RESUMO
Objective: Enlargement of the adrenal glands and variable adrenocortical function have been reported in patients with pulmonary tuberculosis and, in a few studies, in patients with extrapulmonary tuberculosis (EPTB). However, none of the studies have evaluated the course of the adrenal morphology in these patients. Subjects and methods: Prospective study including 37 patients with EPTB and 37 healthy age- and sex-matched controls. The adrenal function was evaluated by measurement of cortisol levels at baseline and after stimulation with ACTH (Acton Prolongatum) before and 6 months after antituberculosis treatment. The size of both adrenal glands was evaluated using 64-slice computed tomography (CT) scanning before and 6 months after treatment. The findings were compared with those in a group of healthy matched controls. Results: Clinical and biochemical parameters were comparable between groups. The mean baseline serum cortisol level was significantly lower in the EPTB group (397.1 ± 184.9 nmol/L) compared with the control group (696.3 ± 101.8 nmol/L). Compared with controls, patients with EPTB had significantly lower mean cortisol levels at baseline and 1 hour after ACTH, both before (397 ± 184.9 nmol/L and 750.7 ± 176.8 nmol/L, respectively) and after (529.7 ± 100.4 nmol/L and 1017.2 ± 119.7 nmol/L, respectively) antituberculosis treatment. Both the length and thickness of the right and left adrenal glands were greater in patients with EPTB than in controls but became comparable to those in controls after treatment completion. Conclusion: Patients with EPTB have an enlarged adrenal size and low baseline and stimulated serum cortisol levels. After treatment completion, cortisol levels increased significantly, and the adrenal size normalized in these patients.
Assuntos
Hidrocortisona , Tuberculose Extrapulmonar , Humanos , Estudos Prospectivos , Antituberculosos/uso terapêutico , Hormônio Adrenocorticotrópico , Glândulas Suprarrenais/diagnóstico por imagemRESUMO
Introducción: los mielolipomas suprarrenales (ML) son neoplasias benignas poco frecuentes constituidas por tejido adiposo y mieloide. Clínicamente asintomáticas, suelen ser diagnosticados incidentalmente. En México existen solo 32 casos publicados de ML, presentándose en pacientes de entre 37 a 65 años, siendo la relación hombre-mujer 1:1.1, el síntoma más comúnmente reportado es dolor abdominal inespecífico, y la cirugía abierta es el principal abordaje quirúrgico empleado en nuestro país (89%). Caso clínico: presentamos una recopilación de la literatura actual sobre ML en México, además de dos casos clínicos de pacientes con ML: un hombre de 67 años con enfermedad diverticular y una mujer de 40 años con dolor en hipocondrio; en ambos se realizó resección tumoral, midiendo 9.5 cm y 13.3 cm, respectivamente. Conclusiones: presentamos dos casos nuevos en nuestro país que corresponden a incidentalomas. En ambos casos la cirugía se realizó para confirmar el diagnóstico, así como para prevenir posibles complicaciones.
Background: Adrenal myelolipomas (ML) are rare benign neoplasms compound of adipose and myeloid tissue. Clinically they are usually asymptomatic, being diagnosed generally by incident. In Mexico, there are only 32 published cases of ML, these occur between 37 and 65 years, with the male-female ratio being 1:1.1, clinically they present with abdominal or lumbar pain, open surgery being the main surgical approach (89%). Clinical case: We made a literature review of ML in Mexico and present two clinical cases: a 67-year-old man in followup for diverticular disease and a 40-year-old woman with pain in the left upper quadrant. In both cases, tumor resection was performed measuring 9.5 cm and 13.3 cm long respectively. Conclusions: We present two new cases in our country that correspond to incidentalomas. In both cases, surgery was performed to confirm the diagnosis, as well as to prevent possible complications
Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Mielolipoma/diagnóstico , Neoplasias das Glândulas Suprarrenais/diagnóstico , Mielolipoma/cirurgia , Mielolipoma/patologia , Neoplasias das Glândulas Suprarrenais/cirurgia , Neoplasias das Glândulas Suprarrenais/patologia , Glândulas Suprarrenais/patologia , Glândulas Suprarrenais/diagnóstico por imagem , MéxicoRESUMO
OBJECTIVES: Establishing standard shear-wave elastography (SWE) values for healthy newborns can help distinguish normal conditions of the adrenal gland (AG) from pathological conditions. We aimed to establish a reference data set for AG stiffness values using SWE in healthy newborns. METHODS: The quantitative stiffness of the AG was measured in the coronal plane in kilopascal (kPa). The quantitative descriptive statistics were presented as mean with standard deviation and median with range. The relationship between the quantitative variables was calculated using "Spearman's rank correlation coefficient test." The intraclass correlation coefficient (ICC) test was used to analyze intraobserver reliability. A p-value <0.05 was considered statistically significant. RESULTS: A total of 120 AGs of 60 healthy newborns (30 females and 30 males) was examined. The mean stiffness values of the right AG for the first and second visits were 7.51±2.45 and 7.54±2.49 kPa, respectively, and those of the left AG for the first and second visits were 7.60±2.03 and 7.42±1.97 kPa, respectively. There was no statistically significant difference between the mean values of adrenal stiffness and the length and width of AG and weight, height, and age (p>0.05). The ICC values for mean stiffness values of each AG were >0.80-0.90, indicating good intraobserver agreement. CONCLUSIONS: This study is the first SWE study to evaluate the AG in healthy newborns. Our study's data can be used as a reference for future research.
