Functional Adrenal Tumors Research Articles

A giant solitary fibrous tumor of the adrenal gland in a 13-year old: a case report and review of the literature

IntroductionSolitary fibrous tumors are tumors of mesenchymal origin that occur in the extremities and occasionally in pleura, meninges, and so on, but are extremely rare in the adrenal gland. Their biological behavior is variable but mostly benign.Case presentationA 13-year-old Oromo girl presented with a progressively increasing right upper abdominal mass of 3 years’ duration. She had dull dragging pain and an occasional low-grade fever. On examination she had 20 × 20 cm mass with well-defined medial and inferior border. Both ultrasound and computed tomography scan showed a highly vascularized mass arising from her right adrenal gland but she had neither the constitutional symptoms of a functional adrenal tumor nor an abnormal biochemical test. Surgical resection showed a vascularized mass with attachments to the right lobe of the liver with a weight of 1900 g. It was found to be a giant solitary fibrous tumor of her right adrenal gland with infrequent mitosis. She stayed for 5 days after surgery and was discharged. She showed remarkable recovery at follow-up at 3 months.ConclusionAlthough very rare, solitary fibrous tumor of the adrenal gland should be considered in differential diagnosis of adrenal masses.

Infantile virilisation caused by an androstenedione-producing adrenal adenoma

Abstract A previously well fifteen-month-old female infant presented to a district general hospital in the United Kingdom with a three-month history of virilisation developing facial acne, coarse pubic hair, labia majora hypertrophy, menstruation, and clitoral enlargement. A functional adrenal tumour was suspected, supported by raised androgen metabolites on urinary steroid profile. An abdominal ultrasound scan identified a unilateral left adrenal mass. A subsequent CT scan of her chest, abdomen, and pelvis for surgical planning and tumour staging confirmed the left adrenal mass, a normal right adrenal gland, and identified a 3 mm left upper lobe lesion of the lung. The infant underwent a transperitoneal left adrenalectomy and developed adrenal insufficiency post-operatively. Histopathological examination of the adrenal mass confirmed a well encapsulated cortical adenoma with a maximum dimension of 45 mm and weight of 9.8 g. The virilisation symptoms improved following surgical excision and she commenced adrenal replacement therapy.

Treatment Outcomes of Transperitoneal Laparoscopic Adrenalectomy in Patients with Functional Adrenal Gland Tumors

Treatment Outcomes of Transperitoneal Laparoscopic Adrenalectomy in Patients with Functional Adrenal Gland Tumors

MP03-04 BRAF V600E MUTATION PROMOTED EXCESS OF HORMONE AND TUMORIGENESIS IN ADRENAL CORTICAL ADENOMA WITH AUTONOMOUS CORTISOL SECRETION

