Urine VMA Research Articles

8774 An Uncommon Presentation Of A Large Silent Pheochromocytoma

Abstract Disclosure: M. Lozano: None. A. Pinero-Pilona: None. Background: The reported estimated incidence of pheochromocytoma is approximately 2-8 cases per 1 million people per year. Of those, silent pheochromocytomas will make up about 8%. Thus, biochemically silent and non-secreting pheochromocytomas are a very rare phenomenon. Clinical Case: A 74-year-old Caucasian female with significant past medical history of primary hypothyroidism, hypercholesterolemia, and nasal sinus carcinoma s/p surgery (in remission) presented to the clinic for endocrine evaluation of a right adrenal mass. The patient was asymptomatic and denied headaches, tachycardia, sweating, severe hypertension, diabetes, muscle weakness, easy bruising, or striae. The mass was initially diagnosed as an incidental finding after a contrast CT scan of the abdomen was performed for diverticulitis. The right adrenal enhancing mass was 2.3 x 3.9 x 4.1 cm in diameter. Subsequent MRI abdomen with and without contrast ordered by the referring physician showed that the adrenal mass had grown to 4.9 x 3.8 x 5.4 cm and was hyperenhancing in nature with central T2 hyperintense signal. Notably, multiple “parasitized and arborealized” vessels were detected within the mass. Such findings led us to suspect metastatic versus primary adrenal neoplasm such as cortical carcinoma as a working diagnosis. Other laboratory studies including plasma free metanephrines (<10 pg/mL, normal 0-88 pg/mL), plasma normetanephrines (29.2 pg/mL, normal 0-285.2 pg/mL) and 24-hour urine collections (24 hr urine epinephrine - 3 ug/24 hr [normal 0-20 ug/24 hr]; 24 hr urine norepinephrine - 75 ug/24 hr [normal 0-135 ug/24 hr]; 24 hr urine VMA - 3 mg/24 hr [normal 0-7.5 mg/24 hr]) were negative for pheochromocytoma. As her mass was greater than 4 cm in diameter, surgical referral was then recommended to the patient. Right adrenalectomy was performed. Pathology report was consistent with pheochromocytoma as supported by immunohistochemistry. Ki-67 proliferation index was 0-10% (average 3-4%, rare hotspots 10%). Atrophy and vascular ectasia were present in residual non-neoplastic adrenal cortex and medulla. Histology showed a nested growth pattern, absence of composite tumor elements, absence of necrosis, and no atypical mitoses. The incidence of non-secreting pheochromocytomas has been quoted to be 0.000064% (1). Conclusion: The case illustrates an uncommon presentation of a large, silent pheochromocytoma with negative plasma metanephrines accompanied by negative urine studies, which have a negative predictive value close to 100% in ruling out a pheochromocytoma. Our case emphasizes the importance of considering pheochromocytoma on the differential of adrenal masses with high attenuation or high enhancement even when biochemical studies suggest otherwise. Reference: (1) Radojkovic, D., et al. "CLINICALLY" SILENT GIANT PHEOCHROMOCYTOMA. CASE REPORT." Acta Endocrinologica (1841-0987) 9.1 (2013). Presentation: 6/1/2024

Changes in blood pressure, blood sugar and creatinine in patients undergoing pheochromocytoma surgery

