 years) presented with typical Cushingoid phenotypes. Their biochemical profiles were consistent with ectopic ACTH-dependent Cushing syndrome with grossly elevated plasma ACTH and urinary free cortisol. One of the patients had vague symptoms of adrenergic hyperactivity and highly elevated levels of plasma metanephrines, whereas the other had no symptoms of pheochromocytoma. The third patient (male aged 64 years) presented with tachycardia, labile blood pressure, and sweating consistent with pheochromocytoma. He had no signs of Cushing syndrome. Plasma and urine samples showed highly elevated concentrations of catecholamines, ACTH, and cortisol. After admission to hospital, all patients deteriorated within a few weeks with multiorgan involvement. All 3 had unilateral adrenal masses, and acute rescue adrenalectomy was performed. Histopathologic examination showed pheochromocytomas with positive ACTH immunostaining. The patients recovered quickly after surgery with restoration of organ functions. Conclusion: Extensive hormone profile evaluations should be carried out in all adult patients presenting with an adrenal mass independent of the clinical presentation. ACTH-producing pheochromocytoma should be considered in patients presenting with the confusing picture of ACTH-dependent Cushing syndrome and a unilateral adrenal mass. Abbreviations: ACTH adrenocorticotropic hormone CT computed tomography MRI magnetic resonance imaging P plasma T2DM type 2 diabetes mellitus

Adrenal imaging (Part 2): Medullary and secondary adrenal lesions

Adrenal malignancies can be either primary adrenal tumors or secondary metastases, with metastases representing the most common malignant adrenal lesion. While imaging cannot always clearly differentiate between various adrenal malignancies, presence of certain imaging features, in conjunction with appropriate clinical background and hormonal profile, can suggest the appropriate diagnosis. The second part of the article on adrenal imaging describes adrenal medullary tumors, secondary adrenal lesions, bilateral adrenal lesions, adrenal incidentalomas and provides an algorithmic approach to adrenal lesions based on current imaging recommendations.

Unusual Presentation of Pheochromocytoma with Polyphagia

ABSTRACT Pheochromocytoma is adrenal medullary tumor known to present in protean ways, especially in children. Here we describe a case of adrenal pheochromocytoma in young girl of 13 years presenting with polyphagia as a predominant symptom. She was successfully treated with laparoscopic adrenalectomy. How to cite this article Bhargav PRK. Unusual presentation of Pheochromocytoma with Polyphagia. World J Endoc Surg 2014;6(3):113-114.

Evaluation and Treatment of Inherited Pheochromocytoma in Pregnancy

ABSTRACT Pheochromocytomas represent a rare, but potentially devastating, cause of hypertension among pregnant patients. Inherited predisposition to these tumors requires vigilant screening, especially in women of child-bearing age. We present an illustrative case of a multiple endocrine neoplasia type 2A patient who was successfully surgically treated for a pheochromocytoma during pregnancy. A review of the existing, English-language literature and screening guidelines was undertaken. Pheochromocytomas presenting during pregnancy, can be safely and effectively treated with laparoscopic surgery, allowing the maintenance of a normal pregnancy. Screening of patients with inherited endocrinopathies that predispose to adrenal medullary tumors must be adapted to maximize the opportunity to detect a pheochromocytoma in the pregravid state. More frequent testing and a lower threshold for biochemical or radiologic investigation are suggested for women in their reproductive years. Abbreviation: MEN—multiple endocrine neoplasia; RET—rearranged during transfection; MRI—magnetic resonance imaging. How to cite this article Thompson AE, James BC, Saunders BD. Evaluation and Treatment of Inherited Pheochromocytoma in Pregnancy. World J Endoc Surg 2013;5(3):82-84.

Giant suprarenal tumor

Adrenal tumors evoke considerable interest and represent various diagnostic challenges. Adrenal tumors can be stratified into adrenal medullary and adrenocortical tumors. Approximately 60% of adrenocortical tumors are hormonally active and show specific signs and symptoms. Patients with a nonfunctioning adrenal tumor usually present with abdominal discomfort due to the mass effect of the tumor. An imaging feature that differentiates benign from malignant adrenal neoplasms is the tumor size. Thus, for the differential diagnosis of adrenal lesions, measurement of the Hounsfield units on an unenhanced computed tomographic scan is of great value when differentiating malignant from benign lesions. Herein, we describe a young female patient who presented with a huge left suprarenal tumor. She underwent complete resection of the adrenal tumor. The final pathological diagnosis was an adrenocortical carcinoma. There has been no evidence of recurrence for the last 4 years.

Diagnosis and therapy of adrenal ganglioneuromas

Objective To investigate the clinical characteristics,manifestation and management of adrenal ganglioneuromas. Methods The data of 15 cases of ganglioneuromas diagnosed by pathology were reviewed retrospectively.Of the 15 cases,5 was male,aged 24 to 45 with an average of 29 years,and other 10 was female,aged 25 to 69 with an average of 31.Ten tumors were located in the right side,which was twice as many as that of the left side.There were 8 patients discovered by B ultrasonograpgy during health check-up,4 patients were detected because of paroxysmal abdominal pain. Three cases mainly presented with paroxysmally hypertension,and one of them had a high level of aldosterone ( 112 pmol/L). One of them had a high level of epinephrine (210 nmol) and nor-epinephrine (496 nmol). The B-ultrasound showed low-echo in all cases.Five cases showed calcification,the border was legible.The border lines of the tumors are not clear with vana cava in two cases. On unenhanced CT scanning,all cases showed low density areas.Eleven of the 15 cases underwent the enhanced CT,but 10 cases showed no enhanced areas on CT scanning.One case underwent MRI and showed low signals in T1 WI and inhomogeneous high signals in T2WI. Results Twelve cases underwent adrenal glands tumorectomy with abdominal NO.11 intercostals incision while other 3 underwent adrenal glands tumorectomy through posterior abdominal laparoscope.The tumors were completely removed in 14 cases,partly removed in 1 case.All patients recovered soon without complications such as bleeding or adrenal crisis.All cases were followed-up 13 to 74 months.The blood pressure of 3 cases with hypertension decreased to normal.The tumors recurred in 1 case,but no metastasis 55 months later. Conclusions It is difficult to differentiate adrenal medullary tumor from ganglioneuromas.The imaging data of iconography before surgery can give helpful information in the diagnosis of ganglioneuroma.Complete surgical excision is the only method for curing and the outcome is satisfactory. Key words: Ganglioneuroma; Adrenal tumor; Diagnosis; Therapy

Secondary Arterial Hypertension: Improvements in Diagnosis and Management in the Last 10 Years

The diagnosis and management of secondary hypertension has improved in the last decade as a result of the advances in the acknowledgment of some physiopathologic mechanisms and mainly by the development of new diagnostic methods. Furthermore, the treatment of some types of secondary hypertension may be solved by noninvasive techniques. Hypertension of renal and renovascular origin, coarctation of the aorta, primary hyperaldosteronism, and adrenal medullary tumors are analyzed. The main results of some relevant studies on diagnostic and treatment of those diseases are presented. Also, some experimental methods are mentioned, taking into account the possibility of clinical use in the near future.