You have accessJournal of UrologyAdrenal1 Apr 2018MP03-04 BRAF V600E MUTATION PROMOTED EXCESS OF HORMONE AND TUMORIGENESIS IN ADRENAL CORTICAL ADENOMA WITH AUTONOMOUS CORTISOL SECRETION Kazuyuki Numakura, Taketoshi Nara, Sohei Kanda, Hiroshi Tsuruta, Mitsuru Saito, Shintaro Narita, Takamitsu Inoue, Shigeru Satoh, and Tomonori Habuchi Kazuyuki NumakuraKazuyuki Numakura More articles by this author , Taketoshi NaraTaketoshi Nara More articles by this author , Sohei KandaSohei Kanda More articles by this author , Hiroshi TsurutaHiroshi Tsuruta More articles by this author , Mitsuru SaitoMitsuru Saito More articles by this author , Shintaro NaritaShintaro Narita More articles by this author , Takamitsu InoueTakamitsu Inoue More articles by this author , Shigeru SatohShigeru Satoh More articles by this author , and Tomonori HabuchiTomonori Habuchi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.3047AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The incidence of incidental adrenal tumors is increasing because of recent screening improvements in imaging modalities. A surgery is performed not only for functional adrenal tumors but also for suspected malignancy or growing size in preoperatively diagnosed non-functioning cortical adenoma (NCA). However, preoperative diagnosis of NCA is often inaccurate. BRAF was well known as tumorigenic driver gene in bowel intestine and other organs. However, an implication of BRAF in adrenal cortical adenoma has never investigated definitely. The purpose of this study was to analyze a clinical meaning of BRAF V600E mutation for acquiring endocrinological activity and tumorigenesis in adrenal cortical adenomas. METHODS In Akita University from September 1997 to July 2017, we performed 80 laparoscopic adrenalectomies for Cushing′s syndrome (CS), subclinical Cushing′s syndrome (SCS) and NCA. The diagnosis of them were determined on the basis of preoperative endocrinological evaluations. We analyzed expression of total BRAF and BRAF V600E mutation in adrenal cortical adenoma patients (CS in 15, SCS in 15, and NCA in 10) using by immunohistochemistry (IHC). RESULTS The correlation observed between expression of total BRAF and BRAF V600E mutation was very strong (r = 0.869). BRAF expression was high in 13 (26%), intermediate in 10 (20%), and low in 17 (34%) (Figure 1). High and intermediate expression of BRAF V600E were detected more frequently in CS (13/15 [86.7%], p<0.001) and SCS (10/15 [66.7%], p=0.003) compared with NCA (0/10 [0%]). No clinical factor, such as tumor diameter, endocrinological factors, and comorbidities, was different in groups. CONCLUSIONS BRAF V600E mutation might be a driver mutation to promote inappropriate cortisol secretion and be a target molecular in adrenal cortical adenoma with autonomous cortisol secretion. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e22 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Kazuyuki Numakura More articles by this author Taketoshi Nara More articles by this author Sohei Kanda More articles by this author Hiroshi Tsuruta More articles by this author Mitsuru Saito More articles by this author Shintaro Narita More articles by this author Takamitsu Inoue More articles by this author Shigeru Satoh More articles by this author Tomonori Habuchi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Harvey Cushing Treated the First Known Patient With Carney Complex.

Context:Carney complex (CNC) is a syndrome characterized by hyperplasia of endocrine organs and may present with clinical features of Cushing syndrome and acromegaly due to functional adrenal and pituitary gland tumors. CNC has been linked to mutations in the regulatory subunit of protein kinase A type I-alpha (PRKAR1A) gene.Design:Tissue samples were taken from the hypothalamus or thalamus or tumors of patients with pituitary adenomas seen and operated on by neurosurgeon Harvey Cushing between 1913 and 1932. Following DNA extraction, sequencing for genes of interest was attempted, including PRKAR1A, AIP, USP8, GNAS1, and GPR101, to explore the possibility that these mutations associated with acromegaly, CNC, and Cushing syndrome have been conserved over time.Results:We report a patient described by Dr. Cushing in 1914 with a clinical presentation and postmortem findings suggestive of CNC. Genetic sequencing of the hypothalamus and pituitary adenoma revealed a germline heterozygous p.Arg74His mutation in the PRKAR1A gene, a codon previously described as mutated in CNC, but with a novel amino acid change.Conclusions:This patient is, to our knowledge, the first molecularly confirmed individual with CNC. This case demonstrates the power of modern genetics in studying archived tissues and the importance of recording detailed clinical notes in the diagnosis of disease.