Objective: To discover the variables that may predict changes in blood pressure and blood sugar levels and to pinpoint the time frame during which such changes occur in patient with pheochromocytoma. Materials and Methodology: Consecutive patients undergoing surgery for pheochromocytoma over a 20-month period were included in this ethics review board-approved, prospective cohort study. Blood pressure and sugar levels were serially monitored using a fixed protocol in the perioperative period and subsequently at 3 months after surgery. Changes were compared and assessed for the predictive factors. Result: Fifty patients undergoing surgical procedures were included in the study of whom 32% developed hypotension and 10% developed hypoglycaemias after surgery. All hypotension episodes occurred within 6 hours of surgery. However, while 7 of 8 patients who developed hypoglycaemia manifest in the first 4 h after surgery, one occurred after 12 h. Occurrence of hypotension correlated with preoperative 24-h urinary vanillylmandelic acid levels (P = 0.024). Out of 21 hypertensive patients, 15 had persistent hypertension at 3 months and this was associated with age (P = 0.04) and diabetes mellitus at presentation. Conclusion: 32% of patients receiving pheochromocytoma surgery experienced postoperative hypotension needing inotropic support. Patients who require greater dosages of alpha-blockers or those with higher 24-h urine VMA levels are more prone to experience this. This happens within the first six hours following surgery. Patients who are older or who have had DM for a long time are more likely to suffer chronic HTN following surgery. Keywords: Pheochromocytoma, hypertension, hypoglycaemia, creatinine.

PS-R06-7: CAUDAL REGRESSION SYNDROME AS A CAUSE OF SECONDARY HYPERTENSION

Hypertension (HT) is a disease with a mainly multifactorial etiology. Although monogenic, embryological, epigenetic causes are rare and the interdisciplinary approach is essential to arrive at the diagnosis. We present the case of a 22-year-old patient with a history of congenital myelomeningocele and daughter of non-consanguineous parents, hospitalized for a hypertensive crisis (220/112 mmHg). It is referred to rule out genetic causes of hypertension. The genealogy shows a history of hypertension and ischaemic heart disease in both parental lines, in two previous generations. Physical examination revealed bilateral pes cavus in the lower limbs, edema, and overlapping of the second toe over the first toe on the left foot. She presented calf atrophy and incontinence, with the use of a bladder catheter and a continent stoma, as post-surgical sequelae. As a relevant finding, elevated aldosterone and plasma renin activity. Normal blood and urine catecholamines, VMA and normetanephrines. MRI of the abdomen and pelvis revealed a double left renal artery corroborated by CT angiography, a right extrarenal pelvis and a bicornuate uterus of normal size. Doppler of renal arteries showed no signs of significant stenosis. Right renal artery 43 cm/s and left renal artery 103 cm/s. The patient presents diagnostic criteria compatible with a caudal regression syndrome, a spectrum of clinical phenotypes with malformations in the lower hemibody that involve the 3 embryonic layers. It is postulated that, in this case, the hypertension is secondary to the embryological defect. The patient continues to be medicated with perindopril/indapamide 10/2.5 mg with adequate blood pressure control. JOURNAL/jhype/04.03/00004872-202301001-01322/figure1/v/2023-10-24T163949Z/r/image-jpeg

Neuroblastoma Presentation With Multiple Cranial Nerve Involvement

Objective NA. Background We report a case of neuroblastoma, a pediatric neuroendocrine tumor of the sympathetic nervous system, in a 3-year-old female with multiple cranial nerve involvement. Design/Methods A 3-year-old afebrile, lethargic female presented with bilateral eyelid droop, right head tilt, slurred speech, gagging, abnormal walking and no bowel movement. Neurological examination noted bilateral ptosis, dysarthria, left tongue deviation, proximal weakness in upper and lower extremities, areflexia in biceps and patellar tendons, dysmetria, and wide-based gait. MRI of the brain showed heterogeneous appearance of the clivus and MRI of the spine showed right adrenal mass and heterogeneous enhancement of multiple vertebrae, suggesting possible metastatic disease. Serum and cerebrospinal studies were unremarkable. Patient was treated with intravenous methylprednisolone and plasmapheresis for suspected paraneoplastic syndrome; however, she continued to clinically progress. Adrenal mass biopsy results and elevated urine VMA and HVA levels were consistent with the diagnosis of neuroblastoma. Nuclear imaging and meta-iodobenzylguanidine scan were negative. Paraneoplastic panels and Lambert Eaton panel were negative for autoantibodies. Total resection of the abdominal mass and right adrenal gland with continued steroid taper, resulted in reported near total symptom resolution. Results Our patient presented with antibody negative paraneoplastic polyneuropathy due to neuroblastoma. Cranial nerve involvement in neuroblastoma can result from tumor involvement of the sympathetic chain, paraneoplastic syndromes, or metastasis to the skull. Our patient's initial imaging suggested potential metastatic or inflammatory involvement of the clivus, suspected of causing her cranial nerve symptoms. However, nuclear studies were negative for metastatic disease and patient's symptoms resolved after resection of the main mass suggesting a paraneoplastic etiology. Although her paraneoplastic panel and Lambert-Eaton panel were negative for common associated antibodies, it is likely an unmeasured autoantibody, cytokine, hormones, or peptide was at play. Conclusions Neuroblastoma should be considered as a differential for a neurological presentation involving multiple cranial nerves in a child.