Assuntos
Técnicas de Imagem por Elasticidade , Glândulas Suprarrenais/diagnóstico por imagem , Feminino , Previsões , Humanos , Recém-Nascido , Masculino , Reprodutibilidade dos TestesAssuntos
Glândulas Suprarrenais/diagnóstico por imagem , Astenia/diagnóstico por imagem , Diarreia/diagnóstico por imagem , Paracoccidioidomicose/diagnóstico por imagem , Vômito/diagnóstico por imagem , Glândulas Suprarrenais/efeitos dos fármacos , Glândulas Suprarrenais/microbiologia , Glândulas Suprarrenais/patologia , Anfotericina B/uso terapêutico , Astenia/tratamento farmacológico , Astenia/microbiologia , Astenia/patologia , Diarreia/tratamento farmacológico , Diarreia/microbiologia , Diarreia/patologia , Fludrocortisona/uso terapêutico , Humanos , Hidrocortisona/uso terapêutico , Itraconazol/uso terapêutico , Masculino , Pessoa de Meia-Idade , Paracoccidioides/efeitos dos fármacos , Paracoccidioides/crescimento & desenvolvimento , Paracoccidioides/patogenicidade , Paracoccidioidomicose/tratamento farmacológico , Paracoccidioidomicose/microbiologia , Paracoccidioidomicose/patologia , Tomografia Computadorizada por Raios X , Vômito/tratamento farmacológico , Vômito/microbiologia , Vômito/patologiaRESUMO
BACKGROUND: Obese patients may have unrecognized primary aldosteronism due to high rates of concomitant hypertension. We hypothesized that obesity impacts the diagnosis and management of patients with primary aldosteronism. METHODS: We conducted a retrospective analysis of all primary aldosteronism patients (n = 418) who underwent adrenal vein sampling (1997-2017). Patients were classified by body mass index as obese (body mass index ≥35) or nonobese (body mass index <35) and diagnostic evaluation was compared between groups. Within the operative cohort (n = 285), primary outcomes were changes in both blood pressure and antihypertensive medications after adrenalectomy. Secondary outcome was clinical resolution by Primary Aldosteronism Surgery Outcomes criteria. RESULTS: Thirty-five percent of patients were obese. Obese patients were more likely to be male (67.8% vs 56.1%, P = .025), somewhat younger (51.5 vs 54.4 years old, P < .012), and require more preoperative antihypertensive medications (6.7 vs 5.7, P = .04) than nonobese patients. Obese patients had lesser rates of radiologic evidence of adrenal tumors (68.4 vs 77.9%, P = .038) despite similar rates of lateralization on adrenal vein sampling. In the operative subset, obese patients had somewhat smaller tumors on final pathology (1.1 vs 1.5 cm, P = .014) but similar rates of complete and partial clinical resolution (P = 1.000). CONCLUSION: Obese primary aldosteronism patients have lesser rates of localization by imaging, likely due to smaller tumor size, however, experience similar benefit from adrenalectomy.
Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico , Adrenalectomia , Anti-Hipertensivos/administração & dosagem , Hiperaldosteronismo/diagnóstico , Hipertensão/terapia , Obesidade/complicações , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/epidemiologia , Neoplasias das Glândulas Suprarrenais/cirurgia , Glândulas Suprarrenais/diagnóstico por imagem , Glândulas Suprarrenais/patologia , Glândulas Suprarrenais/cirurgia , Adulto , Fatores Etários , Idoso , Pressão Sanguínea/efeitos dos fármacos , Índice de Massa Corporal , Feminino , Humanos , Hiperaldosteronismo/epidemiologia , Hiperaldosteronismo/etiologia , Hiperaldosteronismo/cirurgia , Hipertensão/etiologia , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Resultado do TratamentoRESUMO
AIM: To assess the accuracy of delivery date predictions made using fetal adrenal artery Doppler velocimetry in pregnant women with spontaneous preterm birth (PB) and to compare these predictions with cervical length (CL) measurements.Material and methods: A prospective study was performed with 51 pregnant women whose gestational lengths were between 24 and 36 weeks. The main outcome was the time between the Doppler velocimetry examination and delivery, categorized as delivery within 7 days or 7 days later after the examination. A receiver operating characteristics curve was performed to define the cutoffs among deliveries within 7 days for fetal adrenal artery Doppler velocimetry parameters and CL measurements. RESULTS: The incidence of delivery within 7 days was 37.3%, with a statistically significant difference for the pulsatility index (PI; p=0.045) and resistance index (RI; p=0.030) of the fetal adrenal artery. The best cutoff values of PI and RI for predicting deliveries within 7 days were 1.65 and 0.78, respectively. The sensitivity and specificity of PI, RI, and CL (20 mm) were 73.7% (95% CI: 51.9-95.5) and 56.3% (95% CI: 38.1-74.4); 68.4% (95% CI: 45.4-91.4) and 62.5% (95% CI: 44.8-80.2); and 76.5% (95% CI: 54.0-99.0) and 78.1% (95%: CI 71.1-97.7), respectively. CONCLUSION: Fetal adrenal artery Doppler velocimetry can predict delivery within 7 days among pregnant women in cases of spontaneous PB and this prediction is similar to the predictions made using CL measurements.
Assuntos
Glândulas Suprarrenais/irrigação sanguínea , Glândulas Suprarrenais/embriologia , Artérias/diagnóstico por imagem , Nascimento Prematuro/diagnóstico , Reologia/métodos , Ultrassonografia Doppler/métodos , Glândulas Suprarrenais/diagnóstico por imagem , Adulto , Artérias/embriologia , Feminino , Idade Gestacional , Humanos , Gravidez , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto JovemRESUMO
Primary aldosteronism (PA) is the most common form of secondary hypertension (HTN), with an estimated prevalence of 4% of hypertensive patients in primary care and around 10% of referred patients. Patients with PA have higher cardiovascular morbidity and mortality than age- and sex-matched patients with essential HTN and the same degree of blood pressure elevation. PA is characterized by an autonomous aldosterone production causing sodium retention, plasma renin supression, HTN, cardiovascular damage, and increased potassium excretion, leading to variable degrees of hypokalemia. Aldosterone-producing adenomas (APAs) account for around 40% and idiopathic hyperaldosteronism for around 60% of PA cases. The aldosterone-to-renin ratio is the most sensitive screening test for PA. There are several confirmatory tests and the current literature does not identify a "gold standard" confirmatory test for PA. In our institution, we recommend starting case confirmation with the furosemide test. After case confirmation, all patients with PA should undergo adrenal CT as the initial study in subtype testing to exclude adrenocortical carcinoma. Bilateral adrenal vein sampling (AVS) is the gold standard method to define the PA subtype, but it is not indicated in all cases. An experienced radiologist must perform AVS. Unilateral laparoscopic adrenalectomy is the preferential treatment for patients with APAs, and bilateral hyperplasia should be treated with mineralocorticoid antagonist (spironolactone or eplerenone). Cardiovascular morbidity caused by aldosterone excess can be decreased by either unilateral adrenalectomy or mineralocorticoid antagonist. In this review, we address the most relevant issues regarding PA screening, case confirmation, subtype classification, and treatment.
