Multivariable analysis of 63 contemporary patients diagnosed with nelson’s syndrome: A nationwide readmission database study

IntroductionNelson’s syndrome (NS) is a rare complication involving enlargement of an adrenocorticotropic hormone (ACTH) producing tumor in the pituitary following bilateral adrenalectomy in Cushing’s syndrome. Here, we explore the epidemiology, complication profiles, and readmission statistics of 63 patients diagnosed with NS.MethodsThe Nationwide Readmission Database was retrospectively queried for all patients diagnosed with NS (n = 63) or receiving total bilateral adrenalectomy (TBA) surgery (n = 275) between 2016 and 2017. Complications, demographics, and predictive factors were queried for all patients involved. Statistical analysis used Mann-Whitney U nonparametric testing was to compare basic demographics and gaussian-fitted multivariable regression analysis with post hoc odds ratios to compare patient predictors of development of NS and complication rates between the two cohorts.ResultsWe report the largest contemporary patient series of NS through a nationally-representative inpatient database and explore the clinical characteristics of modern NS patients. Modeling revealed that the absence of primary hypertension served as a significant predictor for NS when compared to the TBA control cohort (OR = 0.88; 95%CI = 0.79–0.99; p = 0.037). In addition, analysis of complications between NS and TBA cohorts revealed that NS patients have significantly higher rates of hypoosmolarity/hyponatremia (OR = 1.42; 95%CI = 1.19–1.71; p = 0.00021), hypopituitarism (OR = 1.94; 95%CI = 1.60–2.36; p < 0.0001), and sepsis (OR = 1.51; 95%CI = 1.14–2.00; p = 0.0046).ConclusionContemporary NS is a rare complication of TBA, and modern cases of NS may differ significantly from cases of NS reported in the mid-1900s. As such, a thorough understanding of patient complications and predictive factors for NS are necessary to fully guide patient management in the modern era.     

后腹腔镜肾上腺肿瘤切除术6例报告

目的：评价经腹膜后腔行腹腔镜肾上腺肿瘤切除术的临床价值。方法：对2002年3月至今开展的6例后腹腔镜肾上腺肿瘤切除术进行分析。6例中4例为皮质醇腺瘤，2例为醛固酮腺瘤。结果：6例手术均获成功，手术时间90-140min，平均110min，失血量30-100ml。平均60mL，术中及术后均未输血，6例均无并发症。结论：后腹镜肾上腺肿瘤切除术具有对组织损伤小，出血少，术后恢复快，并发症少等优点，应为治疗非嗜铬细胞瘤肾上腺良性疾病的首选方法。     

Corticosteroid-mediated modulation of carbachol responsiveness in CA1 pyramidal neurons: A voltage clamp analysis

Pyramidal neurons in the rat hippocampal CA1 area contain mineralocorticoid (MRs) and glucocorticoid (GRs) receptors for corticosterone. Previous current clamp experiments showed that depolarizations evoked by carbachol(1–3 μM) depend on relative MR/GR occupation: carbachol responses are small with predominant MR-activation and larger when both receptor types are occupied. Multiple K-conductances underlie the carbachol-induced depolarization. In the present study we used the single electrode voltage clamp technique to examine which K-conductances modulated by carbachol are sensitive to corticosteroid treatment in vitro. We observed that 1 μM carbachol significantly reduced the I_{K, Leak} while the I_M was hardly affected; carbachol effects on the I_{K, Leak} were significantly reduced under conditions of predominant MR activation compared to simultaneous activation of MRs and GRs. With a higher (10 μM) carbachol dose, steroid modulation of the I_{K, Leak} showed a similar tendency. The amplitude of the I_M was largely reduced by 10 μM carbachol but appeared to be not affected by steroid treatment. We conclude that the previously described suppression of the carbachol-induced depolarization with predominant activation MRs is caused by an attenuation of the carbachol action on the I_{K, Leak}. © 1995 Wiley-Liss, Inc.     

Effects of adrenalectomy and type I or type II glucocorticoid receptor activation on 5-HT1A and 5-HT2 receptor binding and 5-HT transporter mRNA expression in rat brain

We evaluated the effects of adrenalectomy (ADX) and replacement with glucocorticoid receptor agonists on serotonin (5-HT) 5-HT_1A and 5-HT₂ receptor binding in rat brain. 5-HT_1A receptor binding was increased in the CA2–CA4 and the dentate gyrus of the hippocampus 1 week after ADX. This effect was prevented by the systemic administration of aldosterone (10 μg/μl/h) but not by RU28362 (10 μg/μl/h). No significant effect was observed on 5-HT₂ receptor binding in rat cortex. The expression of 5-HT transporter mRNA was unchanged in the raphe nucleus as measured by in situ hybridization.     

