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Laparoscopic adrenalectomy for pheochromocytoma is more difficult compared to other adrenal tumors. Wideochir Inne Tech Maloinwazyjne 2015; 10:466-71. [PMID: 26649097 PMCID: PMC4653249 DOI: 10.5114/wiitm.2015.52869] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 03/16/2015] [Accepted: 06/06/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction Laparoscopic adrenalectomy is the gold standard for the treatment of benign adrenal tumors. However, some authors raise the problem of differences in surgery for pheochromocytoma in comparison to other lesions. Aim To compare laparoscopic adrenalectomy for pheochromocytoma and for other tumors. Material and methods Four hundred and thirty-seven patients with adrenal tumors were included in the retrospective analysis. Patients were divided into two groups: 1 (124 patients treated for pheochromocytoma) and 2 (313 patients with other types of tumor). The two groups were compared with respect to mean operative time, intraoperative blood loss, conversion rate, complication rate and the relationship of tumor size with operative time. Results The mean operative time in group 1 was 91 min, and in group 2 it was 82 min (p = 0.016). In both groups 1 and 2, tumor size correlated with operative time (p < 0.0001 and p = 0.0003, respectively). The mean blood loss in groups 1 and 2 was 117 ml and 54 ml, respectively (p = 0.0011). The complication rate in groups 1 and 2 was 4% and 4.2%, respectively (p = 0.9542). In groups 1 and 2, conversion was necessary in 2 (1.6%) and 5 (1.6%) cases, respectively (p = 0.9925). Conclusions Longer operative time and higher blood loss after laparoscopic adrenalectomy for pheochromocytoma indicate its greater difficulty. However, despite these drawbacks, minimally invasive surgery still seems to be an effective and safe method.
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Li J, Yang CH. Diagnosis and treatment of adrenocorticotrophic hormone-independent macronodular adrenocortical hyperplasia: A report of 23 cases in a single center. Exp Ther Med 2014; 9:507-512. [PMID: 25574224 PMCID: PMC4280986 DOI: 10.3892/etm.2014.2115] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 07/21/2014] [Indexed: 12/21/2022] Open
Abstract
The aim of the present study was to present the treatment observations of patients with adrenocorticotrophic hormone (ACTH)-independent macronodular adrenal hyperplasia (AIMAH) from a single medical center. A total of 23 patients with AIMAH were retrospectively reviewed according to the clinical features of the patient. Physical symptoms and biochemical evidence of Cushing’s syndrome (CS) were present in all the cases. High and low dose dexamethasone failed to suppress cortisone secretion on the suppression tests and ACTH levels were low in all the cases. Bilateral enlarged adrenal glands were observed with computed tomography scans in the 23 cases, which were determined to be bilateral adrenal macronodular hyperplasia by pathological analysis. Normal blood pressure was observed in eight patients in the 2–8 years following the bilateral adrenalectomy. A total of 15 cases underwent single side adrenalectomy and their blood pressures markedly decreased three years following surgery; medical treatment was administered to 12 of the 15 patients, while three patients underwent a contralateral adrenalectomy. Nelson’s syndrome was not diagnosed for any of the cases. AIMAH has unique endocrinological, radiological and pathological features, presenting as an independent etiological factor of CS. Diagnosis of AIMAH is usually derived from pathological examination and long term remission may be achieved by unilateral adrenalectomy. Contralateral adrenalectomy should be performed in cases of recurrence, when followed with periodical examination of the symptoms and the serum concentration of cortisol.
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Affiliation(s)
- Jiang Li
- Department of Urology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Chang-Hai Yang
- Department of Urology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
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Zhang Y, Li H, Xiao J, Zhou Y, Zhou Z, Tong A. Bilateral adrenal tumors from different histology: case report and literature review. Cell Biochem Biophys 2014; 71:425-9. [PMID: 25164113 DOI: 10.1007/s12013-014-0216-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Bilateral adrenal tumors are very uncommon in clinical practice and all originate from the same histology. We presented here a case report and literature review of bilateral adrenal tumors from different histology: pheochromocytoma in one side and adrenocortical adenoma in the other side. The patient was a 37 years old female suffered from Cushing's syndrome form 3 years. One year ago she was diagnosed as ACTH-independent Cushing's syndrome and received Laparoscopic adrenalectomy for right adrenal tumor which diagnosed as a pheochromocytoma by the pathological reports. After the operation, patient's clinical manifestation was not change, then half-year later the lab test showed no improvement in the blood biochemical parameters. Finally, CT detected a mass in left adrenal gland. Thereafter, this patient received Laparoscopic adrenalectomy for left adrenal tumor. The tumor was diagnosed as adrenocortical adenoma by the pathologists. One week after operation, the blood biochemical parameters became normal. In conclusion, bilateral adrenal tumors from different histology are very rare, adrenalectomy for both side tumors and preserving the normal adrenal glands is necessary.