Preliminary study on angiogenesis and functional evaluation of benign adrenal pheochromocytoma vessels

Objective: To study the relationship between the pheochromacytomas’ MVD and VEGF expression which are two indexes of angiogenesis, and analyze the difference of MVD and VEGF expression in different groups of pheochromocytomas with the purpose of correlating pheochromocytoma’s function and angiogensis. Methods From June 2009 to December 2015, thirty-one patients histologically diagnosed as benign pheochromocytoma were divided into two groups according to the length of preparing time before operation(group 1≦2 weeks, group 2>2 weeks), and eight normal adrenal glands as the control group. The MVD and VEGF expression of all the pheochromocytomas and normal adrenal glands were evaluated, with the purpose of correlating the MVD and VEGF expression and analyzing the difference among of two groups of pheochromocytomas and normal adrenal glands. The tumors’ diameter, intratumoral necrosis and the patients’ urine VMA were also analyzed with MVD and VEGF expression. Results :1) The mean value of MVD in group 1 is 50.2±15.4 per HP, and less than the group 2 with the mean value 69.5±3.8 per HP(p<0.05), but more than the normal adrenal glands with the mean value 35.1±3.4 per HP(p<0.05). There is no MVD mean value difference between groups divided according to tumors’ diameter, intratumoral necrosis and the patients’ urine VMA. There is 30.8% high VEGF expression in group 1 less than group 2 with 77.8%(p<0.05), and there no high VEGF expression rate difference between groups divided according to tumors’ diameter, intratumoral necrosis and the patients’ urine VMA; The MVD correlates with VEGF expression in pheochromocytomas (r=0.545, p<0.05). Conclusion :1) The function of pheochromocytoma maybe correlate with the angiogenesis. 2) The angiogenesis of pheochromocytoma was more than that of the normal adrenal gland. 3)There are no correlation with the angiogenesis and tumor’s diameter, intratumoral necrosis and the patients’ urine VMA in this study.

