双侧肾上腺结核并左肾结核失功能1例诊治体会

目的：探讨肾上腺结核的临床特征。方法：回顾性分析1例双侧肾上腺结核并左肾结核失功能患者的临床资料,给予手术切除左肾上腺、左肾、肾脂肪囊及部分输尿管。结果：术后病理检查报告为左肾上腺结核及左肾结核。治疗出院后继续抗结核治疗1年。结论：发现肾上腺有占位性病变,依据临床表现、实验室检查及影像学检查结果,证实有肾结核着,应考虑并有肾上腺结核之可能。     

肾上腺结核的诊断与治疗(附4例报道及文献复习)

目的 提高对肾上腺结核诊断与治疗的认识。方法 回顾本院4例肾上腺结核病例的诊断与治疗结合文献复习。4例病例均予生化、B超和CT检查及抗结核、长期激素替代治疗或手术处理。结果 抗结核、长期激素替代治疗或手术处理使肾上腺结核引起的Addison's病得到满意的疗效。结论 根据临床特征,结合生化和肾上腺影像学检查或手术切除病理检查确定肾上腺结核诊断。抗结核、长期激素替代或手术是治疗肾上腺结核的主要方法。     

肾上腺结核合并Addison's病诊断与治疗的现状

Addison's病,全称为慢性原发性肾上腺皮质功能低下症,是由Addison最先描述并予以报道[1].本病最常见的病因为肾上腺结核和自身免疫性肾上腺炎,其他病因有肾上腺皮质受损等.在20世纪50年代以前,结核是引起Addison's病的最常见原因,占70%～80%.随着结核发病率的下降和诊治水平的提高,据文献报道,目前在欧美国家,自身免疫性肾上腺炎已成为Addison's病的首要病因,约占75%～80%,而结核引起者则已降至20%[2].而目前在我国,结核仍是引起Addison's病的最常见原因[3].因此,当有Addison's病的临床表现时,我们首先应想到肾上腺结核存在的可能.     

肾上腺结核的诊断与治疗(附17例报告)

目的 提高对肾上腺结核诊断与治疗的认识.方法 回顾本院1998年1月至2011年1月收治17例肾上腺结核病例的诊断与治疗.17例病例均予实验室检查及影像学检查同时给予抗结核、长期激素替代治疗或手术处理.结果 抗结核、长期激素替代治疗或手术处理使肾上腺结核引起的Addison's病得到满意的疗效.结论 根据临床特征,结合...     

肾上腺静脉栓塞的实验研究

目的 探讨用血管栓塞剂TH胶作肾上腺静脉栓塞治疗肾上腺功能亢进性疾病的可行性。方法 全麻开腹直视下经股静脉插管至双侧肾上腺腰静脉,经导管注入TH胶将肾上腺静脉栓塞。结果 肾上腺静脉栓塞后,其病理损伤由髓质逐渐向皮质发展,前14天变化较快,以淤血、出血、变性及坏死为主,14天后发展较慢,以肉芽组织增生、纤维化为主。皮质醇测定结果与病理变化同步。结论 应用TH胶进行肾上腺静脉栓塞治疗肾上腺功能亢进性疾病是值得试用的一种新方法。     

肾上腺疾病微创外科治疗新进展

肾上腺疾病分为肾上腺皮质和髓质疾病.肾上腺皮质疾病按功能大致可分为三类:功能亢进、功能低下及无功能变化的结节和肿瘤.在皮质功能亢进中,又因分泌激素不同而分为库欣综合征、原发性醛固酮增多症和性激素增多症.肾上腺髓质疾病最重要的是嗜铬细胞瘤,双侧肾上腺髓质增生也可以引起类似嗜铬细胞瘤的临床表现.肾上腺疾病的治疗有的以手术治疗为主,如各种肿瘤;有的施以多种治疗方式,手术只是其方式之一,如各种肾上腺皮质增生症;有的则以药物治疗为主,如肾上腺皮质功能减退症.     

