Solitary Adenoma Research Articles

Aldosterone: Yet Another Path to Blood Pressure Variability and Target Organ Damage.

In this issue of The Journal of Clinical Hypertension, Grillo and colleagues1 demonstrated that blood pressure (BP) variability (BPV) as determined by ambulatory BP monitoring (ABPM) was greater for patients with primary aldosteronism and those with essential hypertension in comparison to patients with no hypertension. The clinical implications of their findings are significant as they demonstrate another important subgroup of patients who are at increased risk for target organ damage from BPV. In addition, these investigators provide more evidence of the clinical utility of ABPM in diagnosing BPV in at-risk patient populations. There is growing evidence from both short-term (24-hour) and long-term assessments that BPV is associated with a higher risk for stroke, myocardial infarction, and kidney disease in patients with essential hypertension.2, 3 A study of 169 hypertensive patients showed that short-term BPV was associated with increased risk for left ventricular hypertrophy, increased carotid artery intimal-media thickness, and albuminuria, and prognosis was related to the number of sites of target organ damage.4 Similarly, Tatasciore and colleagues5 demonstrated increased carotid intima-media thickness and left ventricular mass in patients with greater BPV. These findings were specific for systolic BPV while awake and were independent of mean awake BP levels.5 Long-term BPV with measurements spanning weeks, months, or years is typically assessed by patient home BP monitoring or clinic BP measurements.2 As with short-term BPV, long-term BPV has also been associated with an increased risk of target organ damage in patients with essential hypertension.2 In multiple studies, patients with greater long-term variability in their home BP measurements had a higher prevalence of cardiovascular and kidney damage2, 6 and a higher risk of cardiovascular events and mortality.2, 7-10 Significantly compounding the cardiovascular risk of BPV, hypertensive patients with primary aldosteronism appear to be even more vulnerable to target organ damage compared with patients with only essential hypertension. A study of cardiovascular outcomes compared patients with primary aldosteronism from solitary adenomas or bilateral adrenal hyperplasia with patients who had essential hypertension.11 These cardiovascular events included stroke, myocardial infarction, atrial fibrillation, and echocardiographic and electrocardiographic evidence of left ventricular hypertrophy.11 The investigators found that patients with primary aldosteronism experienced more cardiovascular events than patients with essential hypertension.11 Importantly, the excess cardiovascular event burden in the primary aldosteronism patient group was independent of BP control.11 In a subsequent study, Catena and colleagues12 showed that the prevalence of cardiovascular events was significantly greater in a group of patients with primary aldosteronism (35%) than in patients with essential hypertension (11%). This excess cardiovascular complication burden was also independent and out of proportion to the patient's BP.12 Although both of these studies did not specifically evaluate BPV, it is certainly possible that the findings of Grillo and colleagues, which implicated BPV and target organ damage, is a causative factor for the increased cardiovascular events found in patients with primary aldosteronism. Given the increased risk of target organ damage associated with BPV, it may become critical that clinicians now consider another metric to assess whether their hypertensive patients are receiving optimal antihypertensive treatment; it is now not enough to just achieve a BP below a recommended threshold. A substantial body of clinical research has demonstrated that BPV is a significant causative factor in target organ damage even when BP is adequately controlled with medical therapies. For patients with primary aldosteronism who are already more vulnerable to target organ damage than patients with essential hypertension, BPV may be an even more important factor to measure. As Grillo and colleagues demonstrated in this study, ABPM is a well-suited and useful tool to assess BPV in patients with primary aldosteronism. Currently, the use of ABPM is limited and typically confined to the diagnosis of white-coat hypertension, episodic hypertension, resistant hypertension, and hypotensive symptoms while taking antihypertensive medications and autonomic dysfunction.13-15 However, we suggest that ABPM also be considered as a tool to evaluate the extent of BPV in patients with primary aldosteronism and to determine the effectiveness of an antihypertensive regimen. Finally, the authors discuss potential mechanisms for BPV. We are left concluding that there is much more to learn, including whether the fluctuations in BP are incurring injury or simply reflecting an aspect of target organ changes. Does the fact that one finds BPV in patients with primary aldosteronism offer any clues? Certainly volume expansion is a mediator of the increase in BP in primary aldosteronism and it would seem unlikely that volume per se would vary enough to account for the BPV. A volume-expanded state, however, could sensitize BP to changes in, for example, sympathetic tone. It would be interesting to know how much BPV might decrease following removal of an adrenal tumor that produced aldosterone. An underlying role for aldosterone in the development of hypertensive states as well as hypertensive complications seem to continually widen.

