Adrenal morphology and cortical function in patients with extrapulmonary tuberculosis: response to antituberculosis treatment.

Objective: Enlargement of the adrenal glands and variable adrenocortical function have been reported in patients with pulmonary tuberculosis and, in a few studies, in patients with extrapulmonary tuberculosis (EPTB). However, none of the studies have evaluated the course of the adrenal morphology in these patients. Subjects and methods: Prospective study including 37 patients with EPTB and 37 healthy age- and sex-matched controls. The adrenal function was evaluated by measurement of cortisol levels at baseline and after stimulation with ACTH (Acton Prolongatum) before and 6 months after antituberculosis treatment. The size of both adrenal glands was evaluated using 64-slice computed tomography (CT) scanning before and 6 months after treatment. The findings were compared with those in a group of healthy matched controls. Results: Clinical and biochemical parameters were comparable between groups. The mean baseline serum cortisol level was significantly lower in the EPTB group (397.1 ± 184.9 nmol/L) compared with the control group (696.3 ± 101.8 nmol/L). Compared with controls, patients with EPTB had significantly lower mean cortisol levels at baseline and 1 hour after ACTH, both before (397 ± 184.9 nmol/L and 750.7 ± 176.8 nmol/L, respectively) and after (529.7 ± 100.4 nmol/L and 1017.2 ± 119.7 nmol/L, respectively) antituberculosis treatment. Both the length and thickness of the right and left adrenal glands were greater in patients with EPTB than in controls but became comparable to those in controls after treatment completion. Conclusion: Patients with EPTB have an enlarged adrenal size and low baseline and stimulated serum cortisol levels. After treatment completion, cortisol levels increased significantly, and the adrenal size normalized in these patients.

Mielolipoma suprarrenal, revisión de literatura en México a propósito de dos casos / Adrenal myelolipoma, review of the literature in Mexico apropos of two cases

Introducción: los mielolipomas suprarrenales (ML) son neoplasias benignas poco frecuentes constituidas por tejido adiposo y mieloide. Clínicamente asintomáticas, suelen ser diagnosticados incidentalmente. En México existen solo 32 casos publicados de ML, presentándose en pacientes de entre 37 a 65 años, siendo la relación hombre-mujer 1:1.1, el síntoma más comúnmente reportado es dolor abdominal inespecífico, y la cirugía abierta es el principal abordaje quirúrgico empleado en nuestro país (89%). Caso clínico: presentamos una recopilación de la literatura actual sobre ML en México, además de dos casos clínicos de pacientes con ML: un hombre de 67 años con enfermedad diverticular y una mujer de 40 años con dolor en hipocondrio; en ambos se realizó resección tumoral, midiendo 9.5 cm y 13.3 cm, respectivamente. Conclusiones: presentamos dos casos nuevos en nuestro país que corresponden a incidentalomas. En ambos casos la cirugía se realizó para confirmar el diagnóstico, así como para prevenir posibles complicaciones.

Background: Adrenal myelolipomas (ML) are rare benign neoplasms compound of adipose and myeloid tissue. Clinically they are usually asymptomatic, being diagnosed generally by incident. In Mexico, there are only 32 published cases of ML, these occur between 37 and 65 years, with the male-female ratio being 1:1.1, clinically they present with abdominal or lumbar pain, open surgery being the main surgical approach (89%). Clinical case: We made a literature review of ML in Mexico and present two clinical cases: a 67-year-old man in followup for diverticular disease and a 40-year-old woman with pain in the left upper quadrant. In both cases, tumor resection was performed measuring 9.5 cm and 13.3 cm long respectively. Conclusions: We present two new cases in our country that correspond to incidentalomas. In both cases, surgery was performed to confirm the diagnosis, as well as to prevent possible complications

Shear-wave elastography evaluation of adrenal glands in healthy newborns: a preliminary study.

