Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0001430 (adenoma)
 21,222 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Active Cushing's syndrome during pregnancy is a rare phenomenon which was so far described in the literature only in 85 women. The authors give an account of a patient who developed Cushing's syndrome during pregnancy and who was delivered during the eighth month of a healthy foetus by caesarean section, afterwards the hypercortisolism associated with hyperaldosteronism was treated by dextrolateral adrenalectomy. In the removed adrenal gland was a cortical adenoma made up of clear cells and cells reminding of the zona glomerulosa. Subsequently the authors summarize data from the literature on the prevalence of different pathogenetic forms of Cushing's syndrome in pregnant women, on the influence of hypercortisolism on mother and foetus, on the optimal diagnosis and therapy of this syndrome during pregnancy.
 ...
PMID:[Cushing's syndrome in pregnancy]. 771 95

Lipid metabolism was studied in 21 horses with hyperadrenocorticism. To be included in the study, horses had to have histologic evidence of a pars intermedia adenoma found at necropsy (n = 9), a baseline ACTH concentration greater than 400 pg/ml (n = 6), or a plasma cortisol concentration 2 hours after i.v. administration of 25 IU of ACTH greater than 413 nmol/L (n = 16). Mean +/- SD baseline plasma cortisol concentration was 338 +/- 261 nmol/L (n = 20), mean +/- SD plasma insulin concentration was 97 +/- 54 microU/ml (n = 15), mean +/- SD plasma beta-hydroxybutyrate concentration was 1.8 +/- 1.2 mg/dl (n = 21), and mean +/- SD plasma nonesterified fatty acids concentration was 6.2 +/- 6.4 mg/dl (n = 21). None of the horses had hyperlipemia. Compared with clinically normal horses, horses with hyperadrenocorticism had increased lipolysis and increased ketogenesis. It was concluded that cortisol cannot be the sole factor contributing to insulin resistance in horses with hyperadrenocorticism.
 ...
PMID:Lipid metabolism in horses with hyperadrenocorticism. 776 7

Fourteen patients with adrenocorticotropic hormone (ACTH)-dependent hypercortisolism underwent pituitary scanning with computed axial tomography (CT) and magnetic resonance imaging (MRI). Computed tomography revealed pituitary macroadenomas in two patients, pituitary hyperplasia in one and a suspicion of pituitary microadenoma in one. Thirteen patients underwent MRI. One with a macroadenoma diagnosed on CT did not undergo MRI. The MRI revealed a pituitary macroadenoma in one, microadenoma in three and hyperplasia in two cases. Magnetic resonance imaging following gadolinium diethylene triamine penta acetic acid (gd-DTPA) enhancement revealed four more pituitary microadenomas. All patients who had pituitary adenomas (micro and macro) and hyperplasia underwent trans-sphenoidal pituitary surgery. One of the two patients, who had an enlarged pituitary on imaging but no demonstrable adenoma, was found to have a microadenoma at surgery. Patients with ACTH-dependent hypercortisolism should undergo MRI of the pituitary gland to identify/localize corticotroph pituitary adenomas. The study should include gd-DTPA enhancement in cases where the scan is normal.
 ...
PMID:Cushing's disease: pituitary imaging. 794 10

The patient was a 26-year-old man with Cushing's disease who underwent transsphenoidal microscopic surgery for a pituitary microadenoma. His postoperative course was uneventful, but he died suddenly five years after the operation. At autopsy, a ruptured dissecting aneurysm with marked atherosclerosis was observed in the aorta. In the pituitary, a small focus of adrenocorticotropic hormone (ACTH) producing adenoma, possibly residual adenoma, was detected and Crooke's degeneration was observed in the non-tumorous pituitary gland. But immunohistochemical patterns of pituitary hormones in the non-tumorous pituitary gland were normal and the adrenal cortex was unremarkable. In the hypothalamus, corticotropin-releasing hormone immunoreactivity was not detected and arginine vasopressin was sporadically positive. Considering these findings, this patient may have developed subclinical hypercortisolism due to the residual adenoma at the time of autopsy, despite clinical remission. Cushing's syndrome is considered to be a risk factor dissecting aneurysm, and in this case the metabolic changes in Cushing's disease may have influenced the development of the dissecting aneurysm. Periodic cardiovascular re-evaluations should therefore be performed when there is clinical remission of Cushing's syndrome.
 ...
PMID:A case of ruptured dissecting aneurysm 5 years after pituitary microsurgical treatment of Cushing's disease: autopsy findings in the hypothalamic-pituitary-adrenal axis. 795 28

