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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

Hematoxylin and eosin staining revealing normal appearing adrenal cortical cells (left) and renal cells, including glomeruli (right), fused, without intervening fibrous capsule
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Figure 3: Hematoxylin and eosin staining revealing normal appearing adrenal cortical cells (left) and renal cells, including glomeruli (right), fused, without intervening fibrous capsule

Mentions: In May 2014, the patient underwent laparoscopic right adrenalectomy. During dissection along the inferolateral portion of the adrenal gland it became apparent that the normally avascular plane between the adrenal and renal capsule was absent. Instead, there appeared to be a dense fibrotic adhesion between the surfaces of the two organs. Electrocautery dissection to include a portion of the superior pole of the kidney into the specimen was required for complete excision of the adrenal gland [Figure 2]. The patient tolerated the procedure well, postoperative laboratories revealed normokalemia without supplementation, and a 24-hour urine aldosterone level of less than 1.5 mcg/24 h confirmed the resolution of hyperaldosteronism. The patient's blood pressure was within normal limits with decreasing antihypertensive administration 1 month after excision. Pathologic evaluation of the specimen confirmed multinodular adrenal cortical hyperplasia and partial adrenal - renal fusion [Figure 3] without evidence of adrenal heterotopia.


Intraoperative identification of adrenal-renal fusion.

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

Hematoxylin and eosin staining revealing normal appearing adrenal cortical cells (left) and renal cells, including glomeruli (right), fused, without intervening fibrous capsule
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Hematoxylin and eosin staining revealing normal appearing adrenal cortical cells (left) and renal cells, including glomeruli (right), fused, without intervening fibrous capsule
Mentions: In May 2014, the patient underwent laparoscopic right adrenalectomy. During dissection along the inferolateral portion of the adrenal gland it became apparent that the normally avascular plane between the adrenal and renal capsule was absent. Instead, there appeared to be a dense fibrotic adhesion between the surfaces of the two organs. Electrocautery dissection to include a portion of the superior pole of the kidney into the specimen was required for complete excision of the adrenal gland [Figure 2]. The patient tolerated the procedure well, postoperative laboratories revealed normokalemia without supplementation, and a 24-hour urine aldosterone level of less than 1.5 mcg/24 h confirmed the resolution of hyperaldosteronism. The patient's blood pressure was within normal limits with decreasing antihypertensive administration 1 month after excision. Pathologic evaluation of the specimen confirmed multinodular adrenal cortical hyperplasia and partial adrenal - renal fusion [Figure 3] without evidence of adrenal heterotopia.

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