SUSPECTED PHEOCHROMOCYTOMA PRECIPITATING TAKOTSUBO CARDIOMYOPATHY

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Takotsubo cardiomyopathy (TCM) is characterized by transient systolic dysfunction resulting in hallmark apical ballooning/hypokinesis without the presence of coronary artery disease.1 The pathophysiology entails extreme stress, which generates a sudden and massive surge of catecholamines which then markedly deranges cardiac contractility.1 One source of the catecholamine surge is pheochromocytoma: a catecholamine secreting tumor of the chromaffin cells.2 We present the case of patient who presents with both TCM and a suspected pheochromocytoma. CASE PRESENTATION: A 56-year-old female with history of both STEMI and NSTEMI presented with chest pain, nausea, vomiting, and lightheadedness. Blood pressure was 197/119 mmHg on admission. Cardiac enzymes were normal, however ECG demonstrated new lateral ST elevations in V4-V6. TTE showed apical and anterolateral akinesis with a markedly reduced EF of 18%. Nitroglycerin infusion was initiated, and patient was transferred emergently for cardiac catheterization. Patent coronary vessels were found, no intervention was performed, and medical management was pursued. Echocardiographic and catheterization findings were consistent with TCM. Further chart review showed multiple similar prior episodes plus a prior CT scan which demonstrated a 2 cm adrenal mass. Given clinical suspicion, workup for pheochromocytoma was initiated. Plasma and spot-urine metanephrines, plus spot-urine normetanephrines and 24-hour urine metanephrines were within normal limits. Plasma normetanephrines, 24-hour urine normetanephrines, epinephrine, norepinephrine, and dopamine were elevated at 731.7 pg/mL, 1538 ug/24 hours, 83 pg/mL, 4213 pg/mL, and 1020 pg/mL respectively.The patient's blood pressure was eventually controlled with oral medications. She was initiated on goal-directed medical therapy for her newly reduced EF and discharged home with endocrinology follow-up. DISCUSSION: Detection of pheochromocytoma is elusive and largely depends on elevated catecholamines in urine or blood samples via 24-hour collection. The difficulty lies in the fact that the secretion is intermittent. Measurement of VMA in urine can be done yet despite a high specificity (95%) there is a low sensitivity (64%).3 Pheochromocytoma can result in mass catecholamine release with systemic manifestations, affecting cardiac contractility. CONCLUSIONS: Our patient presented with TCM from a suspected pheochromocytoma. This diagnosis was reached via a combination of echocardiographic imaging showing apical and anterolateral akinesis, not consistent with any single coronary distribution, a clean coronary catheterization, and several lab panels demonstrating elevated levels of catecholamines/metanephrines in both the blood and urine. REFERENCE #1: Ahmad SA, Brito D, Khalid N, Ibrahim MA. Takotsubo Cardiomyopathy. In: StatPearls. StatPearls Publishing; 2020. Accessed November 13, 2020. http://www.ncbi.nlm.nih.gov/books/NBK430798/ REFERENCE #2: Y-Hassan S. Recurrent takotsubo syndrome triggered by undiagnosed pheochromocytoma. International Journal of Cardiology. 2015;187:369-371. doi:10.1016/j.ijcard.2015.03.220 REFERENCE #3: Vora KS, Shah VR. Diagnosis of pheochromocytoma. J Anaesthesiol Clin Pharmacol. 2012;28(2):274-276. doi:10.4103/0970-9185.94931 DISCLOSURES: No relevant relationships by James Gubitosa, source=Web Response No relevant relationships by Shivam Kaushik, source=Web Response

Adrenal cholangiocarcinoma: a case report and literature review

Objective To discuss the clinical characteristics and pathologic features of adrenal cholangiocarcinoma. Methods We reported one extremely rare adrenal cholangiocarcinoma case and review the relative literature. A 71-year-old male was admitted with right adrenal mass for 2 months. Patient has been suffered from hypertension and controlled by oral drugs for ten years. Enhanced computerized tomography (CT) revealed a mass in right adrenal gland area, with the size of 7.1 cm×6.8 cm×4.4 cm and inhomogeneous enhancement in arterial phase. Adrenal functional examination showed no obvious abnormalities of serum catecholamine, supine RAAS, cortisol determination and rhythm and urine VMA detection. Results After medical preparation of phenoxybenzamine for 3 weeks preoperatively, the patient's blood pressure was maintained at 110-125/80-90 mmHg and with stuffy nose and ruddy nail bed. The patient′s weight gained of 1kg than before. Retroperitoneal laparoscopic resection of right adrenal tumor was performed in general anesthesia. The tumor that related to the inferior vena cava and liver was successfully removed without any other damage. The operation time was 155 min and estimated blood volume was 50 ml. Perioperative blood pressure of patient was stable and recovery was well. According to clinical characteristic and pathological test and immunohistochemical results, patient was diagnosed with adrenal cholangiocarcinoma. Followed up for 15 months, no tumor recurrence and metastasis based on ultrasound examination and CT, and with normal blood pressure. Conclusions Adrenal cholangiocarcinoma was extremely rare type in the adrenal malignant tumors based on hepato-adrenal fusion histologically. This case constitutes a contribution for the knowledge of adrenal cholangiocarcinoma. The imaging findings were heterogeneous enhancement of soft tissue masses, and there was no obvious abnormality in adrenal functional examination. The retroperitoneal laparoscopic surgery is a treatment choice for this kind of patient. Key words: Adrenal gland neoplasm; Cholangiocarcinoma; Adrenalectomy