Pentraxin 3 as a New Cardiovascular Marker in Adrenal Adenomas

Pentraxin 3 (PTX3) is an acute-phase glycoprotein, which is increased in patients with cardiovascular disease (CVD) and considered as a predictor of CVD in the general population. Both functional and nonfunctional adrenal tumors are associated with a higher risk of cardiovascular events and mortality. We aimed to investigate plasma PTX3 levels in patients with functioning and nonfunctioning adrenal tumors and determine its relationship with cardiovascular risk factors. Twenty-one patients with functional adrenal tumors (11 pheochromocytomas, 9 Cushing syndrome, and 1 primary hyperaldosteronism), 28 patients with nonfunctional adrenal incidentalomas, and 40 healthy controls were enrolled in the study. Serum PTX3 levels were measured using a human PTX3 enzyme-linked immunosorbent assay. PTX3 concentrations were significantly higher in the adrenal tumor group compared with the control group (3,001.64 ± 374.64 pg/mL vs. 1,173.59 ± 168.89 pg/mL; P<.001). PTX3 concentrations were positively correlated with carotid intima media thickness (CIMT) (r2, 0.464; P<.001), high-sensitivity C-reactive protein (hsCRP) (r2, 0.551; P<.001), diastolic blood pressure (r2, 0.334; P = .003), systolic blood pressure (r2, 0.312; P = .006), and urinary metanephrine concentrations (r2, 0.320; P = .041). Serum PTX3 concentrations in patients with functional adrenal tumors and comorbidities including hypertension, diabetes mellitus, or CVD were higher than in those without comorbidities (3,654.54 ± 447 pg/mL vs. 1,026.96 ± 447.97 pg/mL; P = .008). We found that serum PTX3 concentrations increased in both functional and nonfunctional adrenal tumors. PTX3 levels were correlated with cardiovascular risk factors such as CIMT, hsCRP, and blood pressure. BMI = body mass index; CIMT = carotid intima-media thickness; CRP = C-reactive protein; CT = computed tomography; CVD = cardiovascular disease; FGF2 = fibroblast growth factor 2; hsCRP = high-sensitivity C-reactive protein; PA = primary hyperaldosteronism; PTX3 = pentraxin 3.

Outcome of laparoscopic adrenalectomy for resection of unilateral noninvasive adrenocortical tumors in 11 cats.

To describe the technique and outcomes of laparoscopic adrenalectomy (LA) in cats with adrenocortical neoplasia. Retrospective case series. Eleven client-owned cats with unilateral adrenal tumors. Medical records of cats that underwent LA for unilateral functional adrenal tumors at 3 veterinary teaching hospitals were reviewed. Data collected included signalment, clinical signs, physical examination findings, diagnostic imaging results, preoperative laboratory tests, laparoscopic port placement and techniques, duration of anesthesia and surgery, complications, concomitant procedures, need for conversion to an open celiotomy, histopathological diagnosis, and postoperative survival. Eleven cats were included, 5 with right-sided and 6 with left-sided tumors. Tumors were aldosterone-secreting (n = 8), progesterone-secreting (n = 2), or testosterone-secreting (n = 1). Adrenalectomy was successfully performed in all 11 cats although 4 cases required conversion to an open celiotomy, due to poor visualization (n = 2), close adherence of the tumor to the caudal vena cava (n = 1), and inability to maintain adequate pneumoperitoneum (n = 1). Ten of the 11 cats were discharged from the hospital, with a median survival time of 803 days (range 467-1123 days). One cat died from severe pancreatitis and cardiogenic pulmonary edema. Adrenalectomy can be performed in cats via laparoscopy but is technically challenging, and associated with a relatively high conversion rate (36%).

MP12-03 SUBCLINICAL CUSHING'S SYNDROME IDENTIFIED ON LAPAROSCOPIC ADRENALECTOMY PERFORMED FOR PREOPERATIVE DIAGNOSIS OF NON- FUNCTIONING CORTICAL ADENOMA

