RESUMO
Hypertension is a prevalent disease in developed countries. Adrenal masses, and especially adrenal cysts, are a rare and usually asymptomatic finding, which can go unnoticed or be detected as incidental findings in imaging tests. These circumstances make the multidisciplinary approach mandatory. The case is presented on a 72 year-old woman with uncontrolled high blood pressure referred to the Urology Department due to the incidental finding of a right retroperitoneal mass. A functional and imaging study was performed, establishing a diagnosis of adrenal cyst causing hypertensive symptoms. A literature search was performed in order to assess diagnostic and therapeutic approaches. With the diagnosis of adrenal cyst causing uncontrolled high blood pressure, a right laparoscopic adrenalectomy was performed. After surgery the patient has maintained blood pressure within the normal range. A multidisciplinary approach is necessary for the management of rare diseases. The surgical approach, if possible, should be laparoscopic.
Assuntos
Doenças das Glândulas Suprarrenais/complicações , Cistos/complicações , Hipertensão/etiologia , Doenças das Glândulas Suprarrenais/diagnóstico por imagem , Doenças das Glândulas Suprarrenais/fisiopatologia , Doenças das Glândulas Suprarrenais/cirurgia , Adrenalectomia , Idoso , Anti-Hipertensivos/uso terapêutico , Cistos/irrigação sanguínea , Cistos/diagnóstico por imagem , Cistos/fisiopatologia , Resistência a Medicamentos , Feminino , Humanos , Hipertensão/tratamento farmacológico , Laparoscopia , Tomografia Computadorizada por Raios XRESUMO
The distance from the genitals to the anus, anogenital distance, reflects androgen concentration during prenatal development in mammals. The use of anogenital distance in human studies is still very limited and the quality and consistency of measurements is an important methodological issue. The aim of this study was to assess the feasibility and reproducibility of adult male anogenital distance measurements by two different methods. All men were attending an outpatient clinic at a university hospital and underwent an andrological examination and completed a brief questionnaire. Two variants of anogenital distance [from the anus to the posterior base of the scrotum (AGDAS ) and to the cephalad insertion of the penis (AGDAP )] by two methods (lithotomy or frog-legged position) were assessed in 70 men. Within and between coefficient of variations, intra-class correlation coefficients, two-way repeated-measures analysis of variance, and scatter and Bland-Altman plots were calculated. The two methods produced similar values for AGDAP but different estimates for AGDAS . Nonetheless, the overall agreement (ICC ≥ 0.80) was acceptable for both measures. Therefore, both methods are internally consistent and adequate for epidemiological studies, and may be used depending on the available medical resources, clinical setting, and populations.