Diagnosis and treatment of von Hippel-Lindau disease without angioma: two cases reports and literature review

Objective To study the genetic diagnosis and treatment of von Hippel-Lindau disease without angioma. Methods We retrospectively analyzed clinical data of two cases with VHL and review the related literature.On September 2009, we treated one 30 years old male patient with VHL.Laboratory tests showed that the 24h urine VMA was 166.27μmol/24h.MRI examinations showed a right adrenal mass, which was considered as pheochromocytoma; multiple small cysts kidney; bilateral epididymal multiple nodules; multiple pancreatic cysts.After careful preoperative preparation, the patient underwent right adrenal tumor resection under general anesthesia.During surgery, multiple kidney tumors were noticed, which the freezing pathological diagnosis was clear cell carcinoma.Then, the right radical nephrectomy was performed.The final pathological diagnosis was right adrenal pheochromocytoma and right renal cell carcinoma.Interferon and interleukin-2 therapy were given to the patient after surgery.The patient underwent bilateral epididymal nodule resection, which the pathological diagnosis was papillary cystadenoma.According to those results, a type Ⅱ VHL disease was considered.The patients' family members were further reviewed and accepted the related clinical examinations.We found that his brother had multiple renal tumors and cysts, multiple pancreatic cysts.Because his brother suffered from type Ⅱ VHL disease.the second patient was diagnosed Ⅱ type VHL disease, as well.Since the patient's right kidney tumors were multiple and larger than the left one, he received radical right nephroectomy.Due to the small size of left renal tumor, no additional surgery was further performed.The tumor was diagnosed clear cell carcinoma after surgery.We treated him with interferon and interleukin-2.To move forward a single step, we extracted peripheral blood from two cases and son of one case.We extracted genome DNA, using the meliorated method to amplify three exons located in the translating and splicing region, sequence directly them after purifying and compare with the human mutation database. Results There are no angioma tendency in the retina and central nervous system of the two patients who have polycystic kidney disease, kidney cancer, the pancreas multiple cysts and bilateral testicular multiple cystic lesions.In the gene sequencing of three patients, the 452th nucleotide guanine of the VHL gene was substituted by thymine, resulting in the 78th encode ASP substituted by Ser.The genetic mutations sites in the dendrogram locate in the exon 1 which are all point mutations. Conclusions The character of the sporadic example without angioma correspond with VHL.We can make a explicit diagnosis by genetic mutations examination.In the treatment, it should be adopted by the radical excision on the base of protecting the kidney. Key words: von Hippel-Lindau disease; Kindred study; VHL genes; Diagnosis and treatment

Dealing with Pheochromocytoma during the First Trimester of Pregnancy.

