Adrenal Research Articles

Clinical spectrum and molecular basis in 19 Chinese patients with 46, XY disorder of sexual development caused by NR5A1 mutations

BackgroundNuclear receptor subfamily 5 group A member 1 (NR5A1) plays pivotal roles in steroidogenesis and gonadal development. 46, XY disorder of sexual development (DSD) caused by NR5A1 mutations is a rare genetic condition. This study aimed to provide a comprehensive analysis of the clinical characteristics and molecular defects observed in 19 Chinese patients with NR5A1 variants, including assessing the deleterious effects of novel variants in vitro and evaluating their functional impact on the gonad and adrenal glands in vivo.Materials and methodsSubjects with NR5A1 variants were identified from 223 Chinese 46, XY DSD patients via next-generation sequencing. In-silico analysis and functional assays were performed to evaluate the transcriptional activity, expression levels and nuclear localization of novel NR5A1 variants. The histological structure of the gonads was evaluated via immunohistochemistry (IHC).ResultsPatients with NR5A1 gene variants presented with serious conditions, including micropenis, cryptorchidism, azoospermia, and radiological abnormalities of the spleen. Five novel NR5A1 variants were identified, including heterozygous p.Y5*, p.Q42E and p.L359_L363del, as well as copy number variation (CNV) of chr9:127213317–127570245_del and an exon 6 duplication. A total of 63.2% (12/19) of patients harbored additional variants other than NR5A1. Defective transcriptional regulatory activities and abnormal protein expression levels were observed in NR5A1 variants. The reduced levels of DHEA-S and 11-oxygenated steroids indicate a mild impairment in adrenal function among certain patients. The IHC analysis of the testis revealed intact expression levels of SOX9 in Sertoli cells, while significant differences were observed in the expression pattern of CYP17A1 in Leydig cells among patients. The preserved maturation of adult Leydig cells in the patients may trigger spontaneous puberty.ConclusionsPatients with NR5A1 mutations exhibit complex phenotypes. The observed clinical heterogeneity may be attributed to oligogenic mutations, dysregulated Leydig cell function, as well as the impaired ability to modulate the transcription of target genes.

ATP2A3 in Primary Aldosteronism: Machine Learning-Based Discovery and Functional Validation.

Aldosterone-producing adenomas (APAs) are a common cause of primary aldosteronism that can lead to cardiovascular complications if left untreated. Machine learning-based bioinformatics approaches have emerged as powerful tools for identifying potential disease markers, gaining widespread recognition in biomedical research. We aimed to use machine learning to discover novel biomarkers of APAs to identify new pathophysiological mechanisms. We applied 2 machine learning algorithms to published RNA sequencing data to identify APA feature genes. Validation was performed using APA tissue samples, spatial transcriptomics, pig adrenal glands, and in vitro assays in a human adrenocortical cell line. Machine learning identified ATP2A3 as a key feature gene in APA, and its upregulation in APAs compared with the adjacent cortex was confirmed by spatial transcriptomics. In human adrenocortical cells, angiotensin II treatment increased ATP2A3 gene expression 9.15-fold. Silencing ATP2A3 decreased basal CYP11B2 expression and aldosterone secretion by 3.51-fold and 1.46-fold, respectively, and by 1.77-fold and 1.94-fold under angiotensin II stimulation. Dietary sodium restriction in pigs significantly increased ATP2A3 mRNA and protein levels. Spatial transcriptomics showed that APA cells exhibited higher ATP2A3 gene expression compared with all other adrenal cell types. The suppressive effect of ATP2A3 silencing on CYP11B2 expression was further enhanced by Ca2+ inhibitors. The ATP2A3 gene is highly expressed in APA and is a key regulator of CYP11B2 expression and aldosterone production.