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Affiliation(s)
- Yushi Zhang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Al-Otaibi KM, Abduljabbar MA. Symptomatic cycling Cushing disease managed by simultaneous bilateral laparoscopic adrenalectomy in a 11-year-old boy. J Family Community Med 2014; 21:61-4. [PMID: 24696635 PMCID: PMC3966100 DOI: 10.4103/2230-8229.128791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We report symptomatic cycling Cushing disease in a 11-year-old boy that was managed with simultaneous bilateral laparoscopic adrenalectomy. Positioning and the surgical technique have been fully described. Excellent results were achieved. Recent application of laparoscopic adrenalectomy for various adrenal pathology is highly effective and offers better results than open surgery. Post-operative recovery after laparoscopic technique is significantly shorter than the open technique.
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Affiliation(s)
- Khalid M. Al-Otaibi
- Department of Urology, College of Medicine, University of Dammam, Dammam, Kingdom of Saudi Arabia
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Carter YM, Mazeh H, Sippel RS, Chen H. Safety and feasibility of laparoscopic resection for large (≥ 6 CM) pheochromocytomas without suspected malignancy. Endocr Pract 2013; 18:720-6. [PMID: 22982788 DOI: 10.4158/ep12014.or] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine whether laparoscopic adrenalectomy in patients without radiologic evidence of cancer compromises the perioperative and long-term outcomes in patients with large (≥ 6 cm) pheochromocytomas. METHODS We analyzed a prospective adrenal database of consecutive patients who underwent adrenalectomy at our institution between September 2000 and September 2010. Patients with diagnosed pheochromocytoma who underwent laparoscopic adrenalectomy were included. Patients with tumors smaller than 6 cm were compared with those presenting with tumors 6 cm or larger. RESULTS One hundred fifty-seven patients underwent adrenalectomy, and there were 32 catecholamine-secreting tumors. Of the 33, 7 were excluded from the study because of open surgery. Thus, 25 patients presented with 26 pheochromocytomas and underwent laparoscopic adrenalectomy. Thirteen of the 25 patients (52%) were women. Mean age (± standard error of the mean) was 53 ± 3 years. Mean tumor size was 5.2 ± 0.5 cm, and 11 pheochromocytomas (42%) were 6 cm or larger. Tumor size was significantly different between the large pheochromocytoma and the small pheochromocytoma groups (7.6 ± 0.4 vs 3.6 ± 0.4 cm, P<.001), but there was no significant difference in intraoperative complications, estimated blood loss, cancer diagnosis, or recurrence. The length of stay was comparable between the 2 cohorts, and there were no incidents of capsular invasion or adverse cardiovascular events. CONCLUSION Laparoscopic adrenalectomy of pheochromocytomas larger than 6 cm is feasible and safe with comparable results to those achieved with laparoscopic adrenalectomy in patients with smaller pheochromocytomas.
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Affiliation(s)
- Yvette M Carter
- Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin 53792, USA
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Mauclère-Denost S, Duron-Martinaud S, Nunes ML, Gatta B, Fagour C, Rault A, Gosse P, Tabarin A. [Surgical excision of subclinical cortisol secreting incidentalomas: Impact on blood pressure, BMI and glucose metabolism]. ANNALES D'ENDOCRINOLOGIE 2009; 70:211-7. [PMID: 19457469 DOI: 10.1016/j.ando.2009.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 03/27/2009] [Accepted: 03/31/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To compare clinical, vascular and metabolic parameters before and after surgery in patients with subclinical cortisol secreting incidentalomas. PATIENTS AND METHODS Eight patients were investigated before and 12 months after removal of the mass on hemodynamic (blood pressure by MAPA procedure), anthropometric (body weight, body mass index), and metabolic parameters (glucose level, HbA(1c)). RESULTS In the whole group, 75% of patients displayed decrease in blood pressure (cessation of at least one hypotensive medication) and 33% of them were definitely cured of hypertension. Seventy-one percent of patients lost body weight and 37.5% lost more than 5%. In the whole group of patients, glucose level decreased by 1.1% and medical treatment was discontinuated in two of three diabetic patients. CONCLUSION Subclinical cortisol secreting adrenal incidentalomas are associated with cardiovascular risk factors that may be corrected after removal of the mass. Therefore, surgery may be an appropriate choice in patients with subclinical Cushing's syndrome to improve hypertension, body weight and impaired glucose level. Controlled studies comparing surgical treatment to a medical follow-up including optimal cardiovascular risk factors treatment are needed to define the usefulness of surgery in hypertensive patients with subclinical cortisol secreting incidentalomas.
