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Intraoperative identification of adrenal-renal fusion.

Boll G, Rattan R, Yilmaz O, Tarnoff ME - J Minim Access Surg (2015 Jul-Sep)

Bottom Line: The patient was a 59-year-old man with chronic hypertension refractory to multiple antihypertensives found to be caused by a right-sided aldosterone-producing adrenal adenoma in the setting of bilateral adrenal hyperplasia.Pathologic evaluation confirmed adrenal - renal fusion without adrenal heterotopia.Identified intraoperatively, this may be misdiagnosed as invasive malignancy, and thus awareness of this anomaly may help prevent unnecessarily morbid resection.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Tufts Medical Center, Boston, MA, USA.

ABSTRACT
Adrenal - renal fusion is a rare entity defined as incomplete encapsulation of the adrenal gland and kidney with histologically adjacent functional tissue. This report describes the first published intraoperative identification of this anomaly during laparoscopic adrenalectomy. The patient was a 59-year-old man with chronic hypertension refractory to multiple antihypertensives found to be caused by a right-sided aldosterone-producing adrenal adenoma in the setting of bilateral adrenal hyperplasia. During laparoscopic adrenalectomy, the normal avascular plane between the kidney and adrenal gland was absent. Pathologic evaluation confirmed adrenal - renal fusion without adrenal heterotopia. Identified intraoperatively, this may be misdiagnosed as invasive malignancy, and thus awareness of this anomaly may help prevent unnecessarily morbid resection.

No MeSH data available.


Related in: MedlinePlus

CT Abdomen revealing a smooth round low-attenuating lesion of the right adrenal gland with close approximation of the inferolateral aspect of the right adrenal gland and superior pole of the right kidney
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Figure 1: CT Abdomen revealing a smooth round low-attenuating lesion of the right adrenal gland with close approximation of the inferolateral aspect of the right adrenal gland and superior pole of the right kidney

Mentions: The patient is a 59-year-old man from Bosnia with a two decade history of hypertension refractory to a combination of four high-dose antihypertensive medications. He had concomitant hypokalemia, reaching a nadir of 2.2 mEq/L in 2009, requiring significant daily supplementation. Computed tomography (CT) of the abdomen at that time identified multiple bilateral low-attenuating adrenal lesions. Elevated plasma aldosterone-to-renin concentration ratio (PAC/PRC) confirmed primary hyperaldosteronism. The PAC/PRC worsened, and in 2013, it reached a peak of 281. A repeat CT at that time revealed an enlarging right adrenal lesion [Figure 1]. Adrenal venous sampling (AVS) revealed an aldosterone to cortisol ratio of 1.4 and 12.2 in the left and right adrenal veins, respectively, for a cortisol-corrected aldosterone ratio of approximately nine. The patient was referred to surgery given that the workup suggested a right aldosterone-producing adrenal adenoma in the setting of bilateral adrenal hyperplasia.


Intraoperative identification of adrenal-renal fusion.

Boll G, Rattan R, Yilmaz O, Tarnoff ME - J Minim Access Surg (2015 Jul-Sep)

CT Abdomen revealing a smooth round low-attenuating lesion of the right adrenal gland with close approximation of the inferolateral aspect of the right adrenal gland and superior pole of the right kidney
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4499928&req=5

Figure 1: CT Abdomen revealing a smooth round low-attenuating lesion of the right adrenal gland with close approximation of the inferolateral aspect of the right adrenal gland and superior pole of the right kidney
Mentions: The patient is a 59-year-old man from Bosnia with a two decade history of hypertension refractory to a combination of four high-dose antihypertensive medications. He had concomitant hypokalemia, reaching a nadir of 2.2 mEq/L in 2009, requiring significant daily supplementation. Computed tomography (CT) of the abdomen at that time identified multiple bilateral low-attenuating adrenal lesions. Elevated plasma aldosterone-to-renin concentration ratio (PAC/PRC) confirmed primary hyperaldosteronism. The PAC/PRC worsened, and in 2013, it reached a peak of 281. A repeat CT at that time revealed an enlarging right adrenal lesion [Figure 1]. Adrenal venous sampling (AVS) revealed an aldosterone to cortisol ratio of 1.4 and 12.2 in the left and right adrenal veins, respectively, for a cortisol-corrected aldosterone ratio of approximately nine. The patient was referred to surgery given that the workup suggested a right aldosterone-producing adrenal adenoma in the setting of bilateral adrenal hyperplasia.

Bottom Line: The patient was a 59-year-old man with chronic hypertension refractory to multiple antihypertensives found to be caused by a right-sided aldosterone-producing adrenal adenoma in the setting of bilateral adrenal hyperplasia.Pathologic evaluation confirmed adrenal - renal fusion without adrenal heterotopia.Identified intraoperatively, this may be misdiagnosed as invasive malignancy, and thus awareness of this anomaly may help prevent unnecessarily morbid resection.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Tufts Medical Center, Boston, MA, USA.

ABSTRACT
Adrenal - renal fusion is a rare entity defined as incomplete encapsulation of the adrenal gland and kidney with histologically adjacent functional tissue. This report describes the first published intraoperative identification of this anomaly during laparoscopic adrenalectomy. The patient was a 59-year-old man with chronic hypertension refractory to multiple antihypertensives found to be caused by a right-sided aldosterone-producing adrenal adenoma in the setting of bilateral adrenal hyperplasia. During laparoscopic adrenalectomy, the normal avascular plane between the kidney and adrenal gland was absent. Pathologic evaluation confirmed adrenal - renal fusion without adrenal heterotopia. Identified intraoperatively, this may be misdiagnosed as invasive malignancy, and thus awareness of this anomaly may help prevent unnecessarily morbid resection.

No MeSH data available.


Related in: MedlinePlus