You have accessJournal of UrologyAdrenal1 Apr 2016MP12-03 SUBCLINICAL CUSHING'S SYNDROME IDENTIFIED ON LAPAROSCOPIC ADRENALECTOMY PERFORMED FOR PREOPERATIVE DIAGNOSIS OF NON- FUNCTIONING CORTICAL ADENOMA Kazuyuki Numakura, Norihiko Tsuchiya, Hiroshi Tsuruta, Mitsuru Saito, Takamitsu Inoue, Shintaro Nariata, Mingguo Huang, Shigeru Satoh, and Tomonori Habuchi Kazuyuki NumakuraKazuyuki Numakura More articles by this author , Norihiko TsuchiyaNorihiko Tsuchiya More articles by this author , Hiroshi TsurutaHiroshi Tsuruta More articles by this author , Mitsuru SaitoMitsuru Saito More articles by this author , Takamitsu InoueTakamitsu Inoue More articles by this author , Shintaro NariataShintaro Nariata More articles by this author , Mingguo HuangMingguo Huang More articles by this author , Shigeru SatohShigeru Satoh More articles by this author , and Tomonori HabuchiTomonori Habuchi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2443AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The incidence of incidental adrenal tumors is increasing because of recent screening improvements in imaging modalities. Laparoscopic surgery is performed not only for functional adrenal tumors but also for suspected malignancy or growing size in preoperatively diagnosed non-functioning cortical adenoma (NCA). However, preoperative diagnosis of NCA is often inaccurate and subsequently requires definitive endocrine activity after surgery. The purpose of this study was to analyze the operative results of laparoscopic adrenalectomy for NCA and evaluate the preoperative diagnosis of NCA. METHODS From September 1997 to Aplil 2013, we performed 143 laparoscopic adrenalectomies for adrenal tumor in Akita University. Of the 22 cases were diagnosed as NCA with suspected malignancy or growing size. Patients with negative results on low-dose dexamethasone suppression tests, no activity for renin and aldosterone in blood tests, and no activity for adrenaline and noradrenaline in 24-h urine collection tests were diagnosed as NCA. The mean age of the 22 patients was 60.9 years (range, 34-79 years; males, 11; females, 11), and the right and left sides were affected in 11 and 11 patients, respectively. RESULTS All laparoscopic adrenalectomies were successfully completed, and no open conversion was necessary. The mean operative time was 169 min and blood loss was 67 ml. The mean tumor diameter was 3.7 cm (range, 2.0-6.0 cm). Histological diagnoses were cortical adenoma in 20 patients, medullary adenoma in 1, and myelolipoma in 1. There were no malignancies. Postoperatively, four patients (18.2%) were diagnosed as subclinical Cushing's syndrome (SCS) because of postoperative conditions. The reason for the modified diagnosis of subclinical Cushing's syndrome was as follows; complete remission of diabetes mellitus (DM) in 2 patients, prolonged adrenocorticotropic hormone hyper-secretion in 1, and onset of refractory shock in 1. Larger tumor diameter (4.5 cm vs. 3.6 cm; p = 0.043) and DM (3:1 vs. 1:17; p = 0.044) were associated with SCS. CONCLUSIONS In four patients (18.2%), preoperative diagnosis of NCA was modified after excision of adrenal tumors. One serious complication (postoperative refractory shock) occurred in our series. Although the use of minimally invasive laparoscopic adrenalectomy is getting more and more prevalent, surgical management for suspected NCA should be decided carefully, particularly for patients with NCA having large tumor diameters as well as DM. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e126 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Kazuyuki Numakura More articles by this author Norihiko Tsuchiya More articles by this author Hiroshi Tsuruta More articles by this author Mitsuru Saito More articles by this author Takamitsu Inoue More articles by this author Shintaro Nariata More articles by this author Mingguo Huang More articles by this author Shigeru Satoh More articles by this author Tomonori Habuchi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

FDG PET/CT Scan and Functional Adrenal Tumors: A Pilot Study for Lateralization.

Patients with Cushing's Syndrome (CS) and Conn's Syndrome with bilateral adrenal masses pose a dilemma. Uptake of 18F-FDG by hyperfunctioning adrenal glands has not been previously reported and may help lateralize. The aim was to determine if 18F-FDG PET/CT scan could identify hyperfunctioning adrenal masses and determine a biological basis for uptake. Patients with nonfunctional adenomas (n = 9), CS (n = 11), and Conn's syndrome (n = 4) underwent an 18F-FDG PET/CT scan with a volume of interest circumscribing each mass to obtain a maximal standardized uptake value (SUVmax). Thirty-two adrenal masses were analyzed. Genome-wide expression data from an independent cohort were analyzed in nonfunctioning adenomas (n = 20), Conn's syndrome (n = 29), and CS (n = 24) focusing on GLUT genes. For genes differentially expressed, immunohistochemistry was performed on tissue samples. Cortisol-secreting masses (n = 16) had a higher average SUVmax of 5.9 compared to nonfunctioning masses (n = 11, average SUVmax 4.2) and aldosterone-hypersecreting masses (n = 5, average SUVmax 3.2) (p = 0.007). SUVmax cut-off of 5.33 had 50.0% sensitivity and 81.8% specificity in localizing a cortisol-secreting mass. GLUT3 expression was 2.19-fold higher in patients with CS compared to patients with nonfunctioning adenomas (p = 0.003) and 2.16-fold higher in patients with CS compared to Conn's syndrome (p = 0.006). GLUT3 immunohistochemistry showed 2.2-fold higher staining in CS tumor samples compared to nonfunctioning adenomas. Differential 18F-FDG PET/CT uptake was observed in patients with nonfunctioning, aldosterone-hypersecreting, and cortisol-secreting masses. GLUT3 overexpression in cortisol-secreting tumor likely accounts for the differential uptake. Future larger cohort studies will need to be conducted to determine if 18F-FDG PET/CT uptake can lateralize cortisol-secreting adrenal masses in patients with bilateral adrenal masses.

