RESUMEN
The authors of the article analyze more than 30-year experience of surgical treatment of adrenal gland diseases, offering a detailed description of clinical and morphological features of the main nosological forms such as Itsenko-Cushing disease and syndrome, primary hyperaldosteronism, pheochromocytoma, incidentaloma, and malignant adrenal tumors. The paper contains basic diagnostic criteria, indications to operative treatment, and extents of surgery for each of the diseases considered, as well as comparative analysis of peculiarities of conventional ("open"), and endoscopic adrenal gland surgeries. The article demonstrates significance of various immunohistochemical markers in differentiation between malignant and benign adrenal tumors.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/cirugía , HumanosRESUMEN
The mean blood content of interleukin-6 in patients with adrenal tumors was much higher than in healthy donors. No correlations were revealed between interleukin-6 level, patients sex and age, stage and duration of the disease. Interleukin-6 concentration was maximum in patients with adrenocortical cancer. A negative correlation was found between interleukin-6 level and blood cortisol concentration in patients with cortisol-producing adenoma. In patients with aldosterone-producing adenoma, interleukin-6 level tended to correlate negatively with plasma renin activity.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/inmunología , Interleucina-6/sangre , Adenoma/inmunología , Adenoma/metabolismo , Neoplasias de la Corteza Suprarrenal/inmunología , Neoplasias de la Corteza Suprarrenal/metabolismo , Neoplasias de las Glándulas Suprarrenales/metabolismo , Adulto , Anciano , Aldosterona/biosíntesis , Estudios de Casos y Controles , Femenino , Humanos , Hidrocortisona/biosíntesis , Hidrocortisona/sangre , Masculino , Persona de Mediana Edad , Renina/sangreRESUMEN
The aim of the study was assessment of diagnosis and surgical treatment of adrenal metastases (AM) of renal carcinoma (RC). 10 cases of RC AM have been analysed. Bilateral metastases were diagnosed in 2 patients, ipsilateral in 5 patients, contralateral in 3. Three patients had synchronous metastases, seven had metachronous ones. AM were detected 8 months to 14 years after after operation on the kidney. Non-invasive dynamic control over the retroperitoneal space after nephrectomy for RC using advanced visual methods (ultrasonography, x-ray and resonance magnetic CT) not only detects AM but also determines metastatic genesis of the tumor. Thus, significant verification of RC AM, especially of metachronous origin, requires the study of the findings obtained at clinical, laboratory, ultrasonic, radiation examinations as well as comparison of histological structure of the removed kidney tumor and the adrenal. Early diagnosis and removal of a solitary adrenal metastasis of RC provides prolongation of the patient's life and survival of patients with RC late stages.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/diagnóstico , Neoplasias de las Glándulas Suprarrenales/secundario , Carcinoma de Células Renales/diagnóstico , Carcinoma de Células Renales/secundario , Neoplasias Renales/patología , Neoplasias de las Glándulas Suprarrenales/cirugía , Anciano , Carcinoma de Células Renales/cirugía , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
We compared plasma content of soluble Fas antigen (sFas) in 59 patients with tumors and tumor-like pathologies of the adrenal cortex and medulla and 60 healthy donors (control). The incidence and content of sFas in the plasma from patients with adrenal tumors was significantly higher than in healthy donors. A direct correlation was found between sFas content and patient's age. The maximum sFas concentrations were found in patients with pheochromocytoma and aldosterone-producing adenoma. In patients with adrenocortical cancer plasma content of sFas was lower than in patients with tumors of other morphological types. Plasma sFas content in patients with adrenocortical cancer directly correlated with the size of tumors. Our results suggest that sFas plays a role in the pathogenesis of primary adrenal tumors.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/sangre , Receptor fas/sangre , Neoplasias de las Glándulas Suprarrenales/inmunología , Adulto , Anciano , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The search and measurements of the activity of angiotensin-converting enzyme (ACE) and glucocorticoid receptors of type II (GR II) were made in the adrenals of 19 patients with Icenko-Cushing syndrome (ICS). ACE and GR II were detected in the tissues of the adrenal cortex and cortisol-producing tumors. It is suggested that glucocorticoids may induce ACE activity and in this way potentiate synthesis of angiotensin II. The effect is mediated by GR II. Activation of such tissue components of the renin-angiotensin system contributes much to the mechanism underlying arterial hypertension.