Adrenalectomy reverses chronic injection-induced tolerance to nicotine

A recent study from our laboratory has demonstrated that C57BL/6 male mice that are chronically injected with nicotine develop a profound tolerance to nicotine that is not associated with changes in brain nicotinic receptors. We have proposed that alterations in the secretion of corticosterone (CCS) may regulate tolerance development in chronically injected animals. In the present study we have directly tested this hypothesis. Female DBA/2 mice were injected three times each day for 12 days with saline or 2 mg/kg nicotine. Blood samples were collected at various time points during the course of treatment and plasma CCS levels were determined. The animals were divided into two groups following the last injection on day 12. The first group of animals was tested for nicotine-induced release of corticosterone on day 13 of the experiment and then sacrificed. The brains of these animals were subsequently used to measure nicotinic receptor binding. The second group of animals was adrenalectomized (ADX) or sham-operated on day 13 of the experiment and tested for nicotine sensitivity on day 14 of the experiment. Plasma CCS levels were significantly elevated in animals that were chronically injected with nicotine (versus saline controls) by the fourth day of the experiment. Chronic nicotine-injected animals were tolerant to nicotine-induced CCS release. Animals that were chronically injected with nicotine and sham-operated were tolerant to acute nicotine challenge; however, tolerance to nicotine was not detected in ADX animals. These data support the hypothesis that the capacity to release CCS may underscore the expression of tolerance to nicotine in chronically injected animals.     

Glucocorticoid regulation of hippocampal oxytocin receptor binding

The effects of glucocorticoid hormones on oxytocin receptors in rat hippocampus were investigated. Oxytocin receptor autoradiography (using 0.1 and 1.2 nM concentrations of [¹²⁵I]OVTA) revealed a significant (P < 0.02) decrease in oxytocin receptor binding in adrenalectomized animals 7 days after the surgery. Corticosterone replacement at the time of adrenalectomy prevented the decrease in oxytocin binding. The findings were significant in hippocampus and subiculum. These findings suggest regulation of oxytocin receptors, and possibly oxytocin-regulated behaviors by glucocorticoids.     

异位促肾上腺皮质激素综合征的临床分析

目的 提高异位促肾上腺皮质激素综合征（异位ACTH综合征）诊断和治疗效果。方法 回顾分析1985年7月－1999年7月收治的12例异位ACTH综合征患者的临床表现、诊断和治疗的临床资料。结果 12例患者经内分泌检查诊断为异位ACTH综合症，10例经影像学检查发现原发肿瘤。随访7个月－8年，5例手术切除肿瘤者，3例死亡；3例肾上腺切除者，1例存活至今；4例化疗者均死亡。结论 对有库欣综合征症状的患者，先经内分泌检查确诊为异位ACTH综合征，结合原发肿瘤的症状和体征，对好发肿瘤的部位进行影像学筛查，有助于发现原发肿瘤。对原发肿瘤进行根治性切除，预后较好。     

后腹腔镜及手助腹腔镜肾上腺切除术治疗肾上腺肿瘤(附21例报告)

目的 :探讨腹腔镜微创手术治疗肾上腺肿瘤的适应证及手术方法。方法 :对 18例直径小于 6cm的肾上腺肿瘤患者行后腹腔镜肾上腺切除术 (后腹腔镜组 ) ;对 3例最大直径为 10～ 17cm的肾上腺肿瘤患者行手助腹腔镜肾上腺切除术 (手助腹腔镜组 ) ,并观察手术时间、术中出血量、胃肠功能恢复时间和住院时间。结果 :2 1例患者中 ,2 0例成功。其中后腹腔镜组手术时间 2 5～ 135min ,平均 (82 .8± 31.1)min ,术中出血量 6 5～ 16 0ml,平均 (113.4± 31.8)ml,均未输血。手助腹腔镜组手术时间 180～ 2 10min ,术中出血量 80～ 6 0 0ml。两组患者均于术后 2天排气 ,1～ 3天下床活动 ,术后住院 3～ 7天。结论 :与开放手术相比 ,后腹腔镜肾上腺手术具有创伤小、出血少、恢复快等优点 ;手助腹腔镜为巨大肾上腺肿瘤切除提供了微创手术的新方式。     

Stress-induced modulation of the primary cellular immune response to herpes simplex virus infection is mediated by both adrenal-dependent and independent mechanisms

A murine model of herpes simplex virus (HSV) infection was ussed to examine the role of the adrenal gland in restraint stress-induced suppression of viral immunity. Adrenal-dependent mechanisms were important for suppressing the generation of HSV-specific cytotoxic T lymphocytes (CTL) but not the associated diminished lymphadenopathy in response to local HSV infection. While exogenous corticosterone administration alone was unable to suppress lymphadenopathy and CTL generation in adrenalectomized mice, an adrenal-independent mechanism induced by restraints stress functioned in synergy with corticosterone to suppress lymphadenopathy and CTL development. These results suggest that both adrenal-dependent and independent mechanisms cotribute to stress-induced modulation of HSV immunity.     

5HT3 receptor antagonists do not block nicotine induced hyperactivity in rats

Male Wistar rats with continuous access to 6% ethanol solution and water in their home cages were subjected to food restriction (FR). Reduction of body weight to 80% of normal was associated with a significant increase in ethanol drinking. It is known that the stress of FR gives rise to increased corticosterone secretion, and in line with these findings it was found that the weight of the thymus (whose size is inversely related to corticosterone levels) was reduced to 55% of normal in the present FR rats. Two subsequent experiments indicated that this adrenal activation contributed to the FR-induced enhancement of alcohol drinking. Firstly, adrenalectomized rats showed no evidence of enhanced alcohol drinking during food restriction, suggesting that adrenal corticosterone hypersecretion contributes to the enhanced ethanol consumption during FR. Secondly, treatment of FR rats with the enzyme inhibitor cyanoketone, which blocks stress-induced but not basal corticosterone secretion, at least partly prevented the FR-induced increase in ethanol drinking. These results add further evidence that sustained exposure to corticosterone facilitates ethanol consumption in the rat.