ACTH independent bilateral macronodular adrenocortical hyperplasia (AIMAH) is associated with autonomous hypercortisolism. We report six cases of AIMAH, in which immunohistochemical studies on steroidogenic enzymes (P450scc, 3 beta HSD, P450c21, P450c17, P450c11) were performed on surgically resected adrenal glands. In situ hybridization studies of P450c17 were performed in two cases in order to localize the sites of steroidogenesis. Immunoreactivity to P450scc, P450c21, and P450c11 was observed in both clear and compact cortical cells, with compact cells displaying more intense staining, as reported in Cushing's adenoma and ACTH dependent bilateral adrenocortical hyperplasia. Immunoreactivity to P450c17 was observed predominantly in small compact cells, whereas that to 3 beta HSD occurred exclusively in clear cortical cells. In situ hybridization also demonstrated that P450c17 was localized in small compact cortical cells. This differential expression of 3 beta HSD and P450c17 in clear and compact cortical cells has been observed only in AIMAH among adrenocortical disorders. This ineffective corticosteroidogenesis may contribute to the relatively low production of cortisol. AIMAH should therefore be considered as a distinct subtype of primary adrenocortical Cushing's syndrome.
 ...
PMID:ACTH-independent macronodular adrenocortical hyperplasia: immunohistochemical and in situ hybridization studies of steroidogenic enzymes. 800 46

Adrenalectomy for adrenal tumor was performed on 25 patients at Kushiro municipal general hospital between 1982 and 1993. There were 17 women and 8 men aged 34 to 66 (mean 52.7) years. Clinical diagnoses were pheochromocytoma (6), Cushing's syndrome (8), primary aldosteronism (4), incidentaloma (7). Pathological diagnoses were pheochromocytoma (6), cortical adenoma (17), hyperplasia with hypercortisolism (1), schwannoma (1). Angiography and venous sampling were unuseful for clinical identification of adrenal tumor. After removal of the tumor, glucose-intolerance disappeared in 4 of 6 cases with pheochromocytoma and one of 7 cases with incidentaloma, mental aberration was improved in 2 of 8 cases with Cushing's syndrome, and hypertension was improved in 4 of 7 cases with incidentaloma. Since clinical symptoms (hypertension and glucose-intolerance) were improved postoperatively in 4 of 7 cases with incidentaloma, adrenalectomy is recommended for incidentaloma. Transabdominal approach was suitable for pheochromocytoma and bilateral adrenal tumor, but postoperative recovery was slow. In our experience, pleural injury was found in 40% of translumbar approach. Four laparoscopic operations were performed recently, this procedure gave most fast postoperative recovery to compare with other approach.
 ...
PMID:[Clinical study of 25 cases with adrenal tumor--comparison between transabdominal, translumbar, laparoscopic approach]. 802 40

The potential efficacy of early repeat transsphenoidal surgery for persistent Cushing's disease has not previously been examined. On 222 patients with no prior pituitary treatment and a preoperative diagnosis of Cushing's disease, 29 (13%) remained hypercortisolemic after an initial transsphenoidal pituitary exploration. Seventeen of these 29 patients underwent further surgery 7 to 46 days after the initial transsphenoidal approach in order to completely excise suspected residual tumor. Patients were followed for 4 to 84 months (mean +/- standard deviation, 34 +/- 25 months) to document sustained remission or recurrence of Cushing's disease (a urine free cortisol level > 90 micrograms/day was considered evidence of recurrence). Of the 17 patients with repeat surgery, 12 (71%) had resolution of hypercortisolism (morning plasma cortisol level < 5 micrograms/dl); however, in three of these 12, hypercortisolism recurred 5, 12, and 24 months later. In 14 patients a lesion that appeared to be a tumor was identified during the initial procedure or on histological examination. Of these, 12 had immediate resolution of hypercortisolism and nine are still in remission. Three patients, in whom no adenoma could be identified during the initial surgery or an examination of the partial hypophysectomy specimen from the initial surgery, had persistent Cushing's syndrome after the second operation. Seven (41%) of the 17 patients developed hypopituitarism requiring treatment with thyroid hormone, gonadal steroid, or vasopressin replacement. The low incidence of identification of an adenoma on computerized tomography or magnetic resonance images (three of 17 patients), the failure to find a corticotrophic adenoma during the initial surgery (10 of 17 patients), and the failure of these 17 patients to respond to the initial transsphenoidal surgery suggest that they may comprise a subset of patients who are more difficult to treat successfully with surgery than most patients with Cushing's disease. Despite that, early reoperation induced immediate remission of hypercortisolism in 71% of cases, but did so at the expense of a high risk of hypopituitarism. However, since the alternative treatments (such as radiation therapy, long-term drug therapy, or bilateral adrenalectomy) also have potential adverse effects, early reoperation deserves consideration for the management of persistent Cushing's disease, especially when an adrenocorticotrophic hormone-secreting adenoma was partially excised during the first surgery.
 ...
PMID:Early repeat surgery for persistent Cushing's disease. 827 Oct 20