OBJECTIVES: Establishing standard shear-wave elastography (SWE) values for healthy newborns can help distinguish normal conditions of the adrenal gland (AG) from pathological conditions. We aimed to establish a reference data set for AG stiffness values using SWE in healthy newborns. METHODS: The quantitative stiffness of the AG was measured in the coronal plane in kilopascal (kPa). The quantitative descriptive statistics were presented as mean with standard deviation and median with range. The relationship between the quantitative variables was calculated using "Spearman's rank correlation coefficient test." The intraclass correlation coefficient (ICC) test was used to analyze intraobserver reliability. A p-value <0.05 was considered statistically significant. RESULTS: A total of 120 AGs of 60 healthy newborns (30 females and 30 males) was examined. The mean stiffness values of the right AG for the first and second visits were 7.51±2.45 and 7.54±2.49 kPa, respectively, and those of the left AG for the first and second visits were 7.60±2.03 and 7.42±1.97 kPa, respectively. There was no statistically significant difference between the mean values of adrenal stiffness and the length and width of AG and weight, height, and age (p>0.05). The ICC values for mean stiffness values of each AG were >0.80-0.90, indicating good intraobserver agreement. CONCLUSIONS: This study is the first SWE study to evaluate the AG in healthy newborns. Our study's data can be used as a reference for future research.

Challenges in obesity and primary aldosteronism: Diagnosis and treatment.

BACKGROUND: Obese patients may have unrecognized primary aldosteronism due to high rates of concomitant hypertension. We hypothesized that obesity impacts the diagnosis and management of patients with primary aldosteronism. METHODS: We conducted a retrospective analysis of all primary aldosteronism patients (n = 418) who underwent adrenal vein sampling (1997-2017). Patients were classified by body mass index as obese (body mass index ≥35) or nonobese (body mass index <35) and diagnostic evaluation was compared between groups. Within the operative cohort (n = 285), primary outcomes were changes in both blood pressure and antihypertensive medications after adrenalectomy. Secondary outcome was clinical resolution by Primary Aldosteronism Surgery Outcomes criteria. RESULTS: Thirty-five percent of patients were obese. Obese patients were more likely to be male (67.8% vs 56.1%, P = .025), somewhat younger (51.5 vs 54.4 years old, P < .012), and require more preoperative antihypertensive medications (6.7 vs 5.7, P = .04) than nonobese patients. Obese patients had lesser rates of radiologic evidence of adrenal tumors (68.4 vs 77.9%, P = .038) despite similar rates of lateralization on adrenal vein sampling. In the operative subset, obese patients had somewhat smaller tumors on final pathology (1.1 vs 1.5 cm, P = .014) but similar rates of complete and partial clinical resolution (P = 1.000). CONCLUSION: Obese primary aldosteronism patients have lesser rates of localization by imaging, likely due to smaller tumor size, however, experience similar benefit from adrenalectomy.

Can fetal adrenal artery Doppler velocimetry predict delivery date in pregnant women with spontaneous preterm birth?

AIM: To assess the accuracy of delivery date predictions made using fetal adrenal artery Doppler velocimetry in pregnant women with spontaneous preterm birth (PB) and to compare these predictions with cervical length (CL) measurements.Material and methods: A prospective study was performed with 51 pregnant women whose gestational lengths were between 24 and 36 weeks. The main outcome was the time between the Doppler velocimetry examination and delivery, categorized as delivery within 7 days or 7 days later after the examination. A receiver operating characteristics curve was performed to define the cutoffs among deliveries within 7 days for fetal adrenal artery Doppler velocimetry parameters and CL measurements. RESULTS: The incidence of delivery within 7 days was 37.3%, with a statistically significant difference for the pulsatility index (PI; p=0.045) and resistance index (RI; p=0.030) of the fetal adrenal artery. The best cutoff values of PI and RI for predicting deliveries within 7 days were 1.65 and 0.78, respectively. The sensitivity and specificity of PI, RI, and CL (20 mm) were 73.7% (95% CI: 51.9-95.5) and 56.3% (95% CI: 38.1-74.4); 68.4% (95% CI: 45.4-91.4) and 62.5% (95% CI: 44.8-80.2); and 76.5% (95% CI: 54.0-99.0) and 78.1% (95%: CI 71.1-97.7), respectively. CONCLUSION: Fetal adrenal artery Doppler velocimetry can predict delivery within 7 days among pregnant women in cases of spontaneous PB and this prediction is similar to the predictions made using CL measurements.