Purpose. Pheochromocytoma in association with pregnancy is a very rare, without specific symptoms, life-threatening condition, increasing both maternal and fetal mortality up to 50%. The present paper illustrates the case of a pregnant woman, diagnosed with pheochromocytoma, aiming to demonstrate and discuss the difficulties that arouse during the diagnosis and the problems concerning the treatment. Patient. A 34-year-old woman, in the 9th week of pregnancy, complained for headache, sweating, and a feeling of heavy weight on the right renal area. A tumor of 10 cm diameter at the site of the right adrenal was found. Twenty-four-hour urine catecholamine and VMA excretion levels were well raised. Results. Multidisciplinary approach treated the patient conservatively. Surgical resection of the tumor was performed after the 14th week of pregnancy at the completion of organogenesis. Neither postoperative complications occurred nor hypertension relapse was recorded. The fetus was delivered without complications at the 36th week. Conclusions. There are no consensus and guidelines for treating pheochromocytoma during pregnancy, especially when it is diagnosed in the first trimester. The week of pregnancy and a multidisciplinary approach will determine whether the pregnancy should be continued or not, as well as the time and the approach of surgical treatment.

颈部异位嗜铬细胞瘤一例报告

颈部异位嗜铬细胞瘤十分罕见。作者报道了一例57岁的男性患者，因“发现左颈部肿块6年，头痛眩晕、胸闷胸痛9天”入院。入院时血压大幅度波动，每隔数分钟波动在200/100 mmHg~80/50 mmHg的范围。左颈部肿块进行性增大5年余。血浆17-羟皮质类固醇和17-酮类固醇正常，24小时尿VMA升高(82.7 umol/day (。颈部的CT平扫和增强显示左侧颈部一个4.6 × 3.2 cm大小的肿块。充分的术前准备后行左颈部肿块切除术。手术顺利，无术后并发症。病理和免疫组化显示为左侧颈部异位嗜铬细胞瘤。 Ectopic pheochromocytoma in neck is rare. We reported a 57-year-old male patient who was admitted to hospital because of a mass in left neck for 6 years with headache, dizziness, chest tightness and chest pain for 9 days. He had an alternation of fluctuation of blood pressure between 200/100 - 80/50 mmHg in every several minutes. The mass progressively enlarges for more than 5 years in his left side of neck. His plasma 17-hydroxy corticosteroid and 17-ketosteroid levels were normal. The 24 hours urine VMA level was high (82.7 umol/day (

高速液体クロマトグラフィーによるヒト尿中VMA, HVAおよび5-HIAAの同時定量

高速液体クロマトグラフィーによるヒト尿中VMA, HVAおよび5-HIAAの同時定量

Neonatal suprarenal mass: differential diagnosis and treatment

To develop better diagnosis of and treatment strategy for suprarenal masses in the neonates. A total of 28 neonates with suprarenal mass were treated in the Department of Pediatric Surgery, Children's Hospital of Fudan University, between May 2003 and August 2010. The medical records of these patients were reviewed. The clinical, radiological, surgical and pathological data were collected. Six cases were diagnosed as having adrenal tumors, including 1 adrenal teratoma and 5 adrenal neuroblastomas (NB), and 22 cases were diagnosed as having adrenal hemorrhages. Ultrasound showed that the hematoma started to regress after 7 days to 6 months. Among the NBs, 2 cases were of stage I, 2 cases were of stage IV, and 1 case was of stage III. While 1 stage III patient and 1 stage IV patient underwent adjuvant chemotherapy after the surgery, other cases were cured by surgery alone and currently have no evidence of disease. The suprarenal mass presented cystoids or solid masses detected by ultrasound and CT both in adrenal hemorrhages and in tumors. The accurate diagnosis of neonatal suprarenal mass depends on prenatal ultrasonography, clinical manifestations, urine VMA test, CT and ultrasound, but dynamic observation of suprarenal mass by CT and ultrasound is an important means of differential diagnosis. While conservative therapy is suitable for adrenal hemorrhage, adrenal tumors need surgical excision. In addition, adrenal mass that is difficult to diagnose can be followed up for 1 month without any adverse effects on the therapy and prognosis of the tumor.

546 A Giant Orbital Plexiform Neurofibroma with Massive Intracranial Extention in a Newborn

Orbital masses in newborns are rare. Herein a newborn with a giant orbital tumor is presented. A 10-day female baby was admitted to hospital with proptosis. She was the first...