Recurrent Primaty Adrenal Leiopyosarcoma: A Complete Literature Review and Presentation of a Rare Adrenal Tumor

ABSTRACT Objective: Leiomyosarcomas are mesenchymal tumors that very rarely present as a primary adrenal malignancy. Methods: We present the complete clinical presentation, imaging, and anatomicopathologic features of a unique case of recurrent primary adrenal leiomyosarcoma (PAL) after initial surgery. This case is accompanied by an updated literature review. Results: A 63-year-old Hispanic female referred to our clinic 4 months after having right adrenalectomy. Eight months prior to this encounter, she started to notice bilateral lower extremity edema with skin changes. Computed tomography of the abdomen revealed a large 6.8 × 4.4 cm adrenal mass that appeared to be encroaching in the inferior vena cava with hypodense areas, irregular borders, and a necrotic center. A preoperative hormonal evaluation failed to reveal evidence of a functional adrenal tumor. Microscopic examination revealed spindle cell neoplasia. Immunohistochemistry of the surgical specimen revealed positive staining for desmin, smooth ...

Functional adrenal tumour as a cause of virilised infant

Functional adrenal tumour as a cause of virilised infant

Functional adrenal tumour as a cause of virilised infant

Functional adrenal tumour as a cause of virilised infant

Medicine. A unified cause for adrenal Cushing's syndrome.

Mutations in a signaling protein underlie a class of functional adrenal tumors [Also see Reports by Cao et al. and Sato et al. ]

Case report: Heterotopic intrarenally located adrenocortical oncocytoma

The clinical case of a 65-year-old woman with an incidentally detected left-sided mass in the upper renal pole is presented. A functional adrenal tumor was excluded. The mass was removed retroperitoneoscopically. The perioperative period was uneventful. The histopathological examination revealed a heterotopic intrarenal adrenocortical oncocytoma.Adrenal oncocytic neoplasms are very rare, with, to the authors’ knowledge, only 159 described cases so far. Most cases are non-functioning adenomas that can reach a considerable size. Only 10 heterotopic adrenal oncocytomas have been described (three retroperitoneal and seven intraspinal cases). Although the intrarenal adrenal rest is the most frequently appearing variant of adrenal heterotopia, to the best of our knowledge, this report is the first description of an intrarenally growing adrenocortical oncocytic adenoma.In addition to retroperitoneally located oncocytomas, this case could be interesting for urological practice because there are no diagnostic features which could provide a secure preoperative diagnosis of an adrenal oncocytic neoplasm and its malignant variant. Generally accepted indications for surgery of adrenal masses have to be respected. The definitive pathologic diagnosis is in most cases surprising because of its rarity. Benign adrenal oncocytic neoplasms do not require any adjuvant treatment. The oncocytic variant of adrenocortical carcinoma generally has a poor prognosis.

From the radiologic pathology archives: Adrenal tumors and tumor-like conditions in the adult: radiologic-pathologic correlation.