Percutaneous ultrasound-guided alcohol ablation of solitary parathyroid adenoma in a patient with primary hyperparathyroidism

Parathyroidectomy is considered the definitive cure for primary hyperparathyroidism due to a single parathyroid adenoma, which represents the most common cause of chronic hypercalcemia. However, in few cases, surgery may be technically difficult or risky. We report the use of percutaneous ultrasound-guided alcohol ablation of a parathyroid adenoma as an alternative to surgery in an 88-year-old male patient with significant medical comorbidities.

Intraoperative ultrasound for liver tumor resection in children

BackgroundPrimary hepatic neoplasms in children are rare tumors. All malignant and medically refractive benign primary pediatric liver tumors ultimately require surgical resection for cure. Accurate preoperative imaging including multidetector helical computerized tomography or magnetic resonance imaging (MRI) is necessary to determine resectability. In the literature intraoperative ultrasound (IOUS) has proven to be a vital adjunct to liver surgery in adults, but this is not well established in children. Materials and methodsBetween April 2003 and November 2014, children (<18-y-old) with a primary liver neoplasm, preoperatively evaluated with multidetector helical computerized tomography or MRI, who had IOUS used at the time of surgery were retrospectively reviewed. ResultsPreoperative evaluation with high-resolution MRI and IOUS were discordant in 4 of 19 patients (21%). In one case, right hepatic vein involvement was not accurately assessed with MRI. Two cases showed tumor involvement in segment IV by MRI; however, IOUS revealed no medial segment involvement. The final patient had a large (>5 cm), solitary hepatic adenoma on MRI, but IOUS in this case revealed diffuse adenomatosis. The operative management was altered in three of these cases. ConclusionsAlthough MRI can provide a detailed view of the hepatic anatomy and is an invaluable tool for preoperative planning for the pediatric patient with a primary liver neoplasm, IOUS may provide further and more up to date delineation of tumor extent and should be considered a crucial element in operative planning for hepatectomy in children.

Preoperative localization of hyperfunctioning parathyroid glands with 4D-CT.

Primary hyperparathyroidism (pHPT) is almost exclusively the result of a solitary parathyroid adenoma. In most cases, the affected gland can be surgically removed, but precise preoperative imaging is essential for adenoma localization prior to surgical intervention. In this study, we evaluated the diagnostic value of four-dimensional computed tomography (4D-CT) as a preoperative imaging tool in relation to the localization of pathologic parathyroid glands in patients with pHPT and negative sestamibi scans. This study included 43 consecutive patients with pHPT referred for parathyroidectomy at the Department of Head and Neck Surgery of Copenhagen University Hospital Rigshospitalet in 2011 and 2012. All patients had a 4D-CT performed prior to parathyroidectomy. CT localization of the suspected adenoma was correlated to the actual surgical findings and subsequent histological diagnosis was also available as references for the accuracy of this imaging tool. Hyperfunctioning parathyroid glands were found in 40 patients. 4D-CT identified 32 solitary hyperfunctioning parathyroid glands located on the correct side of the neck (PPV 76 %) and 21 located within the correct quadrant (PPV 49 %). Unilateral resection was performed in 72 % of patients due to the localization findings of preoperative imaging. 4D-CT can, therefore, be considered an effective method for the preoperative localization of parathyroid adenomas and is an important tool in surgical intervention for patients referred to parathyroidectomy.