Asunto(s)
Síndrome de Cushing/complicaciones , Hipertensión/complicaciones , Hipertensión/fisiopatología , Angiotensina II/biosíntesis , Síndrome de Cushing/metabolismo , Glucocorticoides/metabolismo , Humanos , Hipertensión/metabolismo , Peptidil-Dipeptidasa A/metabolismoRESUMEN
Serum content of soluble Fas antigen was measured by enzyme immunoassay in 60 healthy donors, 31 patients with adrenal tumors, and 16 patients with diffuse-and-nodular hyperplasia of the adrenal cortex accompanying primary aldosteronism and Cushing's disease. sFas was more often detected in the serum from patients with tumors of the adrenal cortex and medulla and diffuse-and-nodular hyperplasia of the adrenal cortex and its content varied in a wider range in patients compared to healthy donors. No correlations were found between the incidence of sFas, its content, sex, and age of healthy donors and patients. The highest content of sFas was found in patients with pheochromocytoma and primary aldosteronism. sFas probably plays a role in the pathogenesis of adrenal tumors and hyperplasia.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/sangre , Receptor fas/sangre , Neoplasias de las Glándulas Suprarrenales/inmunología , Adulto , Anciano , Síndrome de Cushing/sangre , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Hiperplasia/metabolismo , Masculino , Persona de Mediana EdadRESUMEN
Adrenal tissue from 6 patients with primary hyperaldosteronism has been examined for the presence of angiotensin-converting enzyme (ACE). Its activity and amount of glucocorticoid receptors of type II (GR-II) were measured. ACE and GR-II were detected in adrenal tissue. GR-II induce ACE activity in interaction with plasma hydrocortisone. The glucocorticoid-receptor mechanism is an essential element in regulation of ACE activity determining a vasopressor effect. Disclosed is one of the aspects of tissue renin-angiotensin system function in primary hyperaldosteronism.
Asunto(s)
Hiperaldosteronismo/metabolismo , Peptidil-Dipeptidasa A/metabolismo , Receptores de Glucocorticoides/metabolismo , Corteza Suprarrenal/metabolismo , Corteza Suprarrenal/fisiopatología , Femenino , Humanos , Hiperaldosteronismo/fisiopatología , MasculinoRESUMEN
In spite of a large size, mesenchymal tumor of the small pelvis was not diagnosed clinically, and hypoglycemia was considered as a manifestation of hyperinsulinism. The tumor was identified as mesenchymal, most likely fibrosarcoma, immunohistochemically. The use of antibodies against insulin, glucagon and somatostatin showed the disturbance in the balance of cells in the hyperplastic islands of the pancreas. Multifocal hyperplasia of the islands is considered as a compensatory adaptive reaction to paraneoplastic extrapancreatic hypoglycemia.
Asunto(s)
Hipoglucemia/patología , Neoplasias Pélvicas/patología , Sarcoma/patología , Anciano , Femenino , Humanos , Hiperplasia/patología , Hipoglucemia/metabolismo , Inmunohistoquímica , Islotes Pancreáticos/patología , Neoplasias Pélvicas/química , Sarcoma/química , SíndromeRESUMEN
Thirty-one patients with insulinoma of the pancreas verified during operation were examined. The localization of the tumor was detected by ultrasonic examination in 9.7%, by X-ray computed tomography in 38.9%, by angiographic study in 32.1%, and by endoscopic retrograde pancreatocholangiography in 11.1% of cases. Complex use of the methods allowed the localization of the tumor to be determined in 48.4% of cases. The smallest diameter of insulinoma diagnosed during ultrasonic examination and endoscopic retrograde pancreatocholangiography was 1.5 cm, X-ray computed tomography and angiography demonstrated tumors measuring 1.0 cm in diameter. The diagnostic efficacy of the methods increases when the tumor is located in the body and tail of the pancreas. The examination scheme for patients with suspected insulinoma must include ultrasonic study and X-ray computed tomography; when their results are negative angiography must be resorted to.
