11/14. Primary aldosteronism with cortisol overproduction from bilateral multiple adrenal adenomas.A 55-year-old woman with bilateral multiple adenomas showed hypertension, muscle weakness, hypokalemia, moon-like face and truncal obesity. Increased serum and urinary levels of aldosterone were observed. serum cortisol level did not show a normal circadian rhythm. Microscopic examination of the resected tumors showed two types of adenoma cells; one (golden yellow tumor) was a large clear cell with foamy cytoplasm which possibly secreted aldosterone and the other (dark brown tumor) was an acidophilic cell with lipofuscin which might have produced cortisol. This is a very rare case of primary aldosteronism with Cushing's syndrome due to multiple bilateral adrenal adenomas.- - - - - - - - - - ranking = 1keywords = aldosteronism (Clic here for more details about this article) |
12/14. 11 beta-Hydroxylase in mitochondrial fractions of functioning and non-functioning adrenocortical tumors.The activity of 11 beta-hydroxylase was investigated in the mitochondrial fractions of 19 surgically resected adrenocortical tumors associated with Cushing's syndrome (4 adenomas and 2 carcinomas), primary aldosteronism (8 adenomas), adrenogenital syndrome (AGS) (2 carcinomas) and no hormonal symptoms (3 adenomas). Five adrenal cortices from patients with mammary carcinoma, renal cell carcinoma and pheochromocytoma were used for the normal control. The activities of 11 beta-hydroxylation of deoxycorticosterone and of 11-deoxycortisol in the control adrenal cortices were 0.66-2.16 pmole/mg protein/min (mean: 1.28 pmole/mg protein/min) and 0.25-0.77 pmole/mg protein/min (mean: 0.56 pmole/mg protein/min), respectively. The activities in adenomas and carcinomas associated with Cushing's syndrome were in the range of normal control. The activities in aldosteronomas were significantly higher in 4 cases than those of the normal control and in the range of the normal control in 4 cases, suggesting that the higher activity of 11 beta-hydroxylase is one of the important factors causing mineralocorticoid excess. The activities in adrenocortical carcinomas with AGS were significantly lower, corroborating clinical findings of androgen excess with suppressed production of mineralocorticoid or glucocorticoid. The activities in two cases of nonfunctioning adenomas were in the range of the normal control, but the third case showed higher activity than the normal control. These results show that the abnormal activity of mitochondrial 11 beta-hydroxylase exists in some aldosteronomas, non-functioning adrenocortical adenomas and carcinomas with AGS.- - - - - - - - - - ranking = 0.2keywords = aldosteronism (Clic here for more details about this article) |
13/14. A case of primary hyperparathyroidism, primary hyperaldosteronism and Cushing's disease.The rare association of parathyroid adenoma with primary hyperaldosteronism, occurring in each of 2 patients, was recently reported from this unit. The present communication records the subsequent development, in one of these patients, of Cushing's syndrome with an anterior pituitary adenoma. Screening for other endocrine abnormalities was negative. A literature search failed to produce any other cases of the association of these three conditions in one patient.- - - - - - - - - - ranking = 1keywords = aldosteronism (Clic here for more details about this article) |
14/14. Hyperadrenalism in childhood and adolescence.Hyperadrenalism in childhood and adolescence has unique features that influence diagnosis and management. We reviewed our experience with 18 patients, ranging in age from 18 months to 18 years. Nine had bilateral adrenal hyperplasia, eight had adrenal neoplasms, and one had micronodular hyperplasia. patients with congenital adrenal hyperplasia and hyperaldosteronism were excluded. Six patients with Cushing's disease diagnosed in earlier years were treated by total adrenalectomy and recently two patients underwent transsphenoidal removal of pituitary tumors. Bilateral adrenalectomy was carried out in one patient with micronodular hyperplasia and in a second because of elevated adrenocorticotrophic hormone (ACTH) levels from an undefined source. Eight patients had adrenal neoplasms, including five adenomas and three carcinomas. We found no reliable criteria to differentiate before surgery between adrenal adenomas and adrenal carcinomas. The most recognizable characteristic of malignancy was tumor size, specifically weight greater than 75 gms. Of the three patients with adrenal carcinoma, one expired 20 months after adrenalectomy and 8 months after receiving palliative partial hepatectomy for liver metastasis. Two patients are well with normal growth and development at 11 and 20 years following adrenalectomy. With the exception of one patient who died 6 years after surgery from a glioblastoma multiforme, all patients with adrenal adenomas are well. Eight patients underwent bilateral adrenalectomy for hypercortisolism. Five of the six who have reached their adult stature are significantly stunted. Four of six patients with Cushing's disease, treated by total adrenalectomy, have developed Nelson's syndrome at 2, 6, 10, and 12 years after surgery. Of the two patients undergoing transsphenoidal surgery, one had recurrent disease at 2 years and was treated by pituitary irradiation with recovery. The patients undergoing adrenalectomy for micronodular hyperplasia and ectopic ACTH are well at 2 and 4 years, respectively. Cushing's disease in children and adolescents is best treated by transsphenoidal removal of the pituitary adenoma. adrenalectomy, once the most accepted approach, plays a secondary role and is indicated primarily in micronodular adrenal hyperplasia, in patients with ectopic ACTH production of an undefined source, and in recurrent Cushing's disease following prior pituitary irradiation. The high incidence of Nelson's syndrome in children treated by adrenalectomy mandates that patients at risk be monitored lifelong for the progression of a pituitary tumor.(ABSTRACT TRUNCATED AT 400 WORDS)- - - - - - - - - - ranking = 0.2keywords = aldosteronism (Clic here for more details about this article) |
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