MiR-124 in Neuroblastoma: Mechanistic Insights, Biomarker Potential, and Therapeutic Prospects

: Neuroblastoma, a malignancy predominantly affecting young children, originates from neural crest cells in the sympathetic nervous system. It primarily appears in the adrenal gland but can also affect nerve tissues in regions, such as the chest, neck, abdomen, and pelvis. Despite advancements in treatment, high-risk neuroblastoma patients often face poor prognoses, underscoring the need for ongoing research. This review paper examines the numerous factors responsible for neuroblastoma, emphasizing the importance of approaching the disorder with more strategic therapeutic methods. MicroRNAs, particularly miR-124, play critical roles in gene regulation and cancer pathogenesis. Abundant in the brain, miR-124 functions as a tumor suppressor by inhibiting cell growth, migration, and invasion and is often dysregulated in neuroblastoma. This study investigates the molecular functions of miR-124 in neuroblastoma, its potential as a biomarker, and its application in targeted therapy. MiR-124 regulates key pathways in neuroblastoma, including PI3K/AKT, TGF-β, and p53 signaling, impacting cell proliferation, apoptosis, and metastasis. The study also explores the promise of miR-124 as a biomarker for neuroblastoma through liquid biopsy, enabling non-invasive diagnosis and disease monitoring. Therapeutic strategies targeting miR-124 pathways show potential for overcoming chemotherapy resistance and improving treatment efficacy. The research underscores the significance of miR-124 in neuroblastoma, aiming to enhance early diagnosis, identify specific drug targets, and expand treatment options, ultimately improving patient outcomes.

A Rare Diagnosis for Vomiting and Polyuria: The Pituitary, the Adrenal Gland, the Thyroid

A Rare Diagnosis for Vomiting and Polyuria: The Pituitary, the Adrenal Gland, the Thyroid

Diagnostic and management challenges in paediatric Cushing's syndrome.

Cushing syndrome (CS) is the result of chronic exposure to glucocorticoid excess. CS in children is most often caused by the administration of exogenous steroids. Endogenous CS is rare in the paediatric population and is caused mainly by tumours of the pituitary and adrenal glands, with ectopic sources being extraordinarily rare before the age of 18 years. In addition, children and young adults with CS present with different epidemiology, management issues, prognosisand outcomes than older adult patients. This complex disorder needs early diagnosis and management to avoid the significant morbidity and even mortality that can result from chronic untreated CS. In this review, we present the complex case of a 7-year-old boy with CS that highlights the diagnostic and management challenges of paediatric CS patients, including the considerations for genetic predisposition and life-long consequences of CS in children and young adults. The diagnostic protocols for the evaluation of CS have been devised for adults and tested predominantly on adults. In this review, we discuss necessary modifications so that the testing can be adjusted for use in children. Additionally, pituitary adenomas in children are generally smaller and thus more difficult to recognize on pituitary imaging. The management of the case and its complexities underline the need for children with CS to be managed in a centre with experienced paediatric endocrinologists and skilled neurosurgeons both for their initial diagnosis and treatment as well as for their long-term follow-up and management.

Epstein-Barr Virus–Associated B-Cell Lymphoproliferative Disorder Involving the Adrenal Gland in Granulomatosis With Polyangiitis

Epstein-Barr Virus–Associated B-Cell Lymphoproliferative Disorder Involving the Adrenal Gland in Granulomatosis With Polyangiitis

Congenital Adrenal Hyperplasia (CAH) - Causes, Diagnosis, Symptoms, Treatment

Introduction and Purpose: Congenital adrenal hyperplasia represents a group of genetic disorders characterized by improper adrenal steroidogenesis, resulting in deficiency or absence of cortisol and/or aldosterone, and varying degrees of disturbances in sexual development. The aim of this study is to raise awareness about the disease, enabling early diagnosis and contributing to reducing neonatal mortality, as the first clinical manifestation of CAH can be the life-threatening salt-wasting syndrome. State of Knowledge: Congenital adrenal hyperplasia (CAH), also known as congenital adrenal hyperplasia, encompasses a group of inherited disorders affecting the adrenal glands located above the kidneys. Adrenal glands produce various hormones, including cortisol, aldosterone, and androgens. CAH involves deficiencies in the enzymes necessary for the production of these hormones, leading to hormonal disturbances. Summary: Congenital adrenal hyperplasia (CAH), also referred to as congenital adrenal hyperplasia (CAH), describes a group of genetic diseases causing defects in adrenal hormone synthesis. CAH results in deficiency or absence of cortisol and/or aldosterone. The most common causes are mutations in the CYP21 gene (21-hydroxylase deficiency), CYP11B2 gene (11β-hydroxylase deficiency), and HSD3B2 gene (3β-hydroxysteroid dehydrogenase deficiency). Enzymatic deficiencies lead to compensatory increases in CRH and ACTH secretion, causing adrenal hyperplasia and excessive androgen synthesis.