Diagnosis and management of primary aldosteronism.

Primary aldosteronism (PA) is the most common form of secondary hypertension (HTN), with an estimated prevalence of 4% of hypertensive patients in primary care and around 10% of referred patients. Patients with PA have higher cardiovascular morbidity and mortality than age- and sex-matched patients with essential HTN and the same degree of blood pressure elevation. PA is characterized by an autonomous aldosterone production causing sodium retention, plasma renin supression, HTN, cardiovascular damage, and increased potassium excretion, leading to variable degrees of hypokalemia. Aldosterone-producing adenomas (APAs) account for around 40% and idiopathic hyperaldosteronism for around 60% of PA cases. The aldosterone-to-renin ratio is the most sensitive screening test for PA. There are several confirmatory tests and the current literature does not identify a "gold standard" confirmatory test for PA. In our institution, we recommend starting case confirmation with the furosemide test. After case confirmation, all patients with PA should undergo adrenal CT as the initial study in subtype testing to exclude adrenocortical carcinoma. Bilateral adrenal vein sampling (AVS) is the gold standard method to define the PA subtype, but it is not indicated in all cases. An experienced radiologist must perform AVS. Unilateral laparoscopic adrenalectomy is the preferential treatment for patients with APAs, and bilateral hyperplasia should be treated with mineralocorticoid antagonist (spironolactone or eplerenone). Cardiovascular morbidity caused by aldosterone excess can be decreased by either unilateral adrenalectomy or mineralocorticoid antagonist. In this review, we address the most relevant issues regarding PA screening, case confirmation, subtype classification, and treatment.

Diagnosis and management of primary aldosteronism

ABSTRACT Primary aldosteronism (PA) is the most common form of secondary hypertension (HTN), with an estimated prevalence of 4% of hypertensive patients in primary care and around 10% of referred patients. Patients with PA have higher cardiovascular morbidity and mortality than age- and sex-matched patients with essential HTN and the same degree of blood pressure elevation. PA is characterized by an autonomous aldosterone production causing sodium retention, plasma renin supression, HTN, cardiovascular damage, and increased potassium excretion, leading to variable degrees of hypokalemia. Aldosterone-producing adenomas (APAs) account for around 40% and idiopathic hyperaldosteronism for around 60% of PA cases. The aldosterone-to-renin ratio is the most sensitive screening test for PA. There are several confirmatory tests and the current literature does not identify a "gold standard" confirmatory test for PA. In our institution, we recommend starting case confirmation with the furosemide test. After case confirmation, all patients with PA should undergo adrenal CT as the initial study in subtype testing to exclude adrenocortical carcinoma. Bilateral adrenal vein sampling (AVS) is the gold standard method to define the PA subtype, but it is not indicated in all cases. An experienced radiologist must perform AVS. Unilateral laparoscopic adrenalectomy is the preferential treatment for patients with APAs, and bilateral hyperplasia should be treated with mineralocorticoid antagonist (spironolactone or eplerenone). Cardiovascular morbidity caused by aldosterone excess can be decreased by either unilateral adrenalectomy or mineralocorticoid antagonist. In this review, we address the most relevant issues regarding PA screening, case confirmation, subtype classification, and treatment.

Morphometric analysis of suprarenal glands (adrenal glands) with multislice computerized tomography / Análisis morfométrico de glándulas suprarenales (glándulas adrenales) con tomografía computarizada multicorte

The aim of our study are to determine the shape, vertebrae level, height, volume, corpus medial and lateral branch thicknesses of AG and the distance from some neighboring structures on multidetector computed tomography (MDCT) images and also to determine the relationship between these data and gender, age, height, weight and body mass index (BMI). The study was conducted on a total of 420 MDCT images consisted of 220 male (mean age 63.44±8.00, 50-81 years), 200 female (mean age 61.23±7.95, 50-84 years) healthy individuals. Vertebrae level of AG (VLAG), height of AG (HAG), adrenal gland volume (VAG), corpus thickness of AG (CTAG), medial section thickness of AG (MTAG) and lateral section thickness of AG (LTAG) were investigated. In our study, RAG were observed on T12 vertebrae level in 38.19 % of males and 42.5 % of females and LAG were also observed at that level in 39.55 % of the male and 51 % of the female individuals. RAG were observed in all males and 98.5 % of the females and LAG were observed 88.63 % of the males and 94 % of the females "Y" shaped. VAG were observed lower in males compared to females in age groups and VAG was observed increasing with age in males; decreased in 60-69 age group of females and increased again in 70 and plus age group. The aim of this study is to determine normal ranges of AG sizes and the relationship of each one with sex, age, height, weight and BMI.

