6 research outputs found
Long-term consequences of surgical excision of cortisol producing adrenocortical adenoma
Wst臋p: U chorych z ACTH-niezale偶nym zespo艂em Cushinga chirurgiczne usuni臋cie guza nadnercza umo偶liwia ich ca艂kowite
wyleczenie. Jednak u cz臋艣ci pacjent贸w po adrenalektomii nadal obserwuje si臋 wyst臋powanie nadci艣nienia t臋tniczego,
oty艂o艣ci i cukrzycy.
Celem pracy by艂a analiza odleg艂ych nast臋pstw chirurgicznego usuni臋cia gruczolaka kory nadnercza wytwarzaj膮cego kortyzol,
ze szczeg贸lnym uwzgl臋dnieniem wp艂ywu wykonanej adrenalektomii na ci艣nienie t臋tnicze.
Materia艂 i metody: Analiz膮 obj臋to 15 chorych (艣r. wieku 54 lata) z nadci艣nieniem t臋tniczym (n = 15), oty艂o艣ci膮 lub nadwag膮
(n = 12) i cukrzyc膮 (n = 7). Czas obserwacji wynosi艂 艣rednio 45 miesi臋cy.
Wyniki: Popraw臋 kontroli ci艣nienia t臋tniczego po jednostronnej adrenalektomii obserwowano u 66,7% chorych. Czynnikiem
zwi臋kszaj膮cym ryzyko niedostatecznej poprawy kontroli ci艣nienia t臋tniczego po operacji by艂 zwi臋kszony wska藕nik
masy cia艂a (BMI, body mass index), wynosz膮cy ponad 30,5 kg/m2 (RR = 4,0 [1,07-14,90]). W okresie obserwacji stwierdzono
obni偶enie maksymalnych warto艣ci ci艣nienia skurczowego o 34 mm Hg (17-50 mm Hg) i rozkurczowego o 25 mm Hg (16-35 mm Hg) (p < 0,01).
W ca艂ej grupie po adrenalektomii stwierdzono zmniejszenie BMI o 3,4 kg/m2 (p = 0,01). Wska藕nik ten obni偶y艂 si臋 o wi臋cej
ni偶 1 kg/m2 u 66,7% chorych.
Tylko u 2 pacjent贸w obserwowano pe艂ne wycofanie si臋 objaw贸w cukrzycy. Steroidy nadnerczowe stale przyjmowa艂o
46,7% chorych w okresie pooperacyjnym. Subiektywne ca艂kowite ust膮pienie objaw贸w chorobowych po operacji stwierdzi艂o
40% badanych, za艣 cz臋艣ciowe - 46,7%.
Wniosek: Chirurgiczne usuni臋cie gruczolaka nadnercza wytwarzaj膮cego kortyzol powoduje popraw臋 kontroli ci艣nienia
t臋tniczego lub u艂atwia zmniejszenie masy cia艂a u znacznego odsetka chorych z zespo艂em Cushinga. Czynnikiem zmniejszaj膮cym
szans臋 na popraw臋 kontroli ci艣nienia t臋tniczego po operacji jest oty艂o艣膰 chorego wyst臋puj膮ca przed adrenalektomi膮.
(Endokrynol Pol 2007; 58 (3): 207-212)Introduction: Surgical excision of adrenocortical tumour in patients with ACTH-independent Cushing syndrome gives
a chance for their entire cure. However in some patients after adrenalectomy persistent arterial hypertension, obesity and
diabetes mellitus is observed.
The aim of the study was to analyse long term consequences of surgical excision of cortisol producing adrenocortical
adenoma with a special attention on the influence of adrenalectomy on arterial blood pressure.
Material and methods: 15 patients (mean age 54 years) suffering from arterial hypertension (n = 15), obesity or overweight
(n = 12) and diabetes mellitus (n = 7) were subjected to analysis. Mean follow up time was 45 months.
