Factors influencing the rising rates of adrenal surgery: analysis of a 25-year experience

Background Adrenal surgery has been radically changed by laparoscopy and it is reasonable to wonder whether the increase in the number of adrenalectomies is entirely justified. There is still debate on the transperitoneal versus the retroperitoneal approach, the advantages and drawbacks of which are discussed here. Methods Between 1983 and 2007, we performed 279 adrenalectomies in 264 consecutive patients, divided into two groups: before and after the advent of laparoscopic adrenalectomy (LA). We analyzed the factors that increased the number of adrenalectomies in recent years. The LAs were further divided into three consecutive periods and the mor- bidity and conversion rates, and mean operating times were compared. Results More procedures were performed after the advent of LA, i.e., 55 (19.7%) beforehand versus 224 (80.3%) afterwards, irrespective of the type of disease, for instance: incidentaloma, 17.6% versus 82.4% (p < 0.0001); pheochromocytoma, 20.7% versus 79.3% (p < 0.0001); Conn\u2019s disease, 19.8% versus 80.2% (p < 0.0001); Cushing\u2019s disease, 17.2% versus 82.8% (p < 0.0001); cortical carcinoma, 30% versus 70% (p < 0.001). Analyzing the three LA periods, operating times were the only statistically significant variable (p < 0.0001). Conclusions The progressive increase in the number of adrenalectomies performed is due more to a better under- standing of adrenal disease than to the availability of minimally invasive techniques. The choice of a laparoscopic approach (trans- or retroperitoneal) should depend on the surgeon\u2019s experience

Role of Piuitary Tumour Transforming Gene 1 in medullary thyroid carcinoma

Background: Pituitary tumour transforming gene 1 (PTTG1) is over-expressed in a variety of endocrine-related tumors. We aimed at evaluating PTTG1 expression and function in human neoplastic parafollicular C cells, represented by medullary thyroid carcinoma (MTC) and C-cell hyperplasia (CCH) samples and by the TT cell line. Methods: TT cells and tissues derived from human CCH and MTC were analyzed by northern blot, furthermore TT cells were subjected to PTTG gene silencing and cells were analyzed for DNA synthesis. Results: PTTG1 expression was significantly higher (P<0.01) in CCH (3-fold), in papillary thyroid cancer and in MTC (5-fold) than in normal thyroid, and in MTC lymph-node metastases as compared to primary lesions (~2-fold; P<0.05). PTTG1 mRNA and protein correlated with tumor diameter and TNM status (P<0.05). In TT cells, PTTG1 silencing did not completely block DNA synthesis, but significantly reduced [3H]Thymidine incorporation (~50%; P<0.01) for up to 3 days. Conclusions: PTTG1 levels correlate with tumor aggressiveness. PTTG1 silencing causes reduced MTC cell proliferation, supporting the hypothesis that PTTG1 might have an important role in C-cell neoplastic proliferation