Type of operation for toxic adenoma, toxic multinodular goitre and Graves’ Disease

Many countries and medical associations have developed guidelines for the management of benign thyroid conditions, including the surgical management of toxic thyroid goitres and the toxic solitary thyroid adenoma. Our aim is to provide evidence to support or reject different kind of operations used for the management of toxic thyroid conditions i.e. toxic goitre and toxic solitary nodule. Hyperthyroidism affects 1.2% of the general population. The main cause is Graves’ Disease (50–80%) followed by the toxic multinodular goitre (TMNG), toxic adenoma (TA) and, finally, thyroiditis (10%). Management includes antithyroid medications, iodine ablation (I131) and surgical resection of the gland. According to the American thyroid association, if surgical management is selected, it is highly recommended to proceed with a total or near-total thyroidectomy in order to minimize the recurrences. This kind of operation is associated with an almost 0% recurrence rate as opposed to subtotal thyroidectomy which is associated with an 8% recurrence rate at 5-year follow-up. The incidence of malignancy in patients with Graves’ disease is less than 2%. In about one-third of patients, there will be regression of the disease. For the patients who are under medical or surgical management, the recurrence rate is almost 50% if only antithyroid medications are used, 21% after I131 ablation, and 5% after surgery. The evidence from the literature shows that TT is associated with a lower recurrence rate and the same incidence of permanent serious complications. ST is associated with a lower rate of temporary hypoparathyroidism. In terms of the development of ophthalmopathy, both the comparison of RCT and non-RCT showed no significant difference between the two approaches. For the management of the toxic thyroid lesions, most guidelines recommend the following:

Type of operation for multinodular goitre and solitary nodule

Many countries and medical associations have developed guidelines for the management of benign thyroid conditions, including the surgical management of multinodular goitre and the non-toxic solitary thyroid adenoma. It is clearly stated in most guidelines that the aim of the surgical procedure is the safe and definite management of the thyroid pathology. Our aim is to provide evidence to support or reject different kinds of surgical procedures used for the management of non-toxic thyroid conditions i.e. multinodular goitre and solitary nodule. Thyroid nodules are common in the general population. Only 4–8% are clinically detectable, but US has shown the incidence to be 13–67%. Many studies have reported that malignancy can be found in 5% of these nodules. The aim of this paper is to present the facts, the pros and cons of each operation used for the management of these thyroid conditions, and provide evidence concerning the ideal procedure that combines safety with the most definite results. Despite the fact that most authors, experts and relevant medical associations currently consider total thyroidectomy (TT) as the gold standard for the management of benign goitre, there is still debate in the literature. It seems that when compared to less radical operations, TT has a lower recurrence rate, and hence a lower risk for complications associated with a reoperation. Moreover, in expert hands, it is equally as safe as less radical procedures in terms of permanent complications (i.e hypoparathyroidism and recurrent laryngeal nerve injury). Nevertheless, subtotal thyroidectomy (ST) has been found to be safer in terms of temporary complications since lower rates have been recorded. The incidence of “occult thyroid cancers” ranges from 3% to 16.6% (level II–III); therefore, if initial surgery is anything less than TT or near-total thyroidectomy, a reoperation is indicated. Obviously, the high recurrence rate along with the significant rate of occult thyroid cancers increases the need for necessary reoperations after a ST; as a result, associated morbidity increases. The incidence of occult cancer in benign solitary non-toxic nodules is 5%, irrespective of the size of the nodule. The literature describes two acceptable surgical options, each with its pros and cons: an upfront TT or a total lobectomy, and in the case of an occult cancer, a completion total thyroidectomy. Both approaches are acceptable to the surgical community and are included in the national guidelines.

MIBI SPECT Scan and Ultrasonography in Preoperative Imaging of Primary Hyperparathyroidism