Assuntos
Hiperaldosteronismo/complicações , Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/terapia , Hipertensão/etiologia , Glândulas Suprarrenais/diagnóstico por imagem , Adrenalectomia , Aldosterona/sangue , Humanos , Hiperaldosteronismo/sangue , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Renina/sangue , Tomografia Computadorizada por Raios XRESUMO
ABSTRACT Primary aldosteronism (PA) is the most common form of secondary hypertension (HTN), with an estimated prevalence of 4% of hypertensive patients in primary care and around 10% of referred patients. Patients with PA have higher cardiovascular morbidity and mortality than age- and sex-matched patients with essential HTN and the same degree of blood pressure elevation. PA is characterized by an autonomous aldosterone production causing sodium retention, plasma renin supression, HTN, cardiovascular damage, and increased potassium excretion, leading to variable degrees of hypokalemia. Aldosterone-producing adenomas (APAs) account for around 40% and idiopathic hyperaldosteronism for around 60% of PA cases. The aldosterone-to-renin ratio is the most sensitive screening test for PA. There are several confirmatory tests and the current literature does not identify a "gold standard" confirmatory test for PA. In our institution, we recommend starting case confirmation with the furosemide test. After case confirmation, all patients with PA should undergo adrenal CT as the initial study in subtype testing to exclude adrenocortical carcinoma. Bilateral adrenal vein sampling (AVS) is the gold standard method to define the PA subtype, but it is not indicated in all cases. An experienced radiologist must perform AVS. Unilateral laparoscopic adrenalectomy is the preferential treatment for patients with APAs, and bilateral hyperplasia should be treated with mineralocorticoid antagonist (spironolactone or eplerenone). Cardiovascular morbidity caused by aldosterone excess can be decreased by either unilateral adrenalectomy or mineralocorticoid antagonist. In this review, we address the most relevant issues regarding PA screening, case confirmation, subtype classification, and treatment.
Assuntos
Humanos , Hiperaldosteronismo/complicações , Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/terapia , Hipertensão/etiologia , Tomografia Computadorizada por Raios X , Renina/sangue , Glândulas Suprarrenais/diagnóstico por imagem , Adrenalectomia , Aldosterona/sangue , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Hiperaldosteronismo/sangueRESUMO
The aim of our study are to determine the shape, vertebrae level, height, volume, corpus medial and lateral branch thicknesses of AG and the distance from some neighboring structures on multidetector computed tomography (MDCT) images and also to determine the relationship between these data and gender, age, height, weight and body mass index (BMI). The study was conducted on a total of 420 MDCT images consisted of 220 male (mean age 63.44±8.00, 50-81 years), 200 female (mean age 61.23±7.95, 50-84 years) healthy individuals. Vertebrae level of AG (VLAG), height of AG (HAG), adrenal gland volume (VAG), corpus thickness of AG (CTAG), medial section thickness of AG (MTAG) and lateral section thickness of AG (LTAG) were investigated. In our study, RAG were observed on T12 vertebrae level in 38.19 % of males and 42.5 % of females and LAG were also observed at that level in 39.55 % of the male and 51 % of the female individuals. RAG were observed in all males and 98.5 % of the females and LAG were observed 88.63 % of the males and 94 % of the females "Y" shaped. VAG were observed lower in males compared to females in age groups and VAG was observed increasing with age in males; decreased in 60-69 age group of females and increased again in 70 and plus age group. The aim of this study is to determine normal ranges of AG sizes and the relationship of each one with sex, age, height, weight and BMI.
Los objetivos de nuestro estudio fueron determinar la forma, el nivel vertebral, la altura, el volumen, el grosor de las ramas medial y lateral del cuerpo de glándulas suprarrenales (GSR) y la distancia de algunas estructuras vecinas en las imágenes de tomografía computada multidetector (TCMD) y determinar la relación entre estos datos y sexo, edad, estatura, peso e índice de masa corporal (IMC). El estudio se realizó en un total de 420 imágenes TCMD de 220 hombres (edad media 63,44 ± 8,00, 50-81 años) y 200 mujeres (edad media 61,23 ± 7,95, 50-84 años) todos sanos. Se investigó el nivel de la GSR respecto a las vértebras, la altura de GRS (AGSR), el volumen de la glándula suprarrenal (VGSR), el grosor del cuerpo, el espesor de la sección mediana de GSR (SMGSR) y el grosor de la sección lateral de GSR (SLGSR). En nuestro estudio, se observó la GSR derecha a nivel de vértebras T12 en el 38,19 % de los hombres y en el 42,5 % de las mujeres y la GSR izquierda se observó a ese nivel en el 39,55 % de los hombres y 51 % de las mujeres. La GSR se presentó en forma de «Y¼ en el lado derecho en todos los hombres y en el 98,5 % de las mujeres y en el lado izquierdo se observó en el 88,63 % de los hombres y 94 % de las mujeres. El VGSR era menor en los hombres en relación con las mujeres en los diferentes grupos de edad y aumentaba con la edad en los hombres; disminuyó en el grupo de 60-69 años de edad de las mujeres y aumentó nuevamente después de los 70 años.