Asunto(s)
Insulinoma/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Colangiopancreatografia Retrógrada Endoscópica , Femenino , Humanos , Insulinoma/cirugía , Masculino , Neoplasias Pancreáticas/cirugía , Reproducibilidad de los Resultados , Tomografía Computarizada por Rayos XRESUMEN
107 patients with Itsenko-Cushing disease were examined for heredity: family history was analyzed in 75 cases, dermatoglyphics was assessed in 44 cases, I- and II-class HLA antigens were studied in 68 cases. The patients were found to have hereditary loading both by Itsenko-Cushing and other diseases (hypertension, atherosclerosis, autoimmune disorders). Clinico-genealogical evaluation made it possible to identify forms of the disease which are inherited autosome-recessively and autosome-dominantly. However, in the majority of patients the disease onset had multifactorial nature, as there were HLA-antigen associations by DR4, DR5, DR7, DRw53, DQw3. Pilot experience with genetic study of the disease showed its genetic determination in some forms, its association with hypertension and atherosclerosis, approaches to prevention, prognosis, classification. Practical recommendations on detailed family history collection in patients with Itsenko-Cushing disease have been developed.
Asunto(s)
Síndrome de Cushing/genética , Adulto , Distribución de Chi-Cuadrado , Enfermedad Crónica , Síndrome de Cushing/epidemiología , Síndrome de Cushing/inmunología , Dermatoglifia , Susceptibilidad a Enfermedades , Femenino , Antígenos HLA/sangre , Humanos , Inmunogenética , Masculino , Linaje , PronósticoRESUMEN
Ninety-seven patients suffering from Itsenko [correction of Icenko]-Cushing disease were examined. Analysis was made first of all of the clinical and laboratory signs pointing to the presence of other endocrine diseases to distinguish two groups of patients. The first group included subjects who did not manifest any concomitant diseases. The number of men and women was the same. The second group was made up of patients with associated Itsenko [correction of Icenko]-Cushing disease and other endocrine diseases. In this particular group, women were predominant. The first group patients demonstrated the predominance of the DR7 incidence, the second group that of the DR5. The method of estimating HLA associations identified is proposed. It allows distinguishing specific and nonspecific associations. In Itsenko [correction of Icenko]-Cushing disease, DR7 association is specific, whereas B8 and DR5 associations are unspecific. A specific polyendocrine autoimmune syndrome associated with Itsenko [correction of Icenko]-Cushing disease was revealed. A concept of the pathogenesis of Itsenko [correction of Icenko]-Cushing disease is advanced.
Asunto(s)
Síndrome de Cushing/inmunología , Enfermedades del Sistema Endocrino/inmunología , Adulto , Enfermedades Autoinmunes/genética , Enfermedades Autoinmunes/inmunología , Enfermedad Crónica , Síndrome de Cushing/genética , Enfermedades del Sistema Endocrino/genética , Femenino , Antígenos HLA/sangre , Antígenos HLA/genética , Humanos , Inmunogenética , Síndromes de Inmunodeficiencia/genética , Síndromes de Inmunodeficiencia/inmunología , MasculinoRESUMEN
Incidence of class I and II HLA antigens was studied in 69 patients suffering from Icenko--Cushing syndrome. Positive association was reported for antigens DRw53, DQw3, DR4, DR5, negative for antigen DR2. Antigen combinations DR5, DR7 and DR4, DR5 proved more prevalent. The risk to develop the disease rose 2-3-fold in case of HLA-DR5 phenotype occurrence with antigen DR4 or DR7. Association with DRw53 and DQw3 antigens showing wide specificity seemed most significant.
Asunto(s)
Síndrome de Cushing/genética , Antígenos de Histocompatibilidad Clase II/genética , Antígenos de Histocompatibilidad Clase I/genética , Adulto , Síndrome de Cushing/etiología , Síndrome de Cushing/inmunología , Epítopos/análisis , Epítopos/genética , Epítopos/inmunología , Femenino , Antígenos de Histocompatibilidad Clase I/análisis , Antígenos de Histocompatibilidad Clase I/inmunología , Antígenos de Histocompatibilidad Clase II/análisis , Antígenos de Histocompatibilidad Clase II/inmunología , Humanos , Masculino , Persona de Mediana Edad , Fenotipo , Factores de RiesgoRESUMEN
Radiation methods were used for examining 176 patients with hormonal-active tumors and 12 patients with hormonal-nonactive tumors. The correct diagnosis of tumor of the adrenals was established with the help of oxysuprarenography in 51.9%. Ultrasonic examination was used in 78.8% and roentgen computed tomography--in 93.5%. Differential diagnostics of the Itsenko--Cushing disease and Cushing syndrome, due to corticosteroma is possible on the basis of the whole complex of findings of USI, RCT and venography with determination of the level of cortisol, aldosterone, catecholamine in blood flowing from the adrenals.