Results: Improvement of blood pressure control after unilateral adrenalectomy was observed in 66.7% of patients. The risk
factor of no improvement of blood pressure control was BMI > 30.5 kg/m2 (RR = 4.0 [1.07-14.90]). During the follow up
period decrease of maximal values of systolic and diastolic blood pressure was observed (34 [17-50] and 25 [16-35] mm Hg
respectively; p < 0.01).
In the entire group of patients a 3.4 kg/m2 decrease of BMI was observed p = 0.01. BMI decreased significantly (more than
1 kg/m2) in 66.7% of patients.
Only in 2 patients a complete regression of diabetes was observed. 46.7% of patients required supplementation with adrenal
steroids. 40% of patients reported a subjective withdrawal of all symptoms of the disease after surgery and 46.7% only
partial remission.
Conclusion: Surgical excision of cortisol producing adrenocortical adenoma results in improvement of blood pressure
control and body weight reduction in a large percentage of patients with Cushing syndrome. Obesity before adrenalectomy
is the factor that reduces a chance for improvement of blood pressure control after surgery.
(Pol J Endocrinol 2007; 58 (3): 207-212
Analysis of pathogenetic factors of persistent hypertension in patients with pheochromocytoma who underwent unilateral adrenalectomy
Wst臋p W przypadku nadci艣nienia t臋tniczego wywo艂anego
guzem chromoch艂onnym metod膮 z wyboru jest leczenie chirurgiczne. Celem niniejszej pracy jest analiza czynnik贸w uczestnicz膮cych w patogenezie utrzymuj膮cych si臋 podwy偶szonych warto艣ci ci艣nienia
t臋tniczego u chorych poddanych jednostronnej adrenalektomii z powodu guza chromoch艂onnego.
Materia艂 i metody W analizowanej grupie 25 chorych
艣rednia warto艣膰 najwy偶szego ci艣nienia skurczowego (SBP) przed operacj膮 wynosi艂a 232,6 ± 38,5 mm Hg, a rozkurczowego (DBP) 133,3 ± 22,2 mm Hg. U 40% chorych nadci艣nienie t臋tnicze mia艂o charakter sta艂y, u 60% - napadowy. 艢redni najwi臋kszy wymiar guza w badaniach obrazowych wynosi艂 58,1 ± 19,6 mm. Czas obserwacji po adrenalektomii wynosi艂 艣rednio 48,0 ± 28,4 miesi膮ca.
Wyniki Spadek warto艣ci najwy偶szego SBP po operacji by艂 znamienny i wynosi艂 艣rednio –85,9 ± 36,9 mm Hg, a DBP –44,1 ± 22,8 mm Hg. Wykazano dodatni膮 zale偶no艣膰 pomi臋dzy obni偶eniem si臋 SBP i DBP po zabiegu i najwi臋kszym wymiarem guza. Przygodna warto艣膰 SBP mierzona u chorych po operacji wynosi艂a 艣rednio 124,6 ± 18,3 mm Hg, a DBP 79,0 ± 9,2 mm Hg. U 56% chorych warto艣ci przygodnego
ci艣nienia t臋tniczego wynosi艂y poni偶ej 140/90 mm Hg, co nie powodowa艂o konieczno艣ci przyjmowania lek贸w przeciwnadci艣nieniowych. W grupie chorych wymagaj膮cych farmakoterapii stwierdzono znamiennie
d艂u偶szy czas wyst臋powania nadci艣nienia t臋tniczego przed adrenalektomi膮 (艣rednio 76,3 ± 63,5 miesi膮ca wobec 30,5 ± 44,1 miesi膮ca) oraz starszy wiek w chwili operacji (艣rednio 46,4 ± 10,2 roku wobec 38,3 ± 9,8 roku).
