The authors analyze the results of many-year application of magnetic imaging to the diagnosis of volume diseases of the adrenals. The method may be effectively used for topical diagnosis of such conditions. Due to some of its characteristics, such as clear differentiation of soft tissues, possibility of examination in 3 and more projections, safety, etc., magnetic imaging may be considered a method of choice in the diagnosis of adrenal tumors. It provides valuable information on the size, shape, localization, and dissemination of adrenal tumors and in some cases differentiates the variants of anatomical norm of the adjacent organs simulating adrenal tumors shown by other topographic methods. Features of magnetic image of tumors different by their hormonal activity: aldosteroma, pheochromocytoma, corticosteroma, "incidentaloma", and malignant tumors are described. Use of paramagnetic contrast agents appreciably improves the quality of magnetic resonance tomographic diagnosis of adrenal tumors, for it permits a more reliable conclusion on the tumor structure and its position amidst the adjacent vascular structures (abdominal aorta and inferior vena cava) and the parenchymatous organs (liver and kidneys), which is particularly valuable for planning surgery.
The effect of drug stimulation of prolactin secretion on the level of its high-molecular (100 kD) and monomeric (23 kD) immunoreactive forms in the blood serum was studied in 5 women with idiopathic hyperprolactinemia with the predominance of the high-molecular form of the hormone. Metoclopramide, a dopamine receptor antagonist, was used for stimulation of prolactin secretion. Fractionation of blood serum immunoreactive prolactin was earned out using gel filtration. A single intravenous infusion of metoclopramide caused a rapid appreciable increase of the total level of immunoreactive hormone, mainly at the expense of its monomer fraction. In contrast to the monomer form, high-molecular prolactin poorly reacted to suppression of the dopaminergic tone. The time course of high- and low-molecular (monomer) forms’ response to metoclopramide differed. The results indicate differences in the regulation of the levels of high- and low-molecular immunoreactive forms of prolactin in the blood of patients with hyperprolactinemia with the predominance of high-molecular hormone and, hence, permit a hypothesis on a different biochemical nature of these two forms and on other than hypophyseal origin of the high-molecular form or its bulk.
Fifty two patients (23 males and 29 females) with neurogenic diabetes insipidus (DI) were examined to define the role and specific features of brain magnetic resonance imaging (MRI) in the diagnosis of hypothalamopituitary abnormalities in this disease retrospectively after establishing the diagnosis. The group understudy included patients who had symptoms of only DI (they had no signs of chiasm or hypopituitarism). The following abnormalities were detected: no hyperintensive signal of the neurohypophysis body on T1-weighed images in 42.3%) of patients, bulky chiasmocellar masses in 13.6%), the empty ephippium in 15.3%), its structural abnormalities in 1.9%). Abnormal MRI scans were absent in 26.9% of patients with neurogenic DI. Since DI may be the first and only symptom of hypothalamopituitary tumor lesion, a sensitive topical technicjue, such as MRI, should be applied. It was found that brain MRI revealed no hyperintensive signal from the neurohypophysis body on T1-weighed images in 61%) of the patients with idiopathic DI, which may be a pathognomonic sign of idiopathic DI.
A new rapid method for assesment of the ratio of immunoreactive prolactin forms with high and low molecular mass has been developed, which permits screening of large groups of patients. It was used in examinations of 44 women with hyperprolactinemea of various origin and with normoprolactinemic galactorrhea. High-molecular immunoreactive prolactin predominated in the blood serum of 25% of patients. This predominance did not depend on the origin of hyperprolactinemia, clinical picture of the disease, or level of total immunoreactive prolactin in the blood. Heterogenous clinical symptoms of the disease were characteristic of these patients: a typical symptom complex was absent in moderate hyperprolactinemia, whereas in patients with manifest hyperprolactinemia of a tumorous origin a classical clinical picture of persistent galactorrhea-amenorrhea was observed. A follow-up showed the predominance of high-molecular prolactin irrespective of the changes in the level of total immunoreactive prolactin in the blood, disease course, onset of pregnancy and labor.
Fifty-seven women with the hyperoprolactinemic syndrome coursing from 6 months to 13 years were examined. Total blood serum immunoreactive prolactin was measured, and craniograms made in all the patients, computer-aided tomography of the head was carried out in 49, and magnetic imaging in 38 patients. A total of 29 micro-, 16 macroadenomas, 1 chaniopharyngiomas, and 2 cases of “empty sella turcica” were revealed. Efficacy of prolactinoma detection by computer-aided tomography and magnetic imaging was 63.2 and 78.9%, respectively. Hence, these methods may effectively diagnose hypophyseal prolactinomas, but magnetic imaging is preferable for the detection of microprolactinomas and in cases with suspected volumic processes of the brain.
The article is devoted to the descripition of the rare case with Icenko-Cushing syndrome caused by multiple bilateral benign and malignant adrenocortical tumors.
It is known a surgeon operating on the adrenal glands, should be aware of the possibility of the presence of ectopic adrenal tissue. According to the literature, there are relapses of Cushing's disease due to hyperfunction of adrenal accessory tissue. Its location may be the perinephric tissue, testicles, mediastinum, kidneys, urinary tract, broad ligament of the uterus, vagina, scrotum. The inclusion of adrenal tissue in the ovaries, liver, pancreas is also described. There is some evidence that additional adrenal tissue can be a source of tumors, including hormonal-active ones. O. I. Nikolaev (1970) cites a case of ectopia of a tumor in the kidney, 4 cases of ectopia in one of the ovaries, which, in addition to symptoms of hypercorticism, was accompanied by severe virilization. However, this pathology is extremely rare, therefore, there are few publications in the literature. In this regard, it seems appropriate to us to make such an observation.
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