Exploring the multifaceted challenges of gastrointestinal metastases in lung adenocarcinoma: a case report highlighting diagnostic dilemmas and therapeutic innovations

BackgroundLung cancer, the primary cause of cancer-related deaths, often metastasizes early, commonly affecting the liver, brain, bones, and adrenal glands. Although gastrointestinal (GI) metastasis is rare, it poses significant diagnostic and therapeutic challenges and is frequently linked to severe complications.Case descriptionWe present a case of a 61-year-old male with a history of lung cancer who presented with intestinal obstruction. The initial diagnosis of poorly differentiated adenocarcinoma was confirmed by computed tomography (CT) and bronchoscopic biopsy. The patient underwent chemotherapy, after which he developed intestinal obstruction. Further imaging and histopathological analysis indicated GI metastasis. Despite treatment with both chemotherapy and immunotherapy, the patient experienced recurrent obstruction, necessitating surgical intervention. Postoperatively, he had another episode of perforation, which was addressed with an emergency laparotomy, revealing metastatic adenocarcinoma at the site of perforation.ConclusionsThis case highlights the complexities in diagnosing and treating GI metastases from lung cancer. It underscores the necessity for multimodal treatment strategies and underscores the urgent need for research focused on early detection methods to improve patient outcomes.

Minimally Invasive Image-Guided Percutaneous Irreversible Electroporation of Adrenal Metastases.

A single-center retrospective study was performed to evaluate the safety and efficacy of minimally invasive irreversible electroporation (IRE) to treat metastatic adrenal tumors. This single-center study, approved by the Institutional Review Board, retrospectively analyzed six patients who underwent image-guided percutaneous IRE for adrenal metastases. Pre-procedural imaging included CT, MRI and/or 18F-FDG PET-CT scans. Primary outcomes measures included technical success, efficacy and safety, while secondary outcome measures were local progression-free survival (LPFS), distant progression-free survival (DPFS) and overall survival (OS). Follow-up scans were scheduled post-procedure, and data analysis employed Excel, SPSS and R. Patients had diverse primary tumor origins including renal cell carcinoma (2/6), colorectal carcinoma (1/6), non-small cell lung carcinoma (1/6), leiomyosarcoma (1/6) and urothelial carcinoma (1/6). Adverse events were minimal, with only one grade 1 complication reported. Tumor characteristics revealed tumors close to critical structures, with a median pre-ablation size of 23mm. Technical success was achieved in all procedures. At first follow-up, one patient had complete response, one patient had partial response of the right adrenal gland and complete response of the left adrenal gland, two patients had partial response and two patients had stable disease. Local tumor progression occurred in two out of seven tumors with a median LPFS of 10.9months, and distant progression was observed in four out of six patients. Percutaneous, minimally invasive IRE shows promise as a safe treatment option for unresectable metastatic adrenal tumors, demonstrating potential effectiveness. However, further studies with larger patient cohorts are needed to confirm its safety and efficacy.

Metabonomics and Transcriptomics Analyses Reveal the Underlying HPA-Axis-Related Mechanisms of Lethality in Larimichthys polyactis Exposed to Underwater Noise Pollution

The problem of marine noise pollution has a long history. Strong noise (>120 dB re 1 µPa) will affects the growth, development, physiological responses, and behaviors of fish, and also can induce the stress response, posing a mortal threat. Although many studies have reported that underwater noise may affect the survival of fish by disturbing their nervous system and endocrine system, the underlying causes of death due to noise stimulation remain unknown. Therefore, in this study, we used the underwater noise stress models to conduct underwater strong noise (50–125 dB re 1 µPa, 10–22,000 Hz) stress experiments on small yellow croaker for 10 min (short-term noise stress) and 6 days (long-term noise stress). A total of 150 fishes (body weight: 40–60 g; body length: 12–14 cm) were used in this study. Omics (metabolomics and transcriptomics) studies and quantitative analyses of important genes (HPA (hypothalamic–pituitary–adrenal)-axis functional genes) were performed to reveal genetic and metabolic changes in the important tissues associated with the HPA axis (brain, heart, and adrenal gland). Finally, we found that the strong noise pollution can significantly interfere with the expression of HPA-axis functional genes (including corticotropin releasing hormone (CRH), corticotropin releasing hormone receptor 2 (CRHR2), and arginine vasotocin (AVT)), and long-term stimulation can further induce metabolic disorders of the functional tissues (brain, heart, and adrenal gland), posing a lethal threat. Meanwhile, we also found that there were two kinds of death processes, direct death and chronic death, and both were closely related to the duration of stimulation and the regulation of the HPA axis.