肾上腺偶发瘤

本文报告了自１９９０－１９９５年收治经ＣＴ，Ｂ超检查发现的１０例肾上腺偶发瘤。其中肾上腺皮质腺瘤４例，肾上腺髓性脂肪瘤３例，肾上腺囊肿２例，肾上腺转移癌１例。全组有３例存在内分泌功能。肾上腺偶发瘤大部分是良性非功能性肿瘤。但也在相当部分为恶发表中具有内分泌功能。     

胎儿肾上腺移植长期随访一例报告

我们于 1991年 10月 2 3日施行 1例胎儿肾上腺移植 ,随访 9年疗效满意 ,报告如下。患者男 ,5 5岁。有结核病史 3 0年 ,因皮肤色素沉着 3 0余年 ,加重半年伴乏力入内分泌科治疗。血压 90 / 60ｍｍＨｇ( 1ｍｍＨｇ =0 .13 3ｋＰａ)。ＣＴ示双侧肾上腺陈旧性结核钙化。实验室检查     

肾上腺移植

肾上腺移植种类较多 ,根据肾上腺组织的不同起源可分为肾上腺皮质移植和肾上腺髓质移植 ;根据免疫学反应可分为自体、同种异体和异种移植 ;根据移植方式不同可分为带血管蒂吻合血管的全肾上腺移植、肾上腺组织移植 (种植 )和肾上腺细胞移植 ;根据供体来源不同可分为胚胎供体肾上腺移植和成年供体肾上腺移植等。早期肾上腺移植主要是肾上腺组织移植即种植 ,效果难以预测。二十世纪5 0年代末肾上腺糖皮质激素人工合成成功 ,激素替代治疗取代了肾上腺移植。但长期的临床实践表明 ,接受替代治疗的患者需终身服药 ,剂量难于掌握 ,且单纯应用糖皮…     

自发性肾上腺出血

目的　提高自发性肾上腺出血的诊治水平。　方法　回顾性总结 1 1例自发性肾上腺出血患者的诊治资料。　结果　 1 0例仅表现为患侧腰痛 ,1例为输尿管癌术中发现肾上腺肿物。肾上腺功能均正常。B超检查 1 1例 ,3例表现为囊性肿物 ,其内可见点状、分隔样强回声 ,7例表现为低回声肿物 ,1例输尿管癌术前肾上腺B超正常。 1 0例CT扫描表现为卵圆形、边界清楚低密度病灶 ,CT值 34 .7～ 85 .0HU ,>50 .0HU者 6例 ,其中 1例可见液平面 ;增强CT扫描 3例 ,肿物无强化。MRI检查 3例 ,显示肾上腺区不均匀肿物 ,T1加权像为等信号 ,T2加权像为低信号。行肾上腺及肿物切除术 6例 ;行部分肾上腺及肿物切除术 5例。术后病理为肾上腺髓质内出血 ,血肿外包绕肾上腺组织。术后肾上腺皮质功能正常 ,随访 7个月～ 8年 ,无肾上腺皮质功能低下表现。　结论　B超、CT、MRI可以帮助诊断自发性肾上腺出血。双侧肾上腺出血、腰腹痛症状明显、单侧肾上腺出血但血肿 >5cm者应采取手术治疗 ,行部分肾上腺及血肿切除术 ,尽量保存血肿周围健康肾上腺组织。     

Tuberculosis of the contralateral adrenal gland: a case report

Unilateral adrenal tuberculosis is a very rare disease. A 66-year-old woman presented with epigastric discomfort and general fatigue. Abdominal CT scan revealed a homogeneous mass shadow in the right adrenal region. Findings of physical examination were normal except that the patient was obese. Hormonal data were in normal range. Adrenal scintiscanning demonstrated no RI uptake in the right adrenal gland. Right adrenalectomy was performed under the diagnosis of nonfunctioning tumor of the right adrenal gland. Histopathological examination, however, revealed typical tuberculosis with Langhans' type of giant cells and infiltrated lymphocytes. Of 322, 148 autopsies performed during the twelve years between 1970 and 1981 in Japan, 228 cases of adrenal tuberculosis were recognized. Furthermore, only 18 cases had tuberculous regions in the adrenal gland alone.     

Primary adrenal tuberculosis: role of computed tomography and CT-guided biopsy in diagnosis

A case of isolated, bilateral, adrenal tuberculosis is presented. A 25-year-old male was admitted to the hospital due to lumbar pain, fever, weight loss and anorexia. Abdominal ultrasonography and computed tomography demonstrated bilateral adrenal enlargement. Laboratory investigations were remarkable for adrenal insufficiency. The Mantoux reaction was positive but there was no evidence of lung or urinary infection. CT-guided biopsy of the left adrenal gland was performed and established the diagnosis of adrenal tuberculosis.     

