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8 pages, 245 KiB

Open AccessArticle

Hemodynamic Instability during Surgery for Pheochromocytoma: A Retrospective Cohort Analysis

by Moritz Senne, Doerte Wichmann, Pascal Pindur, Christian Grasshoff and Sven Mueller

J. Clin. Med. 2022, 11(24), 7471; https://doi.org/10.3390/jcm11247471 - 16 Dec 2022

Cited by 3 | Viewed by 1038

Background: Perioperative hemodynamic instability is one of the most common adverse events in patients undergoing adrenalectomy for pheochromocytoma. The aim of this study was to analyze the impact of perioperative severe hemodynamic instability. Methods: We present a retrospective, single-center analysis in a major [...] Read more.

Background: Perioperative hemodynamic instability is one of the most common adverse events in patients undergoing adrenalectomy for pheochromocytoma. The aim of this study was to analyze the impact of perioperative severe hemodynamic instability. Methods: We present a retrospective, single-center analysis in a major tertiary hospital of all consecutive patients undergoing elective adrenalectomy from 2005 to 2019 for pheochromocytoma. Severe perioperative hypertension and hypotension were evaluated, defined as changes in blood pressure larger than 30% of the preoperative patient-specific mean arterial pressure (MAP). Results: Unilateral adrenalectomy was performed in 67 patients. Intraoperative episodes of hemodynamic instability occurred in 97% of all patients (n = 65), severe hypertension occurred in 24 patients (36%), and severe hypotensive episodes occurred in 62 patients (93%). Patients with more than five severe hypotensive episodes (n = 29) received higher preoperative alpha-adrenergic blockades (phenoxybenzamine 51 ± 50 mg d⁻¹ vs. 29 ± 27 mg d⁻¹; p = 0.023) and had a longer mean ICU stay (39.6 ± 41.5 h vs. 20.6 ± 19.1 h, p = 0.015). Conclusion: Intraoperative hypotensive, rather than hypertensive, episodes occurred during adrenalectomy. The occurrence of more than five hypotensive episodes correlated well with a significantly longer hospital stay and ICU time. Full article

(This article belongs to the Special Issue Current Management of Adrenal Tumors)

Review

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12 pages, 3788 KiB

Open AccessFeature PaperReview

Prognosis of Adrenal Oncocytic Neoplasms (AONs): Literature Review of 287 Cases and Presentation of the Oldest Patient

by Enrico Coppola Bottazzi, Claudio Gambardella, Federico Maria Mongardini, Serafino Vanella, Adele Noviello, Tommaso Palma, Rosa Murano, Giovanni De Chiara, Giovanni Conzo, Ludovico Docimo and Francesco Crafa

J. Clin. Med. 2023, 12(21), 6925; https://doi.org/10.3390/jcm12216925 - 04 Nov 2023

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Abstract

Introduction: The adrenocortical oncocytic neoplasms (AONs) are rare tumors of the adrenal gland, classified as oncocytoma (AO), oncocytic neoplasm of uncertain malignant potential (AONUMP) and oncocytic carcinoma (AOC). The aim of this study was to perform a review of the literature, in order [...] Read more.

Introduction: The adrenocortical oncocytic neoplasms (AONs) are rare tumors of the adrenal gland, classified as oncocytoma (AO), oncocytic neoplasm of uncertain malignant potential (AONUMP) and oncocytic carcinoma (AOC). The aim of this study was to perform a review of the literature, in order to evaluate the prognosis of these rare cancers. We also reported the oldest patient with AON. Methods: A comprehensive literature review using as key words “adrenal oncocytoma”, “adrenal oncocytic neoplasm”, and “adrenal oncocytic carcinoma” was performed. Report of the case: We report the case of an 88-year-old woman receiving a left open adrenalectomy for an AON (15 × 10 × 8 cm). The considerable size and weight together with the presence of necrosis were indicative for a lesion with an uncertain potential for malignancy, according to Weiss modified criteria. After two years, the patient was free from any sign of recurrence. Results: Only 287 AONs were detected in the scientific literature, exploring OVID, MEDLINE, PubMed and SCOPUS as dataset. These tumors are usually incidentalomas with an unpredictable malignant potential. Surgical resection remains the mainstay of treatment for AON. Conclusion: AO and AONUMP have an excellent prognosis and a low mortality rate, with only three cases of recurrence reported in the literature and one metastatic case four years after first adrenal surgery. In contrast, AOC carries a high risk of local relapses, distant metastasis, and a significantly higher mortality rate (30%). Surgical resection remains the primary treatment for adrenal oncocytic neoplasms. Full article

