Adrenal hypersecretion

Hypersecretion from the adrenal glands is associated with hypertension. Causes include Conn syndrome, Cushing syndrome and phaechromocytoma. This article discusses their clinical features, diagnosis and treatment as well as the management of incidentally identified adrenal tumours (incidentaloma).     

Adrenal insufficiency

Roberto Salvatori, MD

JAMA. 2005;294:2481-2488.

A 44-year-old woman reported several weeks of fatigue, somnolence, pain in the large joints, nausea, and decreased appetite. She had also noted an unintentional 11-kg weight loss over a period of 6 months. She had a remote history of amenorrhea, but she was presently menstruating regularly. She was taking no medications, with the exception of acetaminophen as needed for knee pain. The diagnosis of adrenal insufficiency (AI) was considered. Serum cortisol level after adrenocorticotropin hormone (ACTH) stimulation was abnormal. Because her plasma ACTH level was not increased, a diagnosis of secondary AI (due to deficiency in ACTH) was made. Magnetic resonance imaging of the brain performed to exclude the presence of a sellar or suprasellar mass showed reduction in size of the pituitary gland and an increased cerebrospinal fluid content within the sella, consistent with a partially empty sella. The patient’s symptoms improved rapidly with hydrocortisone therapy but during follow-up, the dose of hydrocortisone was found to be excessive. Important differences exist between primary and secondary AI, and the diagnosis of secondary AI may be challenging. The therapy of AI should be carefully tailored to the requirements of the individual patient.

     

Adrenal insufficiency

Adrenal insufficiency can be due to disease of the adrenal gland itself (primary adrenal deficiency) or of the hypothalamic or pituitary regulation of the adrenal gland (secondary adrenal insufficiency). This article discusses its causes, clinical features, diagnosis and treatment.     

正常肾上腺磁共振成像表现及肾上腺肿瘤磁共振成像诊断

用PhilipsGyroscan0.5Tesla超导磁共振仪检查30名正常人肾上腺、8例肾上腺良性肿瘤及1例肾上腺癌。结果：正常双侧肾上腺的高度和宽度均为2.5～3.5cm，厚度为0.8～1.08cm。横断位右侧大多数呈倒置Y型，少数呈V型。左侧大多数呈三角型，少数呈Y型。冠状位双侧同正常解剖学所见一致。正常肾上腺信号强度：T_1加权像(T_1WI）同肾髓质；质子像与肝相同；T_2WI与肌肉相同。肾上腺良性肿瘤表现：T_1WI信号均匀减低，T_2WI信号均匀增高，肿瘤未破坏脂肪包膜。肾上腺癌的表现：T_1WI信号不均匀减低，T_2WI信号不均匀增高，穿破脂肪包膜。     

Adrenal cavernous haemangioma

The adrenal gland is a rare location for haemangioma. Approximately 52 surgical cases have been reported in the literature. We report a huge non-functioning adrenal haemangioma presenting in a 50-year-old woman with flank pain. This was illustrated by computed tomography. It was surgically removed and diagnosed postoperatively as adrenal haemangioma. Although rare, adrenal haemangioma should be included in the differential diagnosis of adrenal neoplasms. The risks of haemorrhage, necrosis and thrombosis impose in the majority of cases surgical excision, particularly in tumours more than 3 cm in diameter.     

肾上腺髓质增生

1 肾上腺髓质增生的历史来源 肾上腺是人体中一对十分重要的内分泌腺体,主要分泌肾上腺糖皮质激素、盐皮质激素、性激素和儿茶酚胺.肾上腺的病变可以造成这些激素分泌的增多或减少,从而导致人体组织器官损害和严重的代谢紊乱.早在1563年,意大利外科医师Eustachius发现人的肾脏上方有一类似三角形帽子样的特殊结构,并绘制成图谱,但对其功能一无所知.     

肾上腺髓样脂肪瘤的CT诊断

目的:探讨肾上腺髓样脂肪瘤的CT诊断及鉴别诊断。方法:对经手术病理证实的7例肾上腺髓样脂肪瘤的临床、病理及CT资料进行回顾性分析。结果:7例肾上腺髓样脂肪瘤中,右侧6例,左侧1例。CT表现为含脂肪成份的混杂密度肿块,边界清晰、光滑,增强扫描肿块内脂肪区域无强化,软组织成份有强化。术前有6例明确诊断,1例误诊为右肾上极血管平滑肌脂肪瘤。结论:CT扫描对本病的定位和定性诊断具有重要价值,为目前明确诊断的首选方法。     

肾上腺交感神经离断术对利血平诱导大鼠肾上腺髓质增生的影响

目的:探讨大鼠肾上腺交感神经离断术在利血平诱导的大鼠肾上腺髓质增生中的作用及肾上腺交感神经与肾上腺髓质增生的关系。方法:雄性Wistar大鼠60只随机分为A、B、C、D 4组各15只,A组为单侧肾上腺交感神经离断组,B组为假手术组,C组为肾上腺髓质增生组,D组为正常对照组。C组用利血平诱导肾上腺髓质增生大鼠模型,A、B组手术7 d后同C组给予相同剂量利血平42 d。分别于停药后第14,28,56天时测大鼠24 h尿3-甲基-4-羟基苦仁酸(VMA)含量及血浆儿茶酚胺(CA)水平,处死大鼠,取肾上腺做病理切片,观察肾上腺髓质增生情况并测肾上腺髓质百分数。结果:在各观察阶段,A、B、C组大鼠24 h尿VMA和血浆CA含量明显高于正常对照组(P<0.05),A组手术侧肾上腺百分数明显低于未手术侧(P<0.05),而与正常对照组无明显差异(P>0.05)。结论:大鼠肾上腺交感神经离断术可抑制利血平诱导大鼠肾上腺髓质增生的作用,利血平通过肾上腺交感神经的介导作用于大鼠肾上腺髓质引起增生,肾上腺交感神经离断术可能对肾上腺髓质增生有治疗作用。     

肾上腺髓质增生大鼠模型酷氨酸羟化酶基因的表达

目的：研究肾上腺髓质增生(AMH)大鼠模型肾上腺组织酪氨酸羟化酶基因表达水平。方法：Wistar大鼠随机分为2组：正常对照组(NC组)和肾上腺髓质增生组(AMH组)。用利血平皮下注射制备肾上腺髓质增生大鼠模型。6周后取出肾上腺组织，用免疫组织化学和原位杂交法分别测定该模型肾上腺组织酪氨酸羟化酶蛋白质及mRNA表达，检测血清中的去甲肾上腺素(NE)、肾上腺素(E)和24h尿3-甲氧4-羟基苦杏仁酸(VMA)的含量，同时测量肾上腺髓质百分数以反映肾上腺髓质增生的程度。结果：肾上腺髓质增生大鼠模型肾上腺组织酪氨酸羟化酶蛋白质及mRNA表达均明显增强，血清中的NE，E和24h尿VMA的含量明显升高，肾上腺髓质百分数明显升高。结论：肾上腺髓质增生大鼠模型肾上腺组织酪氨酸羟化酶基因表达增强。