Los objetivos de nuestro estudio fueron determinar la forma, el nivel vertebral, la altura, el volumen, el grosor de las ramas medial y lateral del cuerpo de glándulas suprarrenales (GSR) y la distancia de algunas estructuras vecinas en las imágenes de tomografía computada multidetector (TCMD) y determinar la relación entre estos datos y sexo, edad, estatura, peso e índice de masa corporal (IMC). El estudio se realizó en un total de 420 imágenes TCMD de 220 hombres (edad media 63,44 ± 8,00, 50-81 años) y 200 mujeres (edad media 61,23 ± 7,95, 50-84 años) todos sanos. Se investigó el nivel de la GSR respecto a las vértebras, la altura de GRS (AGSR), el volumen de la glándula suprarrenal (VGSR), el grosor del cuerpo, el espesor de la sección mediana de GSR (SMGSR) y el grosor de la sección lateral de GSR (SLGSR). En nuestro estudio, se observó la GSR derecha a nivel de vértebras T12 en el 38,19 % de los hombres y en el 42,5 % de las mujeres y la GSR izquierda se observó a ese nivel en el 39,55 % de los hombres y 51 % de las mujeres. La GSR se presentó en forma de «Y¼ en el lado derecho en todos los hombres y en el 98,5 % de las mujeres y en el lado izquierdo se observó en el 88,63 % de los hombres y 94 % de las mujeres. El VGSR era menor en los hombres en relación con las mujeres en los diferentes grupos de edad y aumentaba con la edad en los hombres; disminuyó en el grupo de 60-69 años de edad de las mujeres y aumentó nuevamente después de los 70 años.

A rare case of Ganglioneuroblastoma Encapsulated in Pheochromocytoma.

Pheochromocytoma and Ganglioneuroblastoma are separate diseases and a rare combination in which the diagnosis can only be confirmed by pathological examination after tumor excision. We reported here a case of ganglioneuroblastoma encapsulated in pheochromocytoma. The patient is a woman, 73 years old, hypertensive, with hypothyroidism, associated for 15 years with hypercholesterolemia and hypertriglyceridemia, which had frequent complaints of low back pain. She underwent magnetic resonance and the findings were consistent with the diagnosis of pheochromocytoma. After surgery, anatomic, pathologic and immunohistochemistry analysis confirmed the diagnosis of pheochromocytoma composed by small ganglioneuroblastoma representation with the identification of small focus of infiltration of the adrenal capsule and adipose tissue by pheochromocytoma. This rare association can instigate the discussion of methods of diagnosis, more effective and more appropriate treatments for each patient.

B-mode and Doppler ultrasonography of adrenal glands of healthy dogs / Ultrassonografia modo B e Doppler das glândulas adrenais de cães saudáveis

The aim of this study was to determine the vascular indices of adrenal blood flow in healthy dogs (systolic velocity - SV; diastolic velocity - DV; resistance index - RI). Eighteen dogs (thirty six adrenal) were studied. Physical examination, biochemical profile and dexamethasone suppression test were performed to determine general health status. Echotexture, size, contours and margins, and overall shape of the adrenal gland (right and left) were assessed via ultrasound. By spectral Doppler of the phrenic-abdominal artery, the SV, DV, and RI were acquired. Animals did not show alterations in clinical and laboratory examination and suppression of cortisol. Normal homogeneous and echotexture, regular contours and margins and normal shape and size were verified via B mode. Spectral Doppler of the phrenic-abdominal artery showed monophasic-patterned waves and low vascular resistance and systolic peak evident with means values: left adrenal - SV = 31.34cm/s, DV = 9.54cm/s and RI = 0.69; and right adrenal - SV = 27.83cm/s, DV = 7.71cm/s and RI = 0.68. Doppler evaluation of adrenal was easily implemented and may provide base line data in the study, allowing for the use of this technique as a diagnostic tool for diseases of the dog's adrenal.(AU)