Pheochromocytoma in children and adolescents

Eleven subjects aged <20 yr with histologically proven pheochromocytoma between 1987 and 2006 were analyzed. Family history was present in 18%. In 2 patients, pheochromocytoma was part of VHL and in one it was associated with MEN 2. Twenty four hour urine VMA level was elevated in 100% and metanephrine level in 73%. CT/ MRI were showing the tumor in all. Prazosin extended release tablets (maximum 30 mg/day) were used in 73% and doxazosin (maximum 12 mg/ day) in 27%. Intraoperative BP fluctuations were seen in 27%. All were biochemically cured after surgery. Preoperative á blockade with extended release prazosin and doxazosin were effective in controlling perioperative BP fluctuations. Hence these drugs can be used in children and adolescents without fear of postoperative hypotension.

Diagnosis and treatment on normotensive pheochromocytomas

Objective To discuss the diagnosis and treatment of normotensive pheochromocyto-ma. Methods The clinical data of 22 patients with normotensive pheochromocytoma were reviewed. Inclusion criteria for normotensive pheochromocytoma were no previous history of hypertension and episode of symptoms suggesting high blood pressure. The blood pressure on admission was 90-130/ 60-90 mm Hg with an average of 113/72 mm Hg. Seven patients were found adrenal mass by routine ultrasonic examination. Twelve patients presented with superior abdominal or flank pain. Four pa-tients were present with fatigue, and 2 patients had fever. Headache and palpitation were found in 1 patient. Most of patients were present with large and round mass with low density area in the center of the tumor by uhrosonography and CT. Four patients had elevated level of plasma epinephrine and nor-epinephrine. 24 hours urine CA and VMA were elevated in 5 and 4 patients respectively. Seven pa-tients were prepared with infusion preoperatively to expand intravascular volume, and 2 patients were given prazosin 1.5 mg/d for 5 to 7 days. Results During the operation, seventeen patients had ele-vated blood pressure and 5 patients had no changed. One of seven patients with preoperative prepara-tion had obvious hypertension during operation, and 11 of 15 patients without preoperative preparation had obvious hypertension. The tumors were removed successfully in 21 patients. All the patients were diagnosed pheochromocytoma pathologically. Twenty-one patients had normal blood pressure with no recurrence during the follow-up from 1 month to 7 years. Conclusions The patients with normotensive pheochromocytomas may have lower catecholamine in their plasma and urine. The application of α-blockers and the expanding intravascular volume before operation could be important for the patients safe. Key words: Adrenal gland neoplasmas; Pheochromocytoma; Normal blood pressure; Perioperative care

Effectiveness of green tea on weight reduction in obese Thais: A randomized, controlled trial

This study was undertaken to investigate the effects of green tea on weight reduction in obese Thais. A randomized, controlled trial involving 60 obese subjects (body mass index, BMI > 25kg/m 2) was conducted. All subjects consumed a Thai diet containing 3 meals (8373.6kJ/day) for 12weeks, prepared by the Nutritional Unit at Srinagarind Hospital. The diet contained 65% carbohydrates, 15% protein, and 20% fat. Body weight, BMI, body composition, resting energy expenditure, and substrate oxidation were measured at baseline, and during weeks 4, 8, and 12 of the study. Serum levels of leptin and urine VMA were measured at baseline and during the 12th week. Differences over time and between the treatments (green tea or placebo) over time were determined using two-factor ANOVA with repeated measures. In comparing the two groups, differences in weight loss were 2.70, 5.10, and 3.3kg during the 4th, 8th, and 12th weeks of the study, respectively. At the 8th and 12th weeks of the study, body weight loss was significantly different ( P < 0.05). At the 8th week, the difference in resting energy expenditure was 183.38kJ/day ( P < 0.001), the difference in the respiratory quotient was 0.02 ( P < 0.05), and no significant differences existed in satiety score, food intake, or physical activity. Urine VMA was significantly different in the 12th week of the study ( P < 0.05). We conclude that green tea can reduce body weight in obese Thai subjects by increasing energy expenditure and fat oxidation.