Advanced imaging often reveals adrenal tumors and tumor-like conditions in both symptomatic and asymptomatic patients. When adrenal disease is clinically suspected, cross-sectional imaging can be helpful in evaluating the etiology of the patient's symptoms. When adrenal disease is incidentally identified, what the clinician and patient really want to know is whether the findings are benign or malignant, as this ultimately will affect their next step in management. Using radiologic-pathologic correlation, we broadly classify common, uncommon, and rare tumors and tumor-like conditions that can occur in the adrenal as benign or malignant. This classification follows predominant trends in observed biologic behavior while acknowledging those tumors that may behave in the minority in an unpredictable manner. We review the clinical background and presentation of functional adrenal tumors including Conn syndrome, Cushing syndrome, and catecholamine-secreting tumors, as well as their relationship with adrenal anatomy. We discuss a variety of benign tumors, including adrenal cortical adenoma (including oncocytoma) and pheochromocytoma, as well as uncommonly and rarely encountered tumors such as myelolipoma, hemangioma, lymphangioma, schwannoma, ganglioneuroma, and adenomatoid tumor. A variety of tumefactive but nonneoplastic lesions are addressed, including adrenal cortical hyperplasia, adrenal hemorrhage, adrenal cysts, and infections. Malignant tumors discussed include adrenal cortical carcinoma, the rare malignant pheochromocytoma, lymphoma, metastases, and sarcomas. For each tumor and tumor-like lesion, the clinical presentation, epidemiology, key imaging findings, diagnostic differential considerations, and management options are briefly addressed. Finally, an approach to the workup of suspected or incidentally discovered tumors is presented based on a selected literature survey and our clinical experience. Radiologists play an important role in identification and diagnosis of adrenal tumors and tumor-like conditions in both symptomatic and asymptomatic patients.

Risk Estimator for Adrenal Tumor Functionality

Adrenal lesions are a common imaging finding with a prevalence approaching 10%. Although guidelines recommend dedicated laboratory tests to rule out tumor functionality, many patients never undergo this workup. This study investigates the use of demographic and clinical variables to create an easy scoring system for predicting adrenal tumor functionality (functional adrenal tumors, or FATs). Altogether, 2,807 patients in the NSQIP 2005-2010 database underwent adrenalectomy as their principal operation and had a postoperative diagnosis consistent with an adrenal lesion/disorder. Patients were divided into two groups based on a postoperative diagnosis consistent with tumor functionality. Univariate and multivariate logistic regression analyses were performed to identify specific predictors of FATs and for Cushing's, Conn's, or pheochromocytoma. Overall, 13.2% (n = 402) of adrenalectomies performed were for FATs. Patients with a FAT were younger (age <40, p < 0.01), overweight (BMI > 30 kg/m(2), p < 0.01), hypertensive (p < 0.001). They also had elevated white blood cells (WBC > 11, p < 0.001), serum creatinine (Cr > 1.25 mg/dl, p < 0.001), and sodium (Na > 143 mmol/L, p < 0.001). On multivariate regression, patients with these characteristics were 20.53 times (CI 15.79-25.27) more likely to have a FAT (model c-statistic 0.634, CI 0.605-0.663; Hosmer-Lemeshow test (H-L), p = 0.035). Patients who were younger (p < 0.001), female (p < 0.001), diabetic (p = 0.07), overweight (p = 0.027), with elevated WBCs (p < 0.001) and lower Cr (p < 0.001) were 63.62 times (CI 58.03-69.21) more likely to have Cushing's (model c-statistic 0.685, CI 0.648-0.722; H-L p = 0.954). After external validation, this risk estimator might be used to quantify the probability of tumor functionality in patients with incidental adrenal masses. Although predictive power may be limited, it helps identify patients at high risk for FATs that need more urgent referral to a specialist.

Case report: Heterotopic intrarenally located adrenocortical oncocytoma.

The clinical case of a 65-year-old woman with an incidentally detected left-sided mass in the upper renal pole is presented. A functional adrenal tumor was excluded. The mass was removed retroperitoneoscopically. The perioperative period was uneventful. The histopathological examination revealed a heterotopic intrarenal adrenocortical oncocytoma. Adrenal oncocytic neoplasms are very rare, with, to the authors' knowledge, only 159 described cases so far. Most cases are non-functioning adenomas that can reach a considerable size. Only 10 heterotopic adrenal oncocytomas have been described (three retroperitoneal and seven intraspinal cases). Although the intrarenal adrenal rest is the most frequently appearing variant of adrenal heterotopia, to the best of our knowledge, this report is the first description of an intrarenally growing adrenocortical oncocytic adenoma. In addition to retroperitoneally located oncocytomas, this case could be interesting for urological practice because there are no diagnostic features which could provide a secure preoperative diagnosis of an adrenal oncocytic neoplasm and its malignant variant. Generally accepted indications for surgery of adrenal masses have to be respected. The definitive pathologic diagnosis is in most cases surprising because of its rarity. Benign adrenal oncocytic neoplasms do not require any adjuvant treatment. The oncocytic variant of adrenocortical carcinoma generally has a poor prognosis.