Objetivou-se determinar os índices vasculares do fluxo sanguíneo das glândulas adrenais de cães saudáveis (velocidade sistólica - VS; velocidade diastólica - VD; o índice de resistência - IR). Foram utilizados neste estudo 18 cães (36 adrenais). Foram realizados exame físico, perfil bioquímico e teste de supressão com dexametasona para determinar o estado geral de saúde (higidez). Ecotextura, ecogenicidade, tamanho, contornos e margens e o formato das glândulas adrenais (direito e esquerdo) foram avaliados por meio da ultrassonografia convencional. Ao Doppler espectral da artéria frênico-abdominal, foram adquiridos a VS, a VD e o IR. Os animais não apresentaram alterações aos exames clínico, laboratorial e de supressão do cortisol. Ao exame ultrassonográfico, foram verificados ecotextura homogênea, ecogenicidade, formato e tamanhos normais, além de os contornos e as margens serem regulares. Ao Doppler espectral da artéria frênico-abdominal, verificaram-se ondas com padrão monofásico, com resistência vascular baixa e pico sistólico evidente, sendo os valores médios: adrenal esquerda - VS = 31,34cm/s, VD = 9,54cm/s e IR = 0,69; e adrenal direita - VS = 27,83cm/s, VD = 7,71cm/s e IR = 0,68. A avaliação Doppler das adrenais foi facilmente implementada e pode fornecer dados de referência, permitindo a utilização dessa técnica como uma ferramenta de diagnóstico para doenças das adrenais em cães.(AU)

High 18F-FDG uptake in PMAH correlated with normal expression of Glut1, HK1, HK2, and HK3.

BACKGROUND: Primary macronodular adrenal hyperplasia (PMAH) is a rare cause of Cushing's syndrome, characterized by functioning adrenal macronodules and variable cortisol production. Recently, we demonstrated a high 18F-FDG uptake in PMAH, an unexpected finding for a benign disorder. PURPOSE: To investigate whether there is a correlation between 18F-FDG high uptake and the expression levels of the glycolytic pathway components GLUT1, HK1, HK2, and HK3 in PMAH. MATERIAL AND METHODS: We selected 12 patients undergoing surgery for PMAH who had preoperatively undergone 18F-FDG PET/CT. mRNA and protein expression of the selected genes were evaluated in the adrenal nodules from patients who underwent surgery through quantitative RT-PCR and by immunohistochemistry, respectively. RESULTS: SUVmax in PMAH was in the range of 3.3-8.9 and the adrenal size was in the range of 3.5-15 cm. A strong correlation between 18F-FDG uptake and largest adrenal diameter was observed in patients with PMAH. However, no correlation between 18F-FDG uptake and GLUT1, HK1, HK2, HK3 mRNA, and protein expression was observed. CONCLUSION: High 18F-FDG uptake is observed in the majority of PMAH cases. However, 18F-FDG uptake in PMAH is independent of the expression levels of GLUT1, HK1, HK2, and HK3. Further investigation is required to elucidate the molecular mechanisms underlying increased 18F-FDG uptake in PMAH.

Importance of fasting in preparing dogs for abdominal ultrasound examination of specific organs.

OBJECTIVE: To describe the effect of fasting on the technical success of abdominal ultrasonography specifically in respect of examination of the gall bladder, duodenum, pancreas, adrenal glands and portal vein in dogs. METHODS: Randomised, prospective study of 150 dogs with a variety of physical characteristics. Animals were divided into two groups of 75 dogs each. Dogs in Group 1 were fasted for 8 to 12 hours before ultrasonographic evaluation and those in Group 2 were not but received food anytime between 10 minutes and 2 hours before the procedure. RESULTS: Intraluminal gas can influence the visibility of organs, but intraluminal gas accumulation occurred independently of fasting status. The assessment of abdominal organs was not affected by whether or not an animal was fasted. CLINICAL SIGNIFICANCE: Routine fasting of dogs before abdominal ultrasonography is not essential.