Hydatid Cyst of the Adrenal Gland: A Clinical Study of Six Cases

Hydatid cyst of the adrenal gland (HCAG) is an exceptional occurrence. We report our experience of six cases of HCAG and discuss the diagnosis and treatment of this hydatid localization. We retrospectively reviewed and analyzed the clinical files of six patients admitted to our institution from January 1990 to December 2000 for HCAG. Patients varied in age from 24—59 years. They were five males and one female. One patient had a history of pulmonary hydatidosis treated surgically 10 years previously. Five patients presented with lumbar pain and one patient had bouts of hypertension, headache, and palpitation. Physical examination was normal except in one patient who was hypertensive. Preoperative diagnosis was highly suggested by ultrasonography. CT scan performed in all cases clearly showed the relationship of the cyst with adjacent organs. Serology tests were positive in two cases. One patient had elevated urine VMA and was operated on with the diagnosis of cystic phaeochromocytoma. All six patients were operated on and had either an adrenalectomy (two cases) or partial pericystectomy (four cases). In one case, partial pericystectomy was conducted through a retroperitoneal laparoscopic approach. The hydatid nature of the cyst was confirmed pathologically. All patients had a smooth postoperative course with no cystic recurrence on follow-up. The diagnosis of HCAG is based mainly on ultrasonography and CT scan. Surgery with either partial or total excision of the cyst, with or without preservation of the adrenal gland, is the treatment of choice.

Anafilaxia inducida por ejercicio tras ingesta de manzana

hematimetries, biochemistries, VMA and 5-HIAA in urine. Complement levels, antinuclear antibodies and viruses serology. skin prick test with a common inhalant. Skin prick test and prick by prick with different foods. Total Ig E level and specific Ig E determination by the CAP-Pharmacia System. Oral challenge test with apple, exercise test and exercise challenge test after eating an apple. Prick by prick test with fresh apple was positive. Specific Ig E determination by the CAP-Pharmacia System revealed a positive result. We get to reproduce the episode with an exercise challenge test after eating an apple in the same conditions of usual exercise in both patients.

Le diagnostic du phéochromocytome atypique : un challenge aussi pour le biologiste

Biological diagnosis of pheochromocytoma is relatively easy in those cases releasing great amounts of catecholamines with strong clinical features; instead, diagnosis could be more problematic in atypical or asymptomatic familial pheochromocytoma with small tumors secreting low catecholamine amounts. Several plasma and urine adrenergic markers must be used to confirm the clinical suspicion. We have discussed the biological data of three totally asymptomatic pheochromocytomas (cases n ∘2, 3, 4) and one case with a very discrete clinical manifestation (n ∘1). Three patients had very small tumors (4, 7 and 25 g) secreting preeminently adrenaline, one patient had a 45 g adrenal incidentaloma without clinical expression. Our study shows that, in these special cases, except an unconstant increase of adrenaline, plasma and urine catecholamines and urine VMA can be normal. The most useful markers are plasma and urine methoxyamines. However, plasma methoxyamines are the most sensitive because their increase over reference values is by far greater than in urines. Several factors may explain these findings: a low tumoral secretion, the nature of the released amine, the short half-life of catecholamines in plasma and, in some cases, the involvement of intratumoral catecholamine metabolism. Analysis of the ratio NMN/MN in plasma provides an additional diagnosis tool to reveal adrenaline secretion abnormalities.

Subdiaphragmatic Extralobar Pulmonary Sequestration with Granulomatous Necrotizing Reaction Simulating a Tuberculous Infection: A Case Report

Subdiaphragmatic Extralobar Pulmonary Sequestration with Granulomatous Necrotizing Reaction Simulating a Tuberculous Infection: A Case Report