(This article belongs to the Special Issue Current Management of Adrenal Tumors)

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40 pages, 931 KiB

Open AccessReview

Management of Adrenal Cortical Adenomas: Assessment of Bone Status in Patients with (Non-Functioning) Adrenal Incidentalomas

by Alexandra-Ioana Trandafir, Mihaela Stanciu, Simona Elena Albu, Vasile Razvan Stoian, Irina Ciofu, Cristian Persu, Claudiu Nistor and Mara Carsote

J. Clin. Med. 2023, 12(13), 4244; https://doi.org/10.3390/jcm12134244 - 24 Jun 2023

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Abstract

Our aim is to analyse the bone profile in adults with (non-functioning) adrenal incidentalomas (AIs), specifically addressing the impact of autonomous cortisol secretion (ACS). This narrative review, based on a PubMed search from inception to February 2023 (case reports, non-ACS, and other secondary [...] Read more.

Our aim is to analyse the bone profile in adults with (non-functioning) adrenal incidentalomas (AIs), specifically addressing the impact of autonomous cortisol secretion (ACS). This narrative review, based on a PubMed search from inception to February 2023 (case reports, non-ACS, and other secondary causes of osteoporosis were excluded), included 40 original studies, a total of 3046 patients with female prevalence (female:male ratio of 1921:1125), aged between 20.5 and 95.5 years old. This three decade-based analysis showed that 37 studies provided dual-energy X-ray absorptiometry (DXA) information; another five studies reports results on bone micro-architecture, including trabecular bone score (TBS), spinal deformity index, and high-resolution peripheral quantitative computed tomography; 20 cohorts included data on bone turnover markers (BTMs), while four longitudinal studies followed subjects between 1 and 10.5 years old (surgical versus non-adrenalectomy arms). Post-dexamethasone suppression test (DST) cortisol was inversely associated with bone mineral density (BMD). TBS predicted incidental vertebral fractures (VFx) regardless of BMD, being associated with post-DST cortisol independently of age and BMD. Low BTMs were identified in ACS, but not all studies agreed. An increased prevalence of ACS-related osteoporosis was confirmed in most studies (highest prevalence of 87.5%), as well as of VFx, including in pre-menopause (42.5%), post-menopause (78.6%), and male patients (72.7%) depending on the study, with a 10-fold increased incidental VFx risk up to a 12-fold increased risk after a 2-year follow-up. No specific medication against osteoporosis is indicated in ACS, but adrenalectomy (according to four studies) should be part of the long-term strategy. This bone profile case sample-based study (to our knowledge, one of the largest of its kind) showed that AIs, including the subgroup designated as having ACS, embraces a large panel of osseous complications. The level of evidence remains far from generous; there are still no homogenous results defining ACS and identifying skeletal involvement, which might be a consequence of different investigation clusters underling adrenal and bone assessments over time. However, bone status evaluations and associated therapy decisions remain an essential element of the management of adults with AIs-ACS. Full article

(This article belongs to the Special Issue Current Management of Adrenal Tumors)

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13 pages, 299 KiB

Open AccessReview

Review of Diagnostic Modalities for Adrenal Incidentaloma

by Dominika Okroj, Agata Rzepecka, Przemysław Kłosowski, Anna Babińska and Krzysztof Sworczak

J. Clin. Med. 2023, 12(11), 3739; https://doi.org/10.3390/jcm12113739 - 29 May 2023

Cited by 4 | Viewed by 1449

Abstract

Adrenal incidentalomas are common findings in clinical practice, with a prevalence of up to 4.2% in radiological studies. Due to the large number of focal lesions in the adrenal glands, it can be challenging to make a definitive diagnosis and determine the appropriate [...] Read more.