BMAL1-Potential Player of Aberrant Stress Response in Q31L Mice Model of Affective Disorders: Pilot Results.

Dysregulation in the stress-response system as a result of genetical mutation can provoke the manifestation of affective disorders under stress conditions. Mutations in the human DISC1 gene is one of the main risk factors of affective disorders. It was known that DISC1 regulates a large number of proteins including BMAL1, which is involved in the regulation of glucocorticoid synthesis in the adrenal glands and the sensitivity of glucocorticoid receptor target genes. Male mice with a point mutation Q31L in the Disc1 gene were exposed to chronic unpredictable stress (CUS), after which the behavioral and physiological stress response assessed. To assess whether there were any changes in BMAL1 in key brain regions involved in the stress response, immunohistochemistry was applied. It was shown that the Q31L mice had an aberrant behavioral response, especially to the 2 weeks of CUS, which was expressed in unchanged motor activity, increased time of social interaction, and alterations in anxiety and fear-related behavior. Q31L males did not show an increase in blood corticosterone levels after CUS and a decrease in body weight. Immunohistochemical analysis in intact Q31L mice revealed a decrease in BMAL1 immunofluorescence in the CA1 hippocampal area and lateral habenula. Thus, the Q31L mutation of the Disc1 gene disrupts behavioral and physiological stress response and the BMAL1 dysregulation may underlie it, so this protein can act as a molecular target for the treatment of affective disorders.

Surgical treatment of locally advanced kidney cancer in the T3a–с stage

BACKGROUND: Kidney cancer is a common pathologic condition, which ranks the 3rd place among urologic cancers. In 4–10% of patients, while growing it metastasizes upward the venous vessels up to the thoracic vena cava and right atrium. Selection of the optimal tactics for surgical treatment of such patients still remains a complex and unsolved task. AIM: To assess the surgical treatment findings for the patients suffered from kidney cancer with tumor invasion in the renal and inferior vena cava. MATERIALS AND METHODS: 115 patients with renal cell carcinoma complicated by tumor invasion into renal and inferior vena cava have been operated in North-Western State Medical University named after I.I. Mechnikov from 2003 to 2023. They were 76 (66.1%) men and 39 (33.9%) women, their mean age was 67.0 ± 4.1. Stage T3a covered 53 (46.1%), T3b — 33 (28.7%) and T3c 29 (25.2%) patients. Metastatic lesion of one lymph node was observed in 21 (18.3%) and of multiple nodes in 6 (5.2%) patients. Distant metastases were found in 26 (22.6%) patients: in the lungs in 9.6% and in the adrenal glands in 5.2%. All patients were treated with radical nephrectomy, removing blood trombi from the inferior vena cava system. Eight (7.0%) of them, received the treatment by the method developed in the clinic, which consists in preliminary endovascular extraction of the cranial trombus part. Another 3 (2.6%) patients were treated using cardiopulmonary bypass machine. RESULTS: Early postoperative complications developed in 36 (31.4%) patients. The most common and severe of them were pulmonary embolism (4.4%) and acute cardiovascular insufficiency (10.4%). These complications appeared the causes of death of 4 patients. The mortality rate was 3.5%. The three year survival rate in the T3a group was 70.6%, T3b group — 66.0% and T3c group — 50.6% (p 0.05). CONCLUSIONS: Nephrectomy with vena cava thrombectomy is a radical surgical treatment. Its complexity increases as the tumor thrombus spreads further through the venous system and in some cases requires an interdisciplinary approach.

