Diagnosis Of Adrenal Disease Research Articles

Иммуногистохимическое исследование иннервации надпочечника крысы

The aim of the study was to study the innervation of the cortical part and medulla of the rat adrenal gland using neuroimmunohistochemical markers. Original data on the innervation of the rat Wistar (n = 8) adrenal cortex and medulla were obtained using immunohistochemical detection of the PGP 9.5 protein, synaptophysin, tyrosine hydroxylase, peripherin and serotonin. It was established that all zones of the cortex (glomerular, bundle, and reticular) are innervated by nerve fibers of various neurotransmitter identity. In the cortex, the innervation of the glomerular zone is most pronounced. A thick terminal plexus of varicose axons around islets of endocrinocytes, arterioles and nerve cells was detected in this zone. Cholinergic nerve structures (plexus of preterminal nerve fibers and the terminal synaptic network, which consists of varicose parasympathetic axons located around groups of neuroendocrine cells and sinusoidal capillaries) prevail in the medulla. Parasympathetic and sympathetic intramural ganglia were found in the medulla. Chromaffin cells immunoreactive to various catecholamines and serotonin were found in the adrenal medulla. It was assumed that different sources of sympathetic innervation of the organ are present. These are the medulla's own neurons and sympathetic trunk neurons. Such innervation is important for the regulation of local blood circulation.The results obtained in this study can be used both in scientific research and in the diagnosis of adrenal diseases.

Commentary on “Computed Tomography in the Diagnosis of Adrenal Disease” and “Nonfunctioning Adrenal Masses: Incidental Discovery on Computed Tomography”

AJR:192, March 2009 documents this watershed in the history of adrenal imaging and the starting point for modern adrenal imaging. For the first time, radiologists could see normal or minimally abnormal adrenal glands that were endo­ crinologically hyperactive. Korobkin et al. [1] showed how CT could be used in sympto­ matic patients to visualize functional adrenal masses that produced excessive cortisol, aldosterone, or catecholamines. These early images, obtained with scanning times ranging from 4.8 to 18 seconds, were primitive and laden with artifacts. Indeed, the adrenals were identified only 75% of the time, but some important and enduring observations were made by these early investigators. In patients with Cushing’s disease, func tional adrenal adenomas could be dif fer en ti ated from adrenal hyperplasia caused by adrenocortico­ tropic hormone–secreting tumors. Hyperplasia could take the form of either thickened adrenal limbs or normal­ap pearing glands. Similarly, Conn’s syndrome adenomas could be distin­ guished from adrenal hyperplasia on the basis of the presence of a small mass. Pheochromo­ cytomas were larger, hyperenhancing masses that were easily identified on CT. An ob­ servation surprising even today was that patients with Addison’s disease usually had normal­appearing ad renals rather than hypo­ plastic or atrophic glands. Korobkin et al. [1] also observed that some patients had lesions that looked just like the functional adrenal masses associated with Conn’s syndrome and Cushing’s disease but were not abnormal either clinically or bio chemically. These “incidental” lesions were considered a curios­ ity by Korobkin et al.; however, they would prove to be a harbinger of a problem to confront radiologists in the future. This pro­ blem was documented in the article by Glazer et al. [2] 3 years later. By the time of the article by Glazer et al. [2], imaging had evolved considerably. Scanning Commentary on “Computed Tomography in the Diagnosis of Adrenal Disease” and “Nonfunctioning Adrenal Masses: Incidental Discovery on Computed Tomography”

Endoscopic Ultrasound Imaging of the Adrenals

Endoscopic ultrasound (EUS) imaging of the adrenal glands and the systematic use of EUS imaging in the diagnosis of adrenal diseases have been frequently described since the initial report in 1996 [1] [2] [3] [4] [5] [6] [7] [8] [9]. The present article aims to provide an overview of the technique and procedure of endoscopic ultrasound imaging of the adrenals, illustrating typical findings and discussing the clinical indications for adrenal EUS.

Magnetic resonance tomography in the diagnosis of adrenal diseases

The authors analyze the results of many-year application of magnetic imaging to the diagnosis of volume diseases of the adrenals. The method may be effectively used for topical diagnosis of such conditions. Due to some of its characteristics, such as clear differentiation of soft tissues, possibility of examination in 3 and more projections, safety, etc., magnetic imaging may be considered a method of choice in the diagnosis of adrenal tumors. It provides valuable information on the size, shape, localization, and dissemination of adrenal tumors and in some cases differentiates the variants of anatomical norm of the adjacent organs simulating adrenal tumors shown by other topographic methods. Features of magnetic image of tumors different by their hormonal activity: aldosteroma, pheochromocytoma, corticosteroma, "incidentaloma", and malignant tumors are described. Use of paramagnetic contrast agents appreciably improves the quality of magnetic resonance tomographic diagnosis of adrenal tumors, for it permits a more reliable conclusion on the tumor structure and its position amidst the adjacent vascular structures (abdominal aorta and inferior vena cava) and the parenchymatous organs (liver and kidneys), which is particularly valuable for planning surgery.