Objectives: In patients who have parathyroid adenoma, combination of ultrasonography and technetium Tc 99m sestamethoxyisobutylisonitrile scan (also called sestamibi or MIBI scan), which allows anatomic and functional information about parathyroid adenomas, is used commonly to maximize operative cure. The sensitivity of MIBI scan may be increased by adding single photon emission computed tomography (SPECT) and computed tomography (CT) as a combined MIBI-SPECT CT scan. We assessed the accuracy of ultrasonography and parathyroid MIBISPECT scan in detecting parathyroid adenoma and evaluated the potential benefit of the combined protocol of ultrasonography and MIBI-SPECT parathyroid scan. Methods: In 58 patients who had biochemical evidence of primary hyperparathyroidism, we retrospectively reviewed the preoperative ultrasonography and MIBI-SPECT scans. The results of these studies were correlated with surgical findings. Results: In the 58 patients, surgery showed that 43 patients (74%) had solitary parathyroid adenoma. The sensitivity, specificity and accuracy of MIBI-SPECT for parathyroid adenoma was (72%,80%,74%) and for ultrasonography (53%,60%,55%) respectively. The highest sensitivity is noted with the combination of MIBI-SPECT and ultrasonography (79%), . 9 adenomas (21%) were missed by both modalities. In the 20 adenomas that were missed by ultrasound 11 were detected by MIBI SPECT. Conclusion: The MIBI-SPECT had better performance than ultrasonography for parathyroid adenoma localization. The combined MIBI SPECT and ultrasonography has the highest sensitivity for parathyroid adenoma detection (79%). An alternative strategy may be to use MIBI-SPECT initially, and to proceed to ultrasonography only in patients with negative MIBI- SPECT. This may avoid many ultrasonography procedures.

Primary hyperparathyroidism with Browns Tumour-A case report

Parathyroid adenoma is the commonest cause of primary hyper-calcaemia and usually presents with symptoms/signs of hyper-calcaemia. Brown tumours are rare focal giant-cell lesions that arise as a direct result of the effect of parathyroid hormone on bone tissue in some patients with hyperparathyroidism. Brown tumours can affect the mandible, maxilla, clavicle, ribs, and pelvic bones. Therefore, diagnosis requires a systemic investigation for lesion differentiation. In this case there was a 28 yr old woman who presented with solitary symptom of pain and swelling over left knee joint which was diagnosed as primary hyperparathyroidism with Browns tumour. Primary hyperparathyroidism is caused by a solitary adenoma in most of the cases and comparatively very less by glandular hyperplasia.

A retrospective case-controlled study of video-assisted versus open minimally invasive parathyroidectomy.

IntroductionMinimally invasive parathyroidectomy (MIP) with intraoperative parathyroid hormone assay (IOPTH) has successfully replaced conventional neck exploration in most patients with primary hyperparathyroidism (pHPT) and preoperatively localized parathyroid adenoma.AimTo compare outcomes of video-assisted MIP (MIVAP) to open MIP (OMIP).Material and methodsA retrospective case-controlled study of 455 patients with sporadic pHPT undergoing MIP with IOPTH at our institution in 2003–2012 was undertaken. The primary outcome measure was postoperative pain. Secondary outcome measures were: duration of surgery, recurrent laryngeal nerve (RLN) identification rate, conversion rate, length of hospital stay, cure rate, patients’ satisfaction with cosmetic outcome, morbidity, costs, and diagnostic accuracy of IOPTH.ResultsOf 455 patients with pHPT and a solitary parathyroid adenoma on preoperative imaging, 151 underwent MIVAP and 304 had OMIP. The following outcomes were favourable for MIVAP vs. OMIP: lower pain intensity during 24 h postoperatively (p < 0.001), lower analgesia request rate (p < 0.001), lower analgesics consumption (p < 0.001), higher recurrent laryngeal nerve identification rate (p < 0.001), shorter scar length (p < 0.001), and better cosmetic satisfaction at 1 month (p = 0.013) and at 6 months (p = 0.024) after surgery. However, MIVAP vs. OMIP had longer duration of surgery (p < 0.001), and was more expensive (p < 0.001). No differences were noted in the conversion rate, length of hospital stay, and morbidity.ConclusionsBoth MIVAP and OMIP approaches were equally safe and effective. However, the outcomes of MIVAP operations were superior to OMIP in terms of lesser postoperative pain, lower analgesics consumption, and better cosmetic satisfaction resulting from a smaller scar.