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Affiliation(s)
- S Mauclère-Denost
- Service d'endocrinologie-diabète et maladies métaboliques, USN Haut-Lévêque, CHU de Bordeaux, 33604 Pessac, France
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Zhou J, Ye D, Wu M, Zheng F, Wu F, Wang Z, Li H. Bilateral adrenal tumor: causes and clinical features in eighteen cases. Int Urol Nephrol 2008; 41:547-51. [DOI: 10.1007/s11255-008-9484-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Accepted: 09/22/2008] [Indexed: 11/29/2022]
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Ito T, Imai T, Kikumori T, Shibata A, Horiba T, Kobayashi H, Sawaki M, Watanabe R, Nakao A, Kiuchi T. Adrenal Incidentaloma: Review of 197 Patients and Report of a Drug-Related False-Positive Urinary Normetanephrine Result. Surg Today 2006; 36:961-5. [PMID: 17072715 DOI: 10.1007/s00595-006-3291-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2005] [Accepted: 05/16/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine the incidence and importance of functioning tumors among incidentally discovered adrenal masses in the era of laparoscopic surgery. METHODS We defined adrenal incidentaloma as a tumor detected during abdominal imaging for adrenal-unrelated reasons, and we reviewed 197 consecutive patients with adrenal incidentaloma diagnosed since we started laparoscopic adrenalectomy. RESULTS Incidentaloma was discovered initially in 91 (46%) patients and pheochromocytoma was detected as an incidentaloma in 21 (39%) of 54 patients. One patient, a 21-year-old woman taking mesalamine for ulcerative colitis, had a remarkably elevated urinary normetanephrine level, which resulted in the initial misdiagnosis of a 10-cm right adrenal incidentaloma as a pheochromocytoma. Laparoscopic right adrenalectomy resulted in a pathological diagnosis of ganglioneuroma. A series of urinary normetanephrine measurements were taken in parallel with the mesalamine doses. We found that other patients medicated with mesalamine, without adrenal tumors, had elevated urinary normetanephrine levels, confirming that mesalamine metabolites interfere with urinary normetanephrine measurements. CONCLUSIONS It is essential to diagnose the functional potential of adrenal incidentaloma preoperatively, and not to perform laparoscopic adrenalectomy for adrenal incidentaloma without careful evaluation first.
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Affiliation(s)
- Takahiro Ito
- Department of Breast and Endocrine Surgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Haveran LA, Novitsky YW, Czerniach DR, Kaban GK, Kelly JJ, Litwin DEM. Benefits of Laparoscopic Adrenalectomy: A 10-year Single Institution Experience. Surg Laparosc Endosc Percutan Tech 2006; 16:217-21. [PMID: 16921299 DOI: 10.1097/00129689-200608000-00004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION We aimed to compare the outcomes of laparoscopic and open adrenalectomies and to assess the impact of the availability of advanced laparoscopy on adrenal surgery at our institution. MATERIALS AND METHODS A retrospective analysis of data of all patients who underwent adrenalectomy at the University of Massachusetts Medical Center over a 10-year period. RESULTS Sixty-four consecutive patients underwent adrenalectomy during the study periods. There were 19 open (OA) and 45 laparoscopic (LA) adrenalectomies performed. There was no significant difference between the average size of adrenal masses removed for the LA and the OA groups [4.3 vs. 5.5 cm, respectively (P=0.23)]. LA proved superior to OA, resulting in shorter operative times (171 vs. 229 min, P=0.02), less blood loss (96 vs. 371 mL, P<0.01), shorter time to regular diet (1.9 vs. 4.4 d, P<0.001), and shorter hospital stay (2.5 vs. 5.8 d, P=0.02). In addition, the average annual number of adrenalectomies increased significantly since the establishment of our advanced laparoscopic program (10.0 vs. 2.0, P=0.02). CONCLUSIONS LA offers superior results when compared to OA in terms of operative time, blood loss, return of bowel function, duration of hospital stay, and functional recovery. The availability of advanced laparoscopy has resulted in a significant increase in the number of adrenalectomies performed at our institution without a shift in surgical indications.