Laparoscopic extirpation of giant adrenal ganglioneuroma

Laparoscopic adrenalectomy is the standard of care for management of adrenal neoplasms. However, large sized adrenal lesions are considered as relative contraindication for laparoscopic extirpation. We report laparoscopic excision of giant ganglioneuroma of adrenal gland in a 33-year-old female patient. Patient was presented with left loin pain of 2 months duration. Computed tomography (CT) scan was suggestive of non-enhancing left suprarenal mass measuring 17 × 10 cm. Preoperative endocrine evaluation ruled out functional adrenal tumor. Patient underwent transperitoneal excision of suprarenal mass. The lesion could be completely extirpated laparoscopically. Duration of surgery was 250 minutes. Estimated blood loss was 230 milliliters. Specimen was extracted through pfannenstiel incision. No significant intraoperative or postoperative happenings were recorded. Microscopic features were suggestive of ganglioneuroma of adrenal gland.

Myelolipomatous Adrenal Adenoma and Adrenal Scintigraphy: A Case Presentation and Review of Literature

Adrenal myelolipomas are usually benign and non-functioning masses. On the other hand, adrenal myelolipomatous adenoma that may mimic adrenal myelolipoma on conventional imaging may be a rare cause of subclinical Cushing’s disease. Adrenal scintigraphy (with 131 I-6beta-iodomethyl-19-norcholesterol) can be used to demonstrate increased uptake in a functioning adrenal myelolipomatous adenoma to distinguish it from an adrenal myelolipoma, when the source of the excess hormone secretion after biochemical evaluation is unclear. Treating physicians should be familiar with the occasional use of this imaging modality that can help distinguish functional adrenal tumors from non-functioning ones when conventional imaging fails to do so. A 66-year-old female was found to have an incidental 6.5 cm right adrenal mass during a routine abdominal ultrasound. Complete biochemical evaluation was suggestive of subclinical Cushing’s syndrome. Imaging studies were consistent with adrenal myelolipoma. Adrenal scintigraphy showed a unilateral increased uptake at the site of the adrenal mass. She successfully underwent laparoscopic adrenalectomy of the 6.5 cm mass and she had significant clinical improvement. Myelolipomatous adrenal adenoma (that may mimic adrenal myelolipoma on conventional imaging) may be a rare cause of subclinical Cushing’s, and adrenal scintigraphy may be a useful imaging technique that may help in localizing the lesion, which can then be treated surgically. J Endocrinol Metab. 2014;4(5-6):148-150 doi: http://dx.doi.org/10.14740/jem254w

The Vascular Surgeon's Experience with Adrenal Venous Sampling for the Diagnosis of Primary Hyperaldosteronism

Adrenal venous sampling (AVS) is used to distinguish between bilateral idiopathic hyperplasia and a functional adrenal tumor in patients with hyperaldosteronism. Successful sampling from both adrenal veins is necessary for lateralization and may require more than 1 procedure. AVS has traditionally been performed by interventional radiologists; however, our goal was to examine the outcomes when performed by a vascular surgeon. All patients with a diagnosis of hyperaldosteronism were referred for AVS regardless of imaging findings. Cortisol and aldosterone levels were measured in blood samples from both adrenal veins. Postoperative analysis of intraoperative laboratory values before and after cosyntropin administration determined successful cannulation and sampling of each vein. Between 2007 and 2012, 53 patients underwent AVS by one vascular surgeon. The average age was 54 and 63% were men. Our success rate increased with experience, because during the earlier years (2007-2010) primary and secondary success rates were 58% and 68%, respectively compared with later years (2011-2012) when primary and secondary success rates were 82% and 95%, respectively (P<0.05). Results of AVS altered localization of disease compared with what had been anticipated based on preoperative imaging and thus influenced surgical decision making in 47% of cases. AVS is an important procedure in the work up of hyperaldosteronism to help identify and localize metabolically active tumors. It is an additional area in medicine where a vascular surgeon can lend expertise. Success with the procedure improves with experience and should be performed by high volume surgeons.