Abstract A010: Development and characterization of novel models of lobular breast cancer metastases

Abstract Invasive lobular carcinoma (ILC) is the most common special histological subtype of breast cancer, after No Special Type (NST, ductal carcinoma/IDC), and affects 10-15% of all breast cancer patients. ILC is characterized by E-cadherin loss, Estrogen Receptor (ER) positivity, and a distinct single file invasive growth pattern associated with a unique pattern of metastasis. ILC metastasizes to common breast cancer sites like bone and lung, but ILC also spreads to gynecologic tissues, the peritoneum, gastrointestinal tract and central nervous system - with enrichment for orbital and leptomeningeal metastases. In vitro and in vivo models of ILC metastasis have not been extensively developed. Models of spontaneous metastasis from ER+ breast cancer overall are critically limited; ER+ ILC metastases models present only micro-metastatic disease with extremely long latency (>9 months). Together these issues limit research on the unique nature of metastatic ILC. We leveraged mammary intraductal (MIND) xenografting with two ER+ ILC cell lines (MM134 and 44PE) and confirmed prior reports that these lines spontaneously metastasize to bone, brain, ovary, uterus, lung, and adrenal glands with up to 100% incidence. Importantly, we find that supplementation with low dose estradiol (E2) in drinking water rapidly advances metastatic progression, but not primary tumor growth. Using ex vivo bioluminescence imaging (BLI), we find BLI+ lesions are detectable as early as 90 days. At 150 days post-challenge, 100% of mice have BLI+ metastases at multiple sites. Beyond 22 weeks, 100% of mice present with symptomatic and ultimately lethal CNS metastases. BLI+ macro-metastatic lesions were isolated and expanded ex vivo as organotrophic cell line variants. Analysis of RNA-seq data is ongoing to evaluate 1) common factors enriched in metastatic ILC, and 2) organotrophic factors and pathways enriched in specific metastatic sites. In patients with ILC, bone metastases are typically the first site of metastatic development, occur at a higher incidence versus NST, and are associated with increased morbidity. Bone metastases from ILC patients are more osteogenic compared to the characteristically osteolytic lesions of NST. To examine how ILC cells may promote osteoblastic responses, we prepared ILC and NST conditioned media (CM) and applied it to differentiating osteoblasts (OB). We observed increased OB differentiation and increased mineral deposition with ILC CM compared to NST CM, supporting that ILC cell lines have a distinct impact on the bone microenvironment which may manifest in vivo yet be defined in vitro. Collectively, our observations support that ER+ ILC cell lines can recapitulate key features of clinical disease progression, including spontaneous metastasis mimicking clinical phenotypes. We are leveraging these models to better understand the ILC metastatic cascade and adaptation to unique metastatic niches, and to identify shared and unique attributes of ILC metastases that can be exploited for advancing therapeutics. Citation Format: Joseph L. Sottnik, Matthew J. Sikora. Development and characterization of novel models of lobular breast cancer metastases [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor-body Interactions: The Roles of Micro- and Macroenvironment in Cancer; 2024 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(22_Suppl):Abstract nr A010.

Partial response to treatment with ALK inhibitor in a patient with SQSTM1-ALK fusion positive lung adenocarcinoma

Introduction: Lung cancer is the second most common cancer worldwide and the leading cause of cancer deaths; non-small cell lung cancer (NSCLC) constitutes about 85% of lung cancer cases, with ALK fusions representing 3–6% of them. The SQSTM1-ALK fusion is a rare finding in NSCLC, accounting for only 1.1% of ALK rearrangements. We present a case of lung adenocarcinoma with documentation of SQSTM1-ALK fusion that showed a partial response to alectinib. Case description: This case details the clinical course of a 71-year-old, non-smoking woman with no significant medical history who presented with confusion, aphasia and multiple cerebral lesions detected on imaging. Further investigations revealed a stage IV lung adenocarcinoma with metastases to the brain and adrenal gland. Molecular profiling identified a rare SQSTM1-ALK fusion mutation alongside other genetic abnormalities, including low programmed death-ligand 1 expression and ROS1 kinase protein presence. Treatment with alectinib, initiated based on the identified ALK fusion, resulted in significant tumour regression in the lungs and complete resolution of the adrenal mass, as evidenced by follow-up imaging and clinical assessments. Conclusion: This case highlights the efficacy of alectinib in treating rare ALK fusion variants in and underscores the importance of comprehensive molecular profiling in guiding targeted therapy decisions.

Posterior Retroperitoneal Laparoscopic Adrenalectomy: An Anatomical Essay and Surgical Update.