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Affiliation(s)
- Liam A Haveran
- Department of Surgery, University of Massachusetts Medical Center, Worcester, MA, USA
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Kubo N, Onoda N, Ishikawa T, Ogawa Y, Takashima T, Yamashita Y, Tahara H, Inaba M, Hirakawa K. Simultaneous Bilateral Laparoscopic Adrenalectomy for Adrenocorticotropic Hormone-Independent Macronodular Adrenal Hyerplasia: Report of a Case. Surg Today 2006; 36:642-6. [PMID: 16794802 DOI: 10.1007/s00595-006-3209-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2005] [Accepted: 11/15/2005] [Indexed: 10/24/2022]
Abstract
Cushing's syndrome caused by adrenocorticotropic hormone (ACTH)-independent macronodular adrenal hyperplasia (AIMAH) is an extremely rare disease, which shows bilateral macronodular adrenal hypertrophy and autonomous cortisol production. We herein report a case of AIMAH treated successfully by minimally invasive simultaneous bilateral laparoscopic adrenalectomy. A 73-year-old woman with hypertension, diabetes mellitus, and osteoporosis was referred to our hospital because of an incidentally found huge bilateral adrenal mass. An abdominal computed tomography scan showed large bilateral adrenal glands with multiple nodules. A diagnosis of AIMAH was made and a simultaneous bilateral laparoscopic adrenalectomy was thus performed. The total operation time was 310 min and blood loss was 70 g. Both glands were hypertrophic (right 5 x 3 cm, 48.5 g and left 4 x 2 cm, 39.2 g) and consisted of multiple golden yellow macronodules. The postoperative course was uneventful. A simultaneous bilateral adrenalectomy for AIMAH performed by an experienced surgical team is therefore considered to be a safe and minimally invasive procedure.
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Affiliation(s)
- Naoshi Kubo
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Osaka, Japan
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Valeri A, Bergamini C, Manca G, Mannelli M, Presenti L, Peri A, Borrelli A, Tonelli P. Adrenal incidentaloma: the influence of a decision-making algorithm on the short-term outcome of laparoscopy. J Laparoendosc Adv Surg Tech A 2006; 15:451-9. [PMID: 16185116 DOI: 10.1089/lap.2005.15.451] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND At the present time, the precise indications for laparoscopic surgery of adrenal incidentaloma (AI) have yet to be completely clarified. The most controversial issue is the role of laparoscopy in the treatment of potentially malignant and large adrenal masses. Trying to address these questions, we retrospectively examined a group of patients with AIs. MATERIALS AND METHODS Forty-two patients with AIs who were laparoscopically treated since 1995 were enrolled in this study. The patients were divided into two groups: the 27 patients of the immediate surgery (IS) group were operated on immediately, whereas the 15 subjects in the delayed surgery (DS) group needed further evaluations and/or a follow-up period before surgery. Surgical timing for both groups was decided according to a widely accepted decision-making algorithm. Many outcome parameters of laparoscopy (operative time, blood loss, conversion rate, time to liquid and solid food nutrition, drainage removal, resumption of normal bowel habits, and average hospital stay) were analyzed in the two groups. The subjects had AIs of various sizes and different histotypes. RESULTS Patients in the DS group had a higher risk for malignancy. The definitive pathology revealed a malignant biology in 26.6% of DS vs. 0% of IS cases. No difference in the outcome parameters of laparoscopy was observed between the two groups or among pathologically different AIs. A significant correlation was found between the operative time and the size of the AI (r=0.836, P<0.001, linear regression test). CONCLUSION Our study shows that laparoscopy is feasible and safe for AIs, regardless of the preoperative probability of malignancy. The size of the AI was the only determinant for choosing a laparotomy. Further long-term studies are necessary to confirm the laparoscopic efficacy in terms of oncologic safety.