Wnioski Adrenalektomia u chorych z nadci艣nieniem t臋tniczym
i guzem chromoch艂onnym nadnercza prowadzi do trwa艂ej poprawy najwy偶szych warto艣ci SBP i DBP. D艂u偶szy czas trwania nadci艣nienia przed operacj膮 i starszy wiek chorych w chwili zabiegu przyczyniaj膮
si臋 do uzyskania gorszych wynik贸w adrenalektomii i konieczno艣ci stosowania farmakoterapii w celu utrzymania prawid艂owych warto艣ci ci艣nienia t臋tniczego w okresie pooperacyjnym.Background Surgery is a method of choice in the treatment of patients with pheochromocytoma. The aim of
the study was to analyse factors which participate in pathogenesis of persistent hypertension in patients who
underwent unilateral adrenalectomy due to pheochromocytoma.
Material and methods In the analysed group of 25 patients mean value of maximal systolic blood pressure (SBP) before surgery was 232.6 ± 38.5 mm Hg, and diastolic
(DBP) 133.3 ± 22.2 mm Hg. In 40% of patients arterial hypertension was permanent, and in 60% — paroxysmal.
Mean maximal tumour size in diagnostic imaging was 58.1 ± 19.6 mm. Mean time of observation after adrenalectomy
was 48.0 ± 28.4 months.
Results A significant decrease of maximal SBP and DBP after surgery was achieved (–85.9 ± 36.9 and –44.1 ± 22.8 mm Hg respectively). A positive correlation between decrease of SBP and DBP after surgery and maximal tumour size was revealed. Accidental value of SBP measured in patients after surgery was 124.6 ± 18.3 mm Hg, and DBP — 79.0 ± 9.2 mm Hg.
In 56% of patients accidental blood pressure values were lower than 140/90 mm Hg without any antihipertensive
drugs. In patients who required pharmacological therapy significant longer duration of arterial hypertension before adrenalectomy (mean 76.3 ± 63.5 vs. 30.5 ± 44.1 months) and older age of patients at the time of surgery (mean 46.4 ± 10.2 vs. 38.3 ± 9.8 years) were observed.
Conclusions In patients with arterial hypertension due to
pheochromocytoma adrenalectomy leads to a permanent improvement of maximal values of systolic and diastolic
blood pressure. Longer duration of arterial hypertension before surgery
and older age of patients ignificantly contribute to worse results of adrenalectomy and necessity of antihipertensive therapy in order to keep blood pressure values in the normal range
Rak kory nadnerczy w przedoperacyjnych badaniach obrazowych
Background: Decisions concerning surgical treatment of patients with adrenocortical tumor without hormonal hyperactivity are based on tumor size exceeding 3-6 cm and morphological features of malignancy. The aim of the study was to analyze results of diagnostic imaging in patients with adrenocortical carcinoma (ACC). Material/Methods: Results of diagnostic imaging of 8 patients in whom postoperative pathological examination revealed ACC were analyzed. There were 3 women and 5 men in the analyzed group, with an age range of 32 to 75 years. Imaging was based on US and CT examination supported by MRI in 2 patients. The obtained results were compared with a group of 10 patients with adrenocortical adenoma (ACA). Results are presented as median values and 95% CI. Results: CT results of patients with ACC showed local spread into surrounding fat tissue in 87.5%, adjacent organ invasion in 75%, local lymph node enlargement in 75%, irregular tumor margins in 88%, and heterogeneous structure of all tumors. In patients with ACA, tumor heterogeneity was observed in 40% and local lymph node enlargement in 10%. ACC tumors were significantly larger than ACA ones [77 (66-97) vs. 31 (24-48) mm, respectively, p=0.0002] and more dense [60 (34-85) vs. 16 (10-26) HU, respectively, p=0.0007]. In arterial phase, enhancement of ACC tumors tended to be stronger compared with ACA [81 (29-162) vs. 55 (33-76), p=0.09]. On the basis of CT results, 1 patient was classified as stage II according to Mac Farlane, 6 as stage III, and 1 as stage IV. Intraoperative examination down-staged 2 patients from stage III to stage II. Conclusions: Computed tomography is a method that allows distinguishing adrenocortical adenoma from carcinoma as well as to determine the stage of adrenocortical carcinoma