Posterior retroperitoneal laparoscopic adrenalectomy (PRLA) has emerged as a revolutionary, minimally invasive technique for adrenal gland surgery, offering significant advantages over traditional open approaches. This narrative review aims to provide a comprehensive update on PRLA, focusing on its anatomical foundations, surgical technique, and clinical implications. We conducted an extensive review of the current literature and surgical practices to elucidate the key aspects of PRLA. The procedure leverages a unique "backdoor" approach, accessing the adrenal glands through the retroperitoneum, which necessitates a thorough understanding of the posterior abdominal wall and retroperitoneal anatomy. Proper patient selection, meticulous surgical planning, and adherence to key technical principles are paramount for successful outcomes. In this paper, the surgical technique is described step by step, emphasizing critical aspects such as patient positioning, trocar placement, and adrenal dissection. PRLA demonstrates reduced postoperative pain, shorter hospital stays, and faster recovery times compared to open surgery, while maintaining comparable oncological outcomes for appropriately selected cases. However, the technique presents unique challenges, including a confined working space and the need for surgeons to adapt to a posterior anatomical perspective. We conclude that PRLA, in the right clinical setting, offers a safe and effective alternative to traditional adrenalectomy approaches. Future research should focus on expanding indications and refining techniques to further improve patient outcomes.

The impact of long-term isolation on anxiety, depressive-like and social behavior in aging Wistar-Kyoto (WKY) and spontaneously hypertensive (SHR) male rats

Aging is a complex process associated with multimorbidity. Hypertension, one of widespread states, is among main causes of age-related alterations in behavior, emotionality and sociability. We studied the effects of long-term isolated housing on anxiety, depressive-like and social behavior as well as changes in the adrenocortical and sympathetic systems in the aging normotensive Wistar Kyoto (WKY) and spontaneously hypertensive rats (SHR). Ten-month-old male rats of both strains were subjected to 90-day isolated or group housing. Surprisingly, social isolation induced only mild effect on anxiety without influencing other affective-related behaviors. No effects of isolated housing on sociability or social novelty preferences were revealed. Despite the adrenal gland hypertrophy in the SHRs, corticosterone levels remained stable within the period of isolation but the expression of nuclear glucocorticoid receptor (Nr3c1) mRNA in the adrenals was lower in the SHR as compared to WKY rats. Pre-existing hypertension, associated with SHR genotype, did not significantly contribute to the effects of social isolation. The data suggest that the aged WKY and SHR rats are relatively resilient to chronic social stress associated with isolated housing.

Cannabidiol/cannabidiolic acid-rich hemp (Cannabis sativa L.) extract attenuates cognitive impairments and glial activations in rats exposed to chronic stress

Ethnopharmacological relevanceHemp (Cannabis sativa L.) is increasingly being recognized for its medicinal properties beside utilizing it for food, oil, and textile fibers. The high level of cannabidiol (CBD) content in hemp's flowers shows promising neuroprotective properties without causing psychotomimetic or addictive effects. Recently, products containing CBD and its precursor, cannabidiolic acid (CBDA), have been used to treat stress-related cognitive impairment. However, the therapeutic potential of hemp extract remains inadequately explored.Aim of the study: To investigate the effect of CBD/CBDA-rich hemp extract on learning and memory, neuroendocrine alterations, and hippocampal neuropathological changes in the chronic restraint stress model. Materials and methodsChronic restraint stress (CRS) was induced in male Wistar rats by immobilizing them in a restrainer for 6 h per day for 21 consecutive days. CBD/CBDA-rich hemp extract (10 and 30 mg/kg, intraperitoneal injection) was administered daily, 1 h before restraint. After the last day of CRS, behavioral tests for cognition were conducted using the Y-maze and object recognition tests. Serum corticosterone (CORT) levels were measured by ELISA. Histopathological changes, neuronal density, and the activation of microglia and astrocytes were visualized using cresyl violet and immunohistochemical staining. ResultsA high dose of CBD/CBDA-rich hemp extract effectively ameliorated CRS-induced cognitive impairment and reversed HPA axis hyperactivity in CRS rats by reducing CORT levels and adrenal gland weight. Additionally, CBD/CBDA-rich hemp extract protected CRS-induced damage to hippocampal neurons. Further analysis showed that CBD/CBDA-rich hemp extract reduced specific markers of microglial activation (ionized calcium-binding adaptor molecule-1, Iba-1) and astrocytic structural protein (glial fibrillary acidic protein, GFAP) in CRS rats. ConclusionCBD/CBDA-rich hemp extracts remarkably reversed the stress-induced behavioral perturbations and hippocampal damage, suggesting its ameliorative effect on stress response.