Adrenal incidentalomas are common findings in clinical practice, with a prevalence of up to 4.2% in radiological studies. Due to the large number of focal lesions in the adrenal glands, it can be challenging to make a definitive diagnosis and determine the appropriate management. The purpose of this review is to present current diagnostic modalities used to preoperatively distinguish between adrenocortical adenoma (ACA) and adrenocortical cancer (ACC). Proper management and diagnosis are crucial in avoiding unnecessary adrenalectomies, which occur in over 40% of cases. A literature analysis was conducted to compare ACA and ACC using imaging studies, hormonal evaluation, pathological workup, and liquid biopsy. Before deciding on surgical treatment, the nature of the tumor can be accurately determined using noncontrast CT imaging combined with tumor size and metabolomics. This approach helps to narrow down the group of patients with adrenal tumors who require surgical treatment due to the suspected malignant nature of the lesion. Full article

(This article belongs to the Special Issue Current Management of Adrenal Tumors)

17 pages, 1429 KiB

Open AccessReview

Cardiac Hypertrophy and Related Dysfunctions in Cushing Syndrome Patients—Literature Review

by Akinori Kanzaki, Manabu Kadoya, Satoru Katayama and Hidenori Koyama

J. Clin. Med. 2022, 11(23), 7035; https://doi.org/10.3390/jcm11237035 - 28 Nov 2022

Cited by 1 | Viewed by 1528

Abstract

The survival rate of adrenal Cushing syndrome patients has been greatly increased because of the availability of appropriate surgical and pharmacological treatments. Nevertheless, increased possibility of a heart attack induced by a cardiovascular event remains a major risk factor for the survival of [...] Read more.

The survival rate of adrenal Cushing syndrome patients has been greatly increased because of the availability of appropriate surgical and pharmacological treatments. Nevertheless, increased possibility of a heart attack induced by a cardiovascular event remains a major risk factor for the survival of affected patients. In experimental studies, hypercortisolemia has been found to cause cardiomyocyte hypertrophy via glucocorticoid receptor activation, including the possibility of cross talk among several hypertrophy signals related to cardiomyocytes and tissue-dependent regulation of 11β-hydroxysteroid dehydrogenase type 1. However, the factors are more complex in clinical cases, as both geometric and functional impairments leading to heart failure have been revealed, and their associations with a wide range of factors such as hypertension are crucial. In addition, knowledge regarding such alterations in autonomous cortisol secretion, which has a high risk of leading to heart attack as well as overt Cushing syndrome, is quite limited. When considering the effects of treatment, partial improvement of structural alterations is expected, while functional disorders are controversial. Therefore, whether the normalization of excess cortisol attenuates the risk related to cardiac hypertrophy has yet to be fully elucidated. Full article

(This article belongs to the Special Issue Current Management of Adrenal Tumors)

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9 pages, 416 KiB

Open AccessReview

Surgical Management of Adrenocortical Carcinoma: A Literature Review

by Leonardo Rossi, Chiara Becucci, Carlo Enrico Ambrosini, Marco Puccini, Malince Chicas Vasquez, Benard Gjeloshi and Gabriele Materazzi

J. Clin. Med. 2022, 11(19), 5754; https://doi.org/10.3390/jcm11195754 - 28 Sep 2022

Cited by 2 | Viewed by 1031

Abstract

Background: Adrenocortical carcinoma (ACC) is a rare malignant tumor with a poor prognosis. Radical surgical resection with negative margins represents the only opportunity for a potential cure. This review provides a critical assessment of the existing studies regarding the surgical approaches for the [...] Read more.