Comparação das características e medidas ultrassonográficas das glândulas adrenais de cães e gatos filhotes saudáveis / Comparison of adrenal glands ultrasonographic characteristics and measurements in healthy puppies and kittens

O estudo teve como objetivo analisar e comparar as características e dimensões ultrassonográficas das glândulas adrenais entre cães e gatos filhotes hígidos, estabelecendo padrões de normalidade e de referência. Participaram do estudo 15 cães e 15 gatos filhotes com idade entre cinco e seis meses, de raça mista, peso médio de 3 kg e 2 kg, respectivamente. Os animais foram submetidos ao exame ultrassonográfico das glândulas adrenais, para visibilização das características internas do órgão. A frequência de visibilização das glândulas adrenais foi de 100% nos gatos filhotes, enquanto nos cães filhotes a frequência foi de 75% para a glândula direita e 100% para a esquerda. O comprimento e a largura das glândulas adrenais revelaram diferenças significativas (P = 0,01) entre os cães e gatos filhotes, sendo que as glândulas adrenais dos cães filhotes, direita e esquerda, foram maiores em comprimento (1,08 ± 0,01 cm e 1,11 ± 0,01 cm) e largura (0,42 ± 0,02 cm e 0,45 ± 0,01 cm) em relação ao comprimento (0,64 ± 0,01 cm e 0,63 ± 0,01 cm) e largura (0,30 ± 0,02 cm e 0,34 ± 0,01 cm) dos gatos filhotes. Em ambos os grupos, as glândulas adrenais apresentaram-se hipoecogênicas em relação à gordura adjacente, sendo delimitadas por uma linha hiperecogênica, e não se observou distinção entre as regiões cortical e medular. As dimensões ultrassonográficas de comprimento e largura das glândulas adrenais, direita e esquerda, foram as mesmas em cães e gatos filhotes. A glândula adrenal direita e esquerda dos cães filhotes foram maiores, em comprimento e largura, que as glândulas dos gatos filhotes.

The aim of the study was to analyze and compare the ultrasound characteristics of adrenal glands between healthy puppies and kittens by establishing standards of normality and references. Fifteen healthy crossbred puppies with mean weight of 3 kg and fifteen healthy crossbred kittens with mean weight of 2 kg, aged between five and six months, participated in the study. The animals were submitted to ultrasound exam of adrenal glands for visualization of their internal characteristics. The frequency of visualization of adrenal glands was 100% in kittens. In puppies the frequency was 75% for the right gland and 100% for the left gland. The puppy's adrenal gland, both right and left, were bigger in length (1.08 ± 0.01 cm, 1.11 ± 0.01 cm) and width (0.42 ± 0.02 cm, 0.45 ± 0.01 cm) in relation to kittens' adrenal gland length (0.64 ± 0.01 cm, 0.63 ± 0.01 cm) and width (0.30 ± 0.02 cm, 0.34 ± 0.01 cm). The adrenal gland of puppies and kittens was hypoechogenic to the surrounded fat, delimited by a hyperechogenic line and without distinction of the cortical and medullar region. The ultrasound dimensions of length and width of the adrenal glands, both right and left, were the same in puppies and kittens. The right and left puppies' adrenal glands were longer and wider than the kittens' glands.

Comparação das características e medidas ultrassonográficas das glândulas adrenais de cães e gatos filhotes saudáveis / Comparison of adrenal glands ultrasonographic characteristics and measurements in healthy puppies and kittens