Unilateral Spontaneous Adrenal Hemorrhage During ACTH Treatment of Multiple Sclerosis

Unilateral Spontaneous Adrenal Hemorrhage During ACTH Treatment of Multiple Sclerosis

Clinical experience with the adrenal scanning agents iodine 131-19-iodocholesterol and selenium 75-6-selenomethylcholesterol

Adrenocortical scintigraphy with iodine 131-19-iodocholesterol or selenium 75-6-selenomethylcholesterol was performed in 94 patients with proven or suspected adrenal disease. According to the final diagnosis, 36 patients suffered from primary aldosteronism, 33 from Cushing's syndrome, 8 from low renin hypertension, 6 from nonfunctioning adrenal tumour, 4 from simple obesity, 3 from adrenal metastases, 1 from congenital adrenal hyperplasia, 1 from virilizing adrenal adenoma, 1 from extraadrenal phaeochromocytoma, 1 from ganglioneuroma. Surgical confirmation of the diagnosis was obtained in most cases. With a few exceptions, the scintigraphy results were consistent with the final diagnosis. The two tracers were equally effective adrenal scanning agents. Tracer concentration was measured in a number of surgical specimens, mostly from patients given selenocholesterol. This measurement in surgical samples has not been reported in previous studies with this agent. The results provided a direct validation of uptake measurements in vivo. The data, collected over a 17-year period, demonstrate that despite the advent of new imaging techniques, adrenal scintigraphy that gives both functional and morphologic information still has an important role in the diagnosis of adrenal disease.

Addison's disease due to metastatic carcinoma: The value of CT scan

A case of Addison's disease secondary to bilateral adrenal metastasis is reported. The adrenal metastasis were secondary to bronchogenic carcinoma and the diagnosis was made on the basis of the CT scan. The role of CT in the diagnosis of adrenal disease as well as the importance of including the adrenals in the chest CT scan for preoperative staging of bronchogenic carcinoma is discussed.

Endocrinology and metabolism: an annotated bibliography of recent literature. References to journal articles and other papers.

Endocrinology and metabolism: an annotated bibliography of recent literature. References to journal articles and other papers.

Computed tomography in the diagnosis of adrenal disease.

A series of 63 patients with suspected adrenal disease was evaluated by computed tomography (CT). In 15 additional patients CT diagnosed unsuspected adrenal disease. The CT results were correlated with surgical, postmortem, or compelling clinical data. In those patients with adequate visualization of both adrenals, CT correctly identified all adrenal masses subsequently proven at surgery or postmortem examination. CT accurately predicted the presence or absence of a unilateral adrenal neoplasm in patients with Cushing's syndrome and primary aldosteronism. Unsuspected primary or metastatic neoplasms of the adrenals were occasionally detected in patients scanned for other reasons. CT is a safe and accurate method of evaluating patients with suspected adrenal disease.

Diagnosis of adrenal disease by visualization of human adrenal glands with 131 I-19-iodocholesterol.

Normally functioning adrenal glands in four patients were readily visualized with the Anger camera and a rectilinear photoscanner after administration of 131I-19-iodocholesterol. Three patients with Cushing's syndrome due to ACTH excess showed adrenal glands approximately equal in size and radioactivity concentration. In a patient with persistent Cushing's syndrome after bilateral total adrenalectomy radioactivity was concentrated in the region of the right adrenal bed compatible with a functioning adrenal remnant. A right adrenal adenoma in a patient with Cushing's syndrome measured 3.5 by 3.0 cm on scan, with no uptake in the opposite gland. At surgery, the adenoma measured 3.5 by 3.0 by 2.7 cm. In two patients, one with a 112-g pheochromocytoma and one with extensive calcifications of one adrenal gland, the involved gland was not imaged, but "normal" adrenal images of the normal contralateral glands were shown.

Retroperitoneal pneumography in the investigation of adrenal disease

The accuracy of retroperitoneal pneumography in the diagnosis of adrenal disease has been assessed in a series of 56 examinations, most of which were performed in patients with Cushing's syndrome. The size, shape and quality of delineation of the adrenal glands were each assessed. Fifteen per cent of examinations failed to demonstrate at least one gland, delineation being particularly poor in patients with bilateral adrenocortical hyperplasia. In adults with this condition, only 10% of successful examinations showed enlargement of both glands. Apparent unilateral enlargement was more common in these patients and in 35% we made a misleading diagnosis of adrenal tumour. We failed to diagnose 40% of functioning adenomata. Neither adrenal size nor shape differentiated between tumour and the nodular form of hyperplasia, conditions which tests of adrenal function may at present also fail to distinguish.

On the issue of functional diagnostics of the adrenal glands

Diagnosis of adrenal diseases is one of the most difficult issues of internal pathology. If even an inexperienced doctor can easily recognize the classic form of Addison's disease, then various forms of hyper- and hypofunction of the adrenal glands are not easy to account for for a major specialist.