Contrast-enhanced thin-slice abdominal CT with super-resolution deep learning reconstruction technique: evaluation of image quality and visibility of anatomical structures.

To compare image quality and visibility of anatomical structures on contrast-enhanced thin-slice abdominal CT images reconstructed using super-resolution deep learning reconstruction (SR-DLR), deep learning-based reconstruction (DLR), and hybrid iterative reconstruction (HIR) algorithms. This retrospective study included 54 consecutive patients who underwent contrast-enhanced abdominal CT. Thin-slice images (0.5mm thickness) were reconstructed using SR-DLR, DLR, and HIR. Objective image noise and contrast-to-noise ratio (CNR) for liver parenchyma relative to muscle were assessed. Two radiologists independently graded image quality using a 5-point rating scale for image noise, sharpness, artifact/blur, and overall image quality. They also graded the visibility of small vessels, main pancreatic duct, ureters, adrenal glands, and right adrenal vein on a 5-point scale. SR-DLR yielded significantly lower objective image noise and higher CNR than DLR and HIR (P < .001). The visual scores of SR-DLR for image noise, sharpness, and overall image quality were significantly higher than those of DLR and HIR for both readers (P < .001). Both readers scored significantly higher on SR-DLR than on HIR for visibility for all structures (P < .01), and at least one reader scored significantly higher on SR-DLR than on DLR for visibility for all structures (P < .05). SR-DLR reduced image noise and improved image quality of thin-slice abdominal CT images compared to HIR and DLR. This technique is expected to enable further detailed evaluation of small structures.

Partial adrenalectomy by the posterior retroperitoneoscopic approach: A single institution series of 766 consecutive procedures.

Partial adrenalectomy (PA), as an alternative to total adrenalectomy in selected cases, allows for the preservation of adrenocortical function, especially in hereditary and/or bilateral diseases. In this study, we analyze our experience in posterior retroperitoneoscopic PA (PRPA) and its impact on adrenocortical function. From January 2010 to December 2023, 709 PRPAs were performed on 766 adrenal glands in a total of 697 patients (421F; 276M; and mean age 49.3±15.3). Patients suffered from all types of adrenal tumors (239 pheochromocytoma, 225 Conn's syndrome, 102 Cushing's syndrome (CS), 66 nonfunctioning adenomas, 38 adrenal metastases, and 27 others). Mean tumor size was 2.7±1.5cm. Bilateral disease occurred in 135 patients (60 pheochromocytoma, 19 Conn's syndrome, 32 CS, 2 nonfunctioning adenomas, 17 adrenal metastases, and 5 combined diseases). Mean operating time for unilateral operation was 39.2±17.2min. Minor postoperative complications were observed in 1.5% and major complications in 0.1%. The median hospital stay was 2days. In bilateral cases, 18 of 33 (54%) Cushing patients and nine of 102 (9%) non-Cushing patients received corticosteroid replacement therapy (CRT) early postoperatively. Long-term follow-up data were collected for 242 patients (35%). After unilateral surgery, only patients with CS required CRT (8/24). Eleven (24.4%) out of 45 patients with bilateral non-Cushing disease needed CRT. Eight patients (3%) developed ipsilateral recurrent disease. PRPA is a safe procedure with a low complication and recurrence rate. This makes it the preferred operation in cases of bilateral disease and for selected patients with benign pathologies.

VS 03 - BN Laparoscopic Excision of Aortic Schwannoma

Abstract Background This video presentation describes a laparoscopic approach to the excision of a large retroperitoneal cyst in a 39 year old female presenting with generalised abdominal pain. The patient had a background of Type 2 Diabetes, as well as a laparoscopic hysterectomy. Method The patient presented acutely with the above symptoms. CT and MRI both confirmed a large retroperitoneal cyst measuring 8x9cm. EUS was performed showed a thin walled cyst and a normal pancreas. FNA cytology was benign, hydatid serology was negative Results MDT decision was to go ahead with formal surgical resection. Laparoscopic excision of the cyst was performed, demonstrating that the pancreas was displaced anteriorly, with the coeliac axis displaced to the right. The cyst did not involve the pancreas or adrenal gland. Post operative histology found the cyst to be an aortic schwannoma. Conclusion This video demonstrates the complex retroperitoneal dissection that can be performed laparoscopically. The patient was discharged on post op day 8 with surveillance follow up