Background: Adrenocortical carcinoma (ACC) is a rare malignant tumor with a poor prognosis. Radical surgical resection with negative margins represents the only opportunity for a potential cure. This review provides a critical assessment of the existing studies regarding the surgical approaches for the treatment of ACC. Methods: This review was performed according to criteria reported in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The research was carried out using the PubMed electronic library. This review is limited to comparative studies evaluating minimally invasive adrenalectomy (MIA) and open adrenalectomy (OA) in adult patients affected by ACC. Results: A total of 14 studies were selected for the review, reporting that 2574 patients underwent adrenal surgery for ACC: 1779 (69.1%) by means of OA and 795 (30.8%) by means of MIA. Six studies considered OA to be superior to MIA, whereas eight studies reported that MIA is as effective as OA in highly selected cases. All studies were retrospective with a heterogenous selection of patients. Conclusions: Data regarding the management of MIA are scarce, heterogenous, and mainly based on retrospective studies. OA remains the gold standard approach for the management of ACC; however, MIA may play a role in selected cases treated in high volume institutions with experienced surgeons. Full article

(This article belongs to the Special Issue Current Management of Adrenal Tumors)

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12 pages, 448 KiB

Open AccessReview

Is the Adrenal Incidentaloma Functionally Active? An Approach-To-The-Patient-Based Review

by Stella Bernardi, Veronica Calabrò, Marco Cavallaro, Sara Lovriha, Rita Eramo, Bruno Fabris, Nicolò de Manzini and Chiara Dobrinja

J. Clin. Med. 2022, 11(14), 4064; https://doi.org/10.3390/jcm11144064 - 14 Jul 2022

Cited by 3 | Viewed by 2190

Abstract

Adrenal incidentalomas are a common occurrence. Most of them are adrenocortical adenomas that do not cause harm and do not require surgery, but a non-negligible proportion of incidentalomas is represented by functionally active masses, including cortisol-secreting adenomas (12%), pheochromocytomas (3–6%), aldosterone-secreting adenomas (2–3%), [...] Read more.

Adrenal incidentalomas are a common occurrence. Most of them are adrenocortical adenomas that do not cause harm and do not require surgery, but a non-negligible proportion of incidentalomas is represented by functionally active masses, including cortisol-secreting adenomas (12%), pheochromocytomas (3–6%), aldosterone-secreting adenomas (2–3%), as well as malignant nodules, such as adrenocortical carcinomas (2–5%), which can be either functioning or non-functioning. All patients with an adrenal incidentaloma should undergo a few biochemical screening and confirmatory tests to exclude the presence of a functionally active mass. In this approach-to-the-patient-based review, we will summarize current recommendations on biochemical evaluation and management of functionally active adrenal incidentalomas. For this purpose, we will present four case vignettes, whereby we will describe how patients were managed, then we will review and discuss additional considerations tied to the diagnostic approach, and conclude with practical aspects of patient perioperative management. To improve the perioperative management of patients with functional adrenal incidentalomas, multidisciplinary meetings are advocated. Full article

(This article belongs to the Special Issue Current Management of Adrenal Tumors)

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18 pages, 1905 KiB

Open AccessEditor’s ChoiceReview

Rapidity and Precision of Steroid Hormone Measurement

by Shigehiro Karashima and Issey Osaka

J. Clin. Med. 2022, 11(4), 956; https://doi.org/10.3390/jcm11040956 - 12 Feb 2022

Cited by 12 | Viewed by 6994

Abstract

Steroids are present in all animals and plants, from mammals to prokaryotes. In the medical field, steroids are commonly classified as glucocorticoids, mineralocorticoids, and gonadal steroid hormones. Monitoring of hormones is useful in clinical and research fields for the assessment of physiological changes [...] Read more.

Steroids are present in all animals and plants, from mammals to prokaryotes. In the medical field, steroids are commonly classified as glucocorticoids, mineralocorticoids, and gonadal steroid hormones. Monitoring of hormones is useful in clinical and research fields for the assessment of physiological changes associated with aging, disease risk, and the diagnostic and therapeutic effects of various diseases. Since the discovery and isolation of steroid hormones, measurement methods for steroid hormones in biological samples have advanced substantially. Although immunoassays (IAs) are widely used in daily practice, mass spectrometry (MS)-based methods have been reported to be more specific. Steroid hormone measurement based on MS is desirable in clinical practice; however, there are several drawbacks, including the purchase and maintenance costs of the MS instrument and the need for specialized training of technicians. In this review, we discuss IA- and MS-based methods currently in use and briefly present the history of steroid hormone measurement. In addition, we describe recent advances in IA- and MS-based methods and future applications and considerations. Full article

(This article belongs to the Special Issue Current Management of Adrenal Tumors)

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