Surgical treatment of children with hyperparathyroidism: Single centre experience

BackgroundHyperparathyroidism (HPT) in children is rare and surgical management is supported only by limited evidence. MethodsRetrospective case series of all children under the age of 16years who underwent parathyroidectomy (PTx) between 1978 and 2012. ResultsWe identified 29 children who had surgery for HPT. Six were neonates with neonatal severe hyperparathyroidism (NSHPT) and 23 older children (age range 7–16years) with sporadic (16) or familial (7) HPT and 93% were symptomatic. Accuracy of ultrasound and MIbi in localising solitary parathyroid adenomas was 96%, but less helpful in hyperplasia and neonates.Children with NSHPT underwent 5 curative total and 1 subtotal PTx (no reoperations). Children with familial HPT underwent 3 total and 4 subtotal PTx. One child with subtotal PTx required a reoperation. Children with sporadic HPT underwent subtotal PTx prior to 1980 (2), exploration and removal of enlarged glands 1980–2002 (5) and minimally invasive PTx since 2002 (9) and all cured by the first operation. ConclusionsOur study documents that HPT in children is predominantly symptomatic on presentation and genetically determined in 46% of cases. Imaging is accurate in localising parathyroid adenomas, but not hyperplasias. Total PTx for familial HPT was curative and minimally invasive PTx is the operation of choice for older children with sporadic HPT.

Pre-operative localisation of parathyroid adenomas

Background: A solitary adenoma is the most common cause of primary hyperparathyroidism. Accurate pre-operative localisation can result in the implementation of minimally invasive surgery subsequently improving patient outcome and reducing cost. Dual imaging techniques can improve sensitivity of localisation of parathyroid adenoma.

Adrenal nodularity and somatic mutations in primary aldosteronism: one node is the culprit?

Somatic mutations in genes that influence cell entry of calcium have been identified in aldosterone-producing adenomas (APAs) of adrenal cortex in primary aldosteronism (PA). Many adrenal glands removed for suspicion of APA do not contain a single adenoma but nodular hyperplasia. The objective of the study was to assess multinodularity and phenotypic and genotypic characteristics of adrenals removed because of the suspicion of APAs. We assessed the adrenals of 53 PA patients for histopathological characteristics and immunohistochemistry for aldosterone (P450C18) and cortisol (P450C11) synthesis and for KCNJ5, ATP1A1, ATP2B3, and CACNA1D mutations in microdissected nodi. Glands contained a solitary adenoma in 43% and nodular hyperplasia in 53% of cases. Most adrenal glands contained only one nodule positive for P450C18 expression, with all other nodules negative. KCNJ5 mutations were present in 22 of 53 adrenals (13 adenoma and nine multinodular adrenals). An ATP1A1 and a CACNA1D mutation were found in one multinodular gland each and an ATP2B3 mutation in five APA-containing glands. Mutations were always located in the P450C18-positive nodule. In one gland two nodules containing two different KCNJ5 mutations were present. Zona fasciculata-like cells were more typical for KCNJ5 mutation-containing nodules and zona glomerulosa-like cells for the other three genes. Somatic mutations in KCNJ5, ATP1A1, or CACNA1D genes are not limited to APAs but are also found in the more frequent multinodular adrenals. In multinodular glands, only one nodule harbors a mutation. This suggests that the occurrence of a mutation and nodule formation are independent processes. The implications for clinical management remain to be determined.

Retrospective evaluation of patients with primary hyperparathyroidism in Konya Meram Faculty of Medicine

INTRODUCTION Primary Hyperparathyroidism (PHP), is generalized with calcium, phosphate and bone metabolism disorder due to increased PTH secretion. Increase in circulating hormone causes hypercalcemia and hypophosphatemia. It’s common in fifth and sixth decades and female-male ratio is 3:1 (1). Nephrocalcinosis, recurrent peptic ulcers, mental changes, and more frequently generalized bone resorption may be observed. Nowadays, with the common measurement of blood calcium, it can be diagnosed with minimal or no symptoms. Cause of hyperparathyroidism is solitary adenoma in 80% of patients. More rarely parathyroid hyperplasia and parathyroid carcinomas are seen. Parathyroid hyperplasia is familial and usually associated with other endocrine abnormalities (2). In this study, we aimed to evaluate the clinical, radiological, biochemical parameters in patients with primary hyperparathyroidism.

