Laparoscopic Left Adrenalectomy during Roux-en-Y Gastric Bypass Using a Supragastric Approach

A 54-year-old female had a BMI of 44 kg/m², biliary colic, gastro-eophageal reflux disease, joint pain, hyperlipidemia, and diabetes type 2. Her medical history included complete remission of non-Hodgkin's lymphoma and prolactinoma since 1999. An abdominal CT scan demonstrated an incidental left adrenal tumor, which had increased in diameter from 2 cm to 3 cm in 6 months. A laparoscopic Roux-en-Y gastric bypass with ultrasonography and supragastric left adrenalectomy were performed successfully. Combined surgical procedures appear to be suitable for treatment of coexisting abdominal pathologic findings with minimally invasive surgery. A supragastric approach should be considered when planning a simultaneous gastric bypass and left adrenalectomy.     

Role of endogenous glucocorticoids in the healing of gastric erosions and chronic gastric ulcers in rats

To investigate the role of endogenous glucocorticoids in the healing of gastric lesions, we compared the healing of indomethacin- or cold-restraint-induced gastric erosions as well as aceticacid-induced ulcers in sham-operated rats, adrenalectomized rats and adrenalectomized rats with corticosterone replacement. Adrenalectomy was performed immediately after the formation of gastric erosions (4 h after indomethacin administration or 6 h after the onset of cold-restraint stress) or chronic ulcers (in 3 days after ingestion of acetic acid into the luminal side of the stomach). All ulcerogenic stimuli caused an increase in corticosterone production. Adrenalectomy created corticosterone deficiency and delayed the healing of gastric erosions and chronic ulcers. Replacing corticosterone reversed the deleterious effect of adrenalectomy on healing of gastric damage in adrenalectomized rats. These results suggest that glucocorticoids participate in natural healing processes of injured gastric mucosa. The data obtained also indicate that participation of glucocorticoid in the healing of gastric lesions is more evident under prostaglandin deficient conditions.     

Effects of Adrenalectomy on Serotonin-, Somatostatin-, and Gastrin-Immunoreactive Cells in Rat Gastrointestinal Tract

The effects of bilateral adrenalectomy on theserotonin-, somatostatin-, and gastrinimmunoreactivecells in the rat gastrointestinal tract were studiedfour weeks after surgery. Body weight was reduced and the small intestine shorter inadrenalectomized animals compared with controls, whileno changes were found in the histology of the mucosa. Inthe adrenalectomized animals the number ofserotonin-immunoreactive cells was increased in the cecum and largeintestine, while the somatostatin-immunoreactive cellswere decreased in number in the antrum and increased inthe corpus, cecum, and large intestine. Thegastrinimmunoreactive cells in the antrum were not affected innumber, but their nuclear size was enlarged, possiblyindicating increased cellular activity.     

Risk of Fracture in Primary Aldosteronism: A Population‐Based Cohort Study

Primary aldosteronism (PA) is associated with increased urinary calcium excretion and osteoporosis prevalence. We studied the long‐term effect of hyperaldosterone on fracture risk and possible risk mitigation via treatments, by comparing PA patients and their essential hypertension (EH) counterparts extracted by propensity score match. We used a longitudinal population database from the Taiwan National Health Insurance, and used a validated algorithm to identify PA patients diagnosed in 1997–2010. Our sample included 2533 PA patients, including 921 patients with aldosterone‐producing adenoma (APA). Our methods for assessing excessive fracture risk included multivariable Cox regression and the competing risk regression. The incidence rate of fracture at any site was 14.4 per 1000 person‐years for PA, and 11.2 per 1000 person‐years for APA. In contrast, the incidence rate of fracture at any site was 8.3 per 1000 person‐years in EH controls for PA, and 6.5 per 1000 person‐years in EH controls for APA. Mineralocorticoid receptor antagonist (MRA) treatment might be associated with higher risk of osteoporotic fracture in the whole female PA cohort (subdistribution hazard ratio [SHR] = 2.12, p = 0.008) as well as female APA patients (SHR = 1.15, p = 0.049). As to fracture at any site, MRA treatment was also associated with higher risk; the SHR was 1.88 (p < 0.001) in the whole female PA cohort, and 2.17 (p = 0.019) in female APA patients. PA is tightly associated with higher risk of bone fracture, even in the case where the competing risk of death was controlled. Particularly, female PA patients treated with MRA were confronted with significantly higher risk in bone fracture than their EH controls. © 2017 American Society for Bone and Mineral Research.     

Selective cyclooxygenase-2 inhibitor induces gastric mucosal damage in adrenalectomized rats

We investigated gastric ulcerogenic properties of the selective COX-2 inhibitor in adrenalectomized rats. SC-560 (selective COX-1 inhibitor) or celecoxib (selective COX-2 inhibitor) was given to sham-operated and adrenalectomized rats, with or without corticosterone replacement 11 days after the surgery, and gastric lesions were estimated 8 h later. Neither SC-560 nor celecoxib alone induced any gross damage in the gastric mucosa in sham-operated rats. In adrenalectomized rats, however, celecoxib did provoke gross damage that was prevented by corticosterone pellets. Mucosal PGE₂ content was increased 3-fold after adrenalectomy, and this response was prevented by both celecoxib and corticosterone pellets. The COX-2 mRNA was up-regulated in the stomach of adrenalectomized rats, but this expression was suppressed by corticosterone replacement. These results support our hypothesis that adrenalectomy increases gastric mucosal PGE₂ due to COX-2 expression, and the selective COX-2 inhibitor produces gastric lesions by inhibiting the additional PGE₂ production in adrenalectomized rats.