Adrenocortical adenomas (ACA) are frequently discovered at autopsy. Nowadays, modern radiologic techniques incidentally uncover the usually silent ACA during lifetime. On the basis of various reports and the results of endocrine tests, i.e. dexamethasone suppression (DST) and CRH response, we characterize 3 major types of functioning ACA. Type I ACA (cortisol < 100 nmol/l after 1 mg dexamethasone (DXM)) comprises the majority of the so-called 'nonfunctioning' adrenocortical adenomas. However, these adenomas may not be 'truly nonfunctioning' ACA, as their mean FMAX/ACTHMAX-ratio after CRH is significantly higher than in controls without ACA. Also, 19-iodocholesterol adrenal scan has shown persistent adrenal uptake despite DXM administration in some patients with normal DST. Type II ACA ('pre-Cushing's') is comparable to the euthyroid autonomous adenoma. The results of function tests suggest the existence of an ACTH-hyperresponsive subtype. Finally, type III ACA are associated with overt hypercortisolism. An ACTH-responsive and an ACTH-unresponsive form can be characterized. A continuous functional spectrum and the transition between the different types of adenomas is discussed.
 ...
PMID:The functional spectrum of adrenocortical adenomas. 839 27

1. Petrosal sinus sampling has been used to establish the source of adrenocorticotropin (ACTH) in ACTH-dependent Cushing's syndrome. Naloxone, an opioid antagonist, stimulates ACTH secretion, probably via release of endogenous hypothalamic corticotropin releasing hormone (CRH). 2. Three patients with hypercortisolism were studied. Two showed suppressed (> 50%) urinary-free cortisol excretion with high-dose dexamethasone treatment (2 mg every 6 h for 2 days), one did not suppress. The patients were subjected to bilateral simultaneous inferior petrosal sinus sampling (BSIPSS) with simultaneous peripheral venous (forearm) samples. Basal (unstimulated) samples were taken and naloxone (125 micrograms/kg bodyweight) was given intravenously with subsequent simultaneous sampling. Plasma ACTH was measured by radio-immunoassay (RIA). 3. All cases exhibited a marked rise in immunoreactive (IR)-ACTH levels (pmol/L) after naloxone injection, basal to peak: case 1, left 11.5-22.1, right 9.8 with no rise, peripheral 9.1-9.5; case 2, left 456-863, right 125-501, peripheral 59-82; case 3, left 12.7-13.0, right 277-431, peripheral 12.1-11.7. All results indicate pituitary Cushing's syndrome, with a central to peripheral ratio > 2.3:1. Pituitary Cushing's syndrome was confirmed on the results of trans-sphenoidal pituitary surgery in cases 1 and 3. 4. It is suggested that naloxone injection during petrosal sinus sampling in Cushing's syndrome may assist in the diagnosis of ACTH source, by enhancing ACTH release from a pituitary micro-adenoma.
 ...
PMID:Naloxone stimulation of ACTH secretion during petrosal sinus sampling in Cushing's syndrome. 839 44

In order to study whether or not exogenous and/or endogenous glucocorticoids affect the glucose transport rate in human cells, we examined the transport rate of a non-metabolizable hexose analogue, 3-O-methyl-D-glucose, in polymorphonuclear leukocytes from patients with hypercortisolism. The mean glucose transport rate was prominently decreased in 5 patients with Cushing's syndrome compared with 29 healthy controls (5.4 +/- 1.8 vs 10.4 +/- 2.5 fl/cell.sec, mean +/- SD, p < 0.001) and the transport rate returned to normal range after adenoma resection in 2 of them. In 10 patients with nephrotic syndrome treated with prednisolone, a significant negative correlation was found between transport rates and daily prednisolone doses. When prednisolone of 40 mg/day was administered to a diabetic patient and the dose was gradually reduced, glucose transport rate was transiently decreased during the initial period. In an in vitro study, a synthetic glucocorticoid, dexamethasone, directly inhibited glucose transport rate in those cells in time- and concentration-dependent manners by mainly reducing Vmax. These results suggest that either exogenous or endogenous hypercortisolism in humans is associated with a decrease in glucose transport rate in polymorphonuclear leukocytes, and that the direct effect of glucocorticoids accounts at least in part for the decreased glucose transport rates found in those cells.
 ...
PMID:In vivo and in vitro effects of glucocorticoids on glucose transport in human polymorphonuclear leukocytes. 847 55


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>