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Affiliation(s)
- Andrea Valeri
- Department of General and Vascular Surgery, Careggi Hospital, and Department of Clinical Physiopathology, University of Florence, Italy
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Kercher KW, Novitsky YW, Park A, Matthews BD, Litwin DEM, Heniford BT. Laparoscopic curative resection of pheochromocytomas. Ann Surg 2005; 241:919-26; discussion 926-8. [PMID: 15912041 PMCID: PMC1357171 DOI: 10.1097/01.sla.0000164175.26785.06] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Pheochromocytomas are relatively uncommon tumors whose operative resection has clear medical and technical challenges. While the safety and efficacy of laparoscopic adrenalectomy are relatively well documented, few studies with extended follow-up have been conducted to measure the success of the procedure for the most challenging of the adrenal tumors. In addition, several reports question the applicability of a minimally invasive approach for sizeable pheochromocytomas. The purpose of our investigation was to assess the outcomes of laparoscopic adrenalectomy for pheochromocytomas in the largest study to date when performed by experienced laparoscopic surgeons. METHODS All pheochromocytomas removed by the authors from January 1995 to October 2004 were reviewed under an Institutional Review Board approved protocol. Eighty-five percent were documented in a prospective fashion. RESULTS Eighty consecutive patients underwent laparoscopic resection of 81 pheochromocytomas. Seventy-nine were found in the adrenal (42 left, 35 right, 1 bilateral); 2 were extra-adrenal paragangliomas. Eight patients had multiple endocrine neoplasia syndrome. Two lesions were malignant. There were 48 females and 32 males with a mean age of 45 years (range, 15-79 years). Mean tumor size was 5.0 cm (range, 2-12.1 cm); 41 of these lesions were 5 cm in size or larger. Average operative time and blood loss were 169 minutes (range, 69-375 minutes) and 97 mL (range, 20-500 mL), respectively. Intraoperative hypertension (systolic blood pressure, >170 mm Hg) was reported in 53% of patients and hypotension (systolic blood pressure, <90 mm Hg) in 28% of patients. There were no conversions to open surgery. Mean length of stay was 2.3 days (range, 1-10 days). There were 6 perioperative morbidities (7.5%) and no mortalities. No patient required a blood transfusion. No recurrence of endocrinopathy has been documented at a mean follow-up of 21.4 months. CONCLUSION Laparoscopic resection of pheochromocytomas, including large lesions, can be accomplished safely by experienced surgeons. A short hospital stay with minimal operative morbidity and eradication of endocrinopathy support the minimally invasive approach for adrenalectomy in the setting of pheochromocytoma.
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Affiliation(s)
- Kent W Kercher
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina 28232, USA
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Antonini SR, Fragoso MC, Lacroix A. Hiperplasia adrenal macronodular independente de ACTH (AIMAH): aspectos clínicos e moleculares. ACTA ACUST UNITED AC 2004; 48:620-36. [PMID: 15761531 DOI: 10.1590/s0004-27302004000500006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A AIMAH é caracterizada pela presença de macronódulos em ambas as adrenais, na ausência da estimulação do ACTH. Habitualmente, as manifestações clínicas aparecem somente após várias décadas de vida, provavelmente em função da baixa atividade esteroidogênica do tecido hiperplásico. Entretanto, em indivíduos assintomáticos cuja AIMAH foi descoberta acidentalmente, o eixo HHA já se encontra alterado. Estudos têm demonstrado que, na maioria dos casos de AIMAH, a secreção de cortisol é regulada de modo "aberrante" por hormônios como o GIP, AVP, catecolaminas, LH/hCG e serotonina, através de seus respectivos receptores, ectópicos ou eutópicos, porém aberrantemente acoplados à esteroidogênese. Os mecanismos moleculares responsáveis pela expressão ectópica dos receptores hormonais e/ou de seu acoplamento anormal à esteroidogênese adrenal ainda são pouco conhecidos. Embora a expressão aberrante destes receptores hormonais possa desempenhar um papel importante na iniciação da proliferação celular aumentada, bem como na esteroidogênese, é provável que eventos genéticos adicionais ocorram, envolvendo a regulação do ciclo celular, adesão e transcrição. Mutações no gene GNAS1 não associadas à síndrome de McCune-Albright podem ser encontradas em raros casos de AIMAH. Em alguns casos, a presença de receptor hormonal aberrante abre novas possibilidades de tratamento farmacológico específico do hipercortisolismo, seja isolado ou associado à adrenalectomia unilateral.
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Affiliation(s)
- Sonir R Antonini
- Departamento de Pediatria, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, USP.
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