Visceral abdominal fat measured by computed tomography is associated with an increased risk of colorectal adenoma

We investigated whether visceral adipose tissue (VAT) measured by computed tomography (CT) is a risk factor for colorectal adenoma. For a total of 1,328 patients (857 without adenoma, 471 with colorectal adenoma) undergoing colonoscopy and CT, associations between colorectal adenoma and body mass index (BMI), VAT area and subcutaneous adipose tissue (SAT) were assessed using odds ratios (ORs) with 95% confidence intervals (CIs) adjusted for age, sex, family history, smoking, alcohol intake, diabetes mellitus, aspirin use and nonsteroidal anti-inflammatory drug use. Multivariate analysis showed that colorectal adenoma was marginally associated (p=0.06) with BMI, but not with SAT, while it was significantly associated with VAT and the VAT to SAT ratio (VAT/SAT) for both categorical data and trend (p<0.05). When the obesity indices were considered simultaneously, colorectal adenoma remained significantly associated with VAT and VAT/SAT (p<0.05), but not BMI and SAT. In patients with colorectal adenoma, the adjusted OR for the highest quartiles of VAT and VAT/SAT was 1.90 (95% CI 1.16-3.13) and 2.25 (95% CI 1.49-3.41), respectively, compared to the lowest quartiles. Only VAT area was significantly associated with colorectal adenoma in both men and women (p<0.05). Proximal, multiple and advanced adenomas had significantly higher VAT areas (p<0.05) than distal, solitary and nonadvanced adenomas. Our findings implicate abdominal VAT in the development and progression of colorectal adenoma, and it was better obesity index for colorectal adenoma than BMI in both sexes.

Primary diffuse large B-cell lymphoma developing within a rectal tubular adenoma with low-grade dysplasia: a case report

IntroductionColorectal lymphomas represent only 5% to 10% of gastrointestinal lymphomas, after the stomach and small intestine. Primary lymphoma of the colon and rectum is an unusual observation, constituting only 0.2% to 0.5% of all malignant tumors arising from the colorectal region. Very little is known about the correlation between adenoma and lymphoma in the colorectal tract. We report here a rare case of diffuse large B-cell lymphoma developing within a solitary tubular adenoma with low-grade dysplasia of the rectum.Case presentationAn 83-year-old Caucasian man was referred to our hospital intermittent anal bleeding and irregular bowel. Colonoscopy revealed a 1cm solitary rectal polyp, which was completely removed by endoscopic resection. Histologic studies revealed low-grade intraepithelial dysplasia; the stroma of adenoma showed focal localization by highly proliferative lymphoid cells. Immunohistochemical analyses demonstrated that lymphoid cells were positive for CD20 and bcl2, whereas they were negative for CD3, CD5, CD10, CD23, CD30, CD138 and cyclin D1. Approximately 90% of the neoplastic cells reacted positively when stained with an antibody to Ki-67. Molecular studies showed the presence of a monoclonal immunoglobulin heavy chain gene rearrangement.To determine primary or secondary lymphoma localization, Dawson’s criteria were applied to the case. A diagnosis of primary diffuse large B- lymphoma Ann Arbor stage 1A was established. Subsequently, the patient was referred to oncology to establish the stage and to select appropriate treatment.ConclusionsThe case of diffuse large B-cell lymphoma developing within a tubular adenoma, as reported here, is considered a rare event. Little about the prognosis of primary colorectal lymphomas is available and therapeutic treatment protocol is unclear. This case report provides more information on the history and macroscopic appearance of lymphomas presenting in an unusual location. To report additional cases in the future would be helpful in redefining the diagnostic, prognostic and therapeutic approach.