O estudo teve como objetivo analisar e comparar as características e dimensões ultrassonográficas das glândulas adrenais entre cães e gatos filhotes hígidos, estabelecendo padrões de normalidade e de referência. Participaram do estudo 15 cães e 15 gatos filhotes com idade entre cinco e seis meses, de raça mista, peso médio de 3 kg e 2 kg, respectivamente. Os animais foram submetidos ao exame ultrassonográfico das glândulas adrenais, para visibilização das características internas do órgão. A frequência de visibilização das glândulas adrenais foi de 100% nos gatos filhotes, enquanto nos cães filhotes a frequência foi de 75% para a glândula direita e 100% para a esquerda. O comprimento e a largura das glândulas adrenais revelaram diferenças significativas (P = 0,01) entre os cães e gatos filhotes, sendo que as glândulas adrenais dos cães filhotes, direita e esquerda, foram maiores em comprimento (1,08 ± 0,01 cm e 1,11 ± 0,01 cm) e largura (0,42 ± 0,02 cm e 0,45 ± 0,01 cm) em relação ao comprimento (0,64 ± 0,01 cm e 0,63 ± 0,01 cm) e largura (0,30 ± 0,02 cm e 0,34 ± 0,01 cm) dos gatos filhotes. Em ambos os grupos, as glândulas adrenais apresentaram-se hipoecogênicas em relação à gordura adjacente, sendo delimitadas por uma linha hiperecogênica, e não se observou distinção entre as regiões cortical e medular. As dimensões ultrassonográficas de comprimento e largura das glândulas adrenais, direita e esquerda, foram as mesmas em cães e gatos filhotes. A glândula adrenal direita e esquerda dos cães filhotes foram maiores, em comprimento e largura, que as glândulas dos gatos filhotes.(AU)

The aim of the study was to analyze and compare the ultrasound characteristics of adrenal glands between healthy puppies and kittens by establishing standards of normality and references. Fifteen healthy crossbred puppies with mean weight of 3 kg and fifteen healthy crossbred kittens with mean weight of 2 kg, aged between five and six months, participated in the study. The animals were submitted to ultrasound exam of adrenal glands for visualization of their internal characteristics. The frequency of visualization of adrenal glands was 100% in kittens. In puppies the frequency was 75% for the right gland and 100% for the left gland. The puppy's adrenal gland, both right and left, were bigger in length (1.08 ± 0.01 cm, 1.11 ± 0.01 cm) and width (0.42 ± 0.02 cm, 0.45 ± 0.01 cm) in relation to kittens' adrenal gland length (0.64 ± 0.01 cm, 0.63 ± 0.01 cm) and width (0.30 ± 0.02 cm, 0.34 ± 0.01 cm). The adrenal gland of puppies and kittens was hypoechogenic to the surrounded fat, delimited by a hyperechogenic line and without distinction of the cortical and medullar region. The ultrasound dimensions of length and width of the adrenal glands, both right and left, were the same in puppies and kittens. The right and left puppies' adrenal glands were longer and wider than the kittens' glands.(AU)

Glutamine/glutamate metabolism studied with magnetic resonance spectroscopic imaging for the characterization of adrenal nodules and masses.

PURPOSE: To assess glutamine/glutamate (Glx) and lactate (Lac) metabolism using proton magnetic resonance spectroscopic imaging (1H-MRS) in order to differentiate between adrenal gland nodules and masses (adenomas, pheochromocytomas, carcinomas, and metastases). MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained. A total of 130 patients (47 men) with 132 adrenal nodules/masses were prospectively assessed (54 ± 14.8 years). A multivoxel system was used with a two-dimensional point-resolved spectroscopy/chemical-shift imaging sequence. Spectroscopic data were interpreted by visual inspection and peak amplitudes of lipids (Lip), choline (Cho), creatine (Cr), Lac, and Glx. Lac/Cr and Glx/Cr were calculated. Glx/Cr was assessed in relation to lesion size. RESULTS: Statistically significant differences were observed in Glx/Cr results between adenomas and pheochromocytomas (P < 0.05), however, with a low positive predictive value (PPV). Glx levels were directly proportional to lesion size in carcinomas. A cutoff point of 1.44 was established for the differentiation between carcinomas larger versus smaller than 4 cm, with 75% sensitivity, 100% specificity, 100% PPV, and 80% accuracy. Lac/Cr results showed no differences across lesions. A cutoff point of -6.5 for Lac/Cr was established for carcinoma diagnosis. CONCLUSION: Glx levels are directly proportional to lesion size in carcinomas. A cutoff point of -6.5 Lac/Cr differentiates carcinomas from noncarcinomas.