Hypercalcemia in a patient with tuberculous adrenal insufficiency

OBJECTIVES: To raise awareness of hypercalcemia as a rare and at times inaugural manifestation of adrenal insufficiency. CASE REPORT: Evaluation of hypercalcemia in a 43-year-old man showed adrenal insufficiency. Biopsies of the testes and adrenal glands revealed epithelioid and giant cell lesions indicating tuberculosis. Although tuberculosis can contribute to hypercalcemia, this possibility was ruled out in our patient by the low serum 1,25-dihydroxy-vitamin D3 levels and return to normal of serum calcium and renal function under hormone replacement therapy. It should be noted, however, that a course of pamidronate was given. CONCLUSION: The mechanism of hypercalcemia associated with adrenal insufficiency is controversial. Hyperparathyroidism was ruled out in our patient. Adrenal insufficiency should be considered in some patients with hypercalcemia.     

Unilateral asymptomatic adrenal tuberculoma: the role of percutaneous biopsy

We report the case of a 55-year-old male with a large left adrenal mass that conformed to the normal shape of the adrenal gland. Percutaneous biopsy revealed tuberculosis and, following anti-tuberculosis therapy, there was a >75% decrease in the size of the mass. In large tumefactions of the adrenal glands in which a normal adrenal contour is maintained, a percutaneous biopsy may obviate the need for major intervention.     

Traumatic adrenal injuries

PURPOSE: We determined the prevalence, management and general prognosis of blunt isolated and nonisolated adrenal injuries in a pediatric population. MATERIAL AND METHODS: We analyzed trauma data from a pediatric institution for the period 1991 to 1998 to identify patients with blunt traumatic adrenal injuries diagnosed by computerized tomography. We then performed a detailed chart review to obtain data on the presence of concomitant intra-abdominal and extra-abdominal injuries, transfusion requirements, intensive care unit monitoring requirements, hospital course and the presence of followup studies. RESULTS: Among 9,199 pediatric trauma cases we identified 20 adrenal injuries (0.22%), of which 15 (75%) were nonisolated and 5 (25%) were isolated. The right adrenal gland was injured in 17 (85%) of the 20 patients. In the 15 nonisolated adrenal injuries concomitant injury to the liver (13 cases, 87%) and ipsilateral kidney (8 cases, 53%) were most common. Three (60%) of the 5 patients with isolated adrenal injury required transfusion for adrenal hemorrhage. No patient required intensive care unit monitoring or operative intervention. Only 2 (10%) of the 20 patients underwent followup computerized tomography, both of whom had resolution of the adrenal injury. CONCLUSIONS: In the pediatric population blunt adrenal injuries are rare and typically present as part of a multiorgan trauma. The right adrenal gland is more likely to be injured, with liver trauma as the most commonly associated injury, followed by ipsilateral renal injury. Although there is a possibility of significant adrenal hemorrhage requiring transfusion, adrenal trauma is typically self-limited and does not require intensive care monitoring or operative intervention.     

Imaging of adrenal masses

PURPOSE OF REVIEW: This review aims to outline recent developments in adrenal imaging and characterization. Controversies in the management of adrenal incidentalomas will be addressed. RECENT FINDINGS: Evaluation of density readings on unenhanced computed tomography and on contrast-enhanced delayed series has tremendously improved the characterization of adrenal masses. Attenuation measurements may, however, vary between different scanner types and may also be influenced by patient factors and the scanning technique. Evaluation of the mean percentage washout for adrenal masses on delayed enhanced computed tomography series is independent of such factors and allows the characterization of adrenal lesions with high sensitivity and specificity. In magnetic resonance imaging, dynamic gadolinium-enhanced and chemical-shift techniques have significantly improved the characterization of adrenal masses. Nuclear medicine studies prove to be useful adjuncts. Controversial reports have been published on the role of positron emission tomography/computed tomography in adrenal imaging. Adrenal venous sampling may allow differentiation of aldosteronoma and idiopathic hyperaldosteronism. SUMMARY: Recent developments in adrenal mass imaging have improved the characterization of adrenal mass lesions. The need for histology sampling of incidentally discovered adrenal masses has been significantly reduced due to the high specificity of these new techniques. Controversies still exist regarding the optimal strategy for hormonal screening of a patient with an incidentally detected adrenal mass.