Genu valgum and primary hyperparathyroidism in children

Bony deformity due to primary hyperparathyroidism is a rare entity in children. Case Series: We describe two children who presented with genu valgum to the Endocrine Department. Ten children with primary hyperparathyroidism presenting with genu valgum have been reported in literature and have been reviewed by us. Biochemical investigations revealed parathyroid hormone dependent hypercalcemia despite a deficiency of vitamin D in both children. A single parathyroid adenoma was identified by ultrasonography and Tc-99m MIBI scan. Both children underwent resection of the solitary parathyroid lesion which was confirmed as adenoma by histopathological examination. All cases reported in literature had solitary parathyroid adenoma and had onset around puberty consistent with our observation that pubertal growth spurt is responsible for the occurrence of genu valgum in children with previously undiagnosed primary hyperparathyroidism. Genu valgum is a common skeletal deformity in children with primary hyperparathyroidism. Solitary parathyroid adenoma was identified in all reported cases and all underwent parathyroidectomy. Pubertal growth spurt seems to contribute to the occurrence of genu valgum in children with primary hyperparathyroidism.

Management of hypertension in primary aldosteronism.

Hypertension causes significant morbidity and mortality worldwide, owing to its deleterious effects on the cardiovascular and renal systems. Primary hyperaldosteronism (PA) is the most common cause of reversible hypertension, affecting 5%-18% of adults with hypertension. PA is estimated to result from bilateral adrenal hyperplasia in two-thirds of patients, and from unilateral aldosterone-secreting adenoma in approximately one-third. Suspected cases are initially screened by measurement of the plasma aldosterone-renin-ratio, and may be confirmed by additional noninvasive tests. Localization of aldostosterone hypersecretion is then determined by computed tomography imaging, and in selective cases with adrenal vein sampling. Solitary adenomas are managed by laparoscopic or robotic resection, while bilateral hyperplasia is treated with mineralocorticoid antagonists. Biochemical cure following adrenalectomy occurs in 99% of patients, and hemodynamic improvement is seen in over 90%, prompting a reduction in quantity of anti-hypertensive medications in most patients. End-organ damage secondary to hypertension and excess aldosterone is significantly improved by both surgical and medical treatment, as manifested by decreased left ventricular hypertrophy, arterial stiffness, and proteinuria, highlighting the importance of proper diagnosis and treatment of primary hyperaldosteronism. Although numerous independent predictors of resolution of hypertension after adrenalectomy for unilateral adenomas have been described, the Aldosteronoma Resolution Score is a validated multifactorial model convenient for use in daily clinical practice.

Surgical Technique: Paratiroidectomia Minim Invazivă - Aspecte Tehnice, Experienţă Iniţială, Scurt Review al Literaturii

Primary hyperparathyroidism (pHPT) is a common disease, in the majority of cases determined by a single solitary parathyroid adenoma; it is more frequently encountered among older women, between 50-60 years. Due to advances in imaging, preoperative localization of the hyperfunctioning or enlarged gland is almost always possible. In this perspective the classic bilateral neck exploration shifted to limited (focused) surgical approaches i.e. minimally invasive parathyroidectomy (MIP). The aim of this study is to do a short literature review of MIP surgical techniques and to present the surgical procedure we have used, along with our initial experience, respectively.

Focal nodular hyperplasia of the liver.

A benign, non-neoplastic, reactive growth of the liver, focal nodular hyperplasia (FNH) of the liver was first clearly described by Edmondson in the 1950’s, although there are various prior reports that likely represent the same lesion. A variety of synonyms have been applied including focal cirrhosis, pedunculated adenoma, solitary hyperplastic nodule, mixed adenoma, hamartoma and hamartomatous cholangeiohepatoma.

Hyperparathyroidism Two Years after Radioactive Iodine Therapy in an Adolescent Male

Primary hyperparathyroidism is a very rare complication following radioactive iodine therapy. There is typically a latency period of more than a decade following radiation exposure and, therefore, it is observed almost exclusively in adults. Consequently, pediatricians are not aware of the association. We present a case of primary hyperparathyroidism due to a solitary parathyroid adenoma occurring in an adolescent male two years following radioactive iodine treatment for papillary thyroid carcinoma. Periodic screening of serum calcium following ablative doses of radioactive iodine for thyroid cancer may be justified even in adolescents.