METHODS: The aim of this study is to investigate the effect of time-of-day on serum hormones and gene expression in adrenal glands, studying the impact of sex, obesogenic diet, and timing of proanthocyanidins administration, with a focus on glucocorticoids synthesis by this gland.
RESULTS: Female and male rats, assigned to a standard chow or a cafeteria diet-fed group, receive a daily oral dose of a grape seed proanthocyanidin extract (GSPE), or a vehicle (when light is turned on, or when light is turned off). Corticosterone, estradiol, and testosterone serum levels, and the expression analysis of clock genes and genes related to corticosterone synthesis pathway, are assessed. Serum hormone levels exhibited a marked time-of-day effect also see in the expression of scavenger receptor class B member 1 (Scarb1) and cyp11b genes. The correlation between these two genes and period circadian regulator 2 (Per2) is also extended to other clock genes, although to a lesser extent: cryptochrome (Cry) and nuclear receptor subfamily 1 group D member 1 (Rev-erba).
CONCLUSIONS: The strong correlations found suggest an important role of local Per2 (but also of Cry and Rev-erbA) in regulating the expression of the enzymes involved in the corticosterone synthesis pathway. The expression of clock genes in adrenals is influenced by sex and diet but not by GSPE.

Objective: To analyze the anatomical characteristics of the adrenal veins through adrenal venography to improve the success rate of adrenal venography (AVS). Methods: This study was a cross-sectional study. Patients who were diagnosed with primary aldosteronism and underwent AVS from January 2019 to October 2023 at the First Affiliated Hospital of Dalian Medical University were included. Adrenal vein imaging was collected from the enrolled patients. We performed statistical analysis on the adrenal vein orifice position, inflow angle, and adrenal venography morphology. The adrenal venous orifice was defined as the location where the catheter was placed at the end of the calm inhalation. Spearman correlation analysis was used to explore the relationship between the positions of bilateral adrenal vein orifices and body mass index (BMI). Results: A total of 282 patients with successful bilateral AVS and complete bilateral adrenal vein imaging were enrolled, of whom 57.1% (161/282) were male and the age was (53.3±10.7) years old. The orifice of the left adrenal vein was located between the middle segment of the 11th thoracic vertebra and the upper segment of the 2nd lumbar vertebra. The inflow angle relative to the position of the orifice was all leftward and upward. The orifice of the right adrenal vein was located between the upper segment of the 11th thoracic vertebra and the lower segment of the 1st lumbar vertebra, and 91.1% (257/282) had a rightward and downward angle of inflow relative to the position of the orifice. The position of the adrenal vein orifices on both the left (r=0.211, P<0.001) and right (r=0.196, P=0.001) showed positive correlation with BMI. The position of the right adrenal vein orifice also increased with the position of the left adrenal orifice (r=0.530, P<0.001). The most common adrenal venography morphology on the right side was triangular (36.5%, 103/282), while the most common venography morphology on the left side was glandular (66.3%, 187/282). Conclusions: The anatomical morphology of adrenal veins are diverse. Being familiar with the morphological characteristics of the adrenal vein and identifying the adrenal vein accurately during surgery has important clinical value in improving the success rate of AVS.
目的： 通过肾上腺静脉造影分析肾上腺静脉的解剖形态特征，以提高肾上腺静脉取血成功率。 方法： 本研究为横断面研究。选取2019年1月至2023年10月于大连医科大学附属第一医院确诊为原发性醛固酮增多症并行肾上腺静脉取血的患者。收集入选患者的肾上腺静脉影像资料，统计分析肾上腺静脉开口位置、流入角度和肾上腺静脉形态。肾上腺静脉开口位置定义为平静吸气末导管位置。采用Spearman相关性分析探讨两侧肾上腺静脉开口位置的关系及其与体重指数的相关性。 结果： 纳入282例双侧肾上腺静脉取血成功且双侧肾上腺静脉显影完全的患者，男性占比57.1%（161/282），年龄（53.3±10.7）岁。左侧肾上腺静脉开口位于第11胸椎中段至第2腰椎上段，其相对于开口位置的流入角度均为向左向上。右侧肾上腺静脉开口位于第11胸椎上段至第1腰椎下段，91.1%（257/282）相对于开口位置的流入角度是向右向下的。左（r=0.211，P<0.001）、右（r=0.196，P=0.001）两侧肾上腺静脉开口位置均随体重指数增大而增高。右侧肾上腺静脉开口位置随左侧肾上腺开口位置增高而增高（r=0.530，P<0.001）。右侧肾上腺静脉造影形态以三角型最为常见［36.5%（103/282）］，而左侧以腺体型最为常见［66.3%（187/282）］。 结论： 肾上腺静脉解剖形态多样。熟悉肾上腺静脉形态特点，术中快速准确判别肾上腺静脉对提高肾上腺静脉取血成功率有重要临床价值。.

UNASSIGNED: The aim of this study is to investigate the effect of obesity on the results of laparoscopic adrenal surgery in patients with Cushing syndrome.
UNASSIGNED: This retrospective study was performed in Department of General Surgery at Erciyes University School of Medicine between January 2010 and January 2023. Our analysis included Cushing syndrome patients who underwent unilateral laparoscopic adrenalectomy (LA) with the transabdominal lateral approach. All patients were evaluated in terms of age, sex, tumor diameter, body mass index (BMI), American Society of Anesthesiologists physical status classification, morbidities, surgery history, tumor side, operative time, conversion to open surgery, complications, and length of hospital stay.
UNASSIGNED: A total of 90 patients (75 females and 15 males) underwent a transperitoneal LA. Patients were divided into 2 groups according to their BMI: obese group (≥30 kg/m2; n = 53, 58.8%) and nonobese group (<30 kg/m2; n = 37, 41.2%). All patients were classified into 3 subgroups: obese patient group, BMI ≥30-39 kg/m2 (n = 23); morbidly obese patient group, BMI ≥40 kg/m2 (n = 14); and nonobese patient group, BMI <30 kg/m2 (n = 53). There was no significant difference in intraoperative complications, conversion to open surgery, operative time, or length of hospital stay between the groups. Only conversion to open surgery was a risk factor for postoperative complications in univariate and multivariate analyses (odds ratio, 15.4; 95% confidence interval, 1.277-185.599; P = 0.031).
UNASSIGNED: Our results showed that LA is safe and effective in patients with Cushing syndrome with morbid obesity, allowing acceptable morbidity and length of hospital stay.

UNASSIGNED: Adrenal gland cysts are a rare entity, with a reported incidence in post-mortem series of 0.06-0.18%. However, the incidence seems to be increasing in recent years. The presentation of adrenal gland cysts is usually asymptomatic, but those cases in which symptoms are present are usually non-specific, which makes adrenal cysts generally recognized as incidentalomas. The finding is mainly made by computed tomography. The main objective of this article was to describe the clinical course of a patient with an adrenal gland pseudocyst, which is accompanied by symptoms of compression and persistent pain of long evolution in the left flank.
UNASSIGNED: A 65-year-old female patient attended the emergency room of a second-level hospital due to an increase in volume of the abdominal region with a sensation of fullness, heartburn, vomiting and pain. Computed tomography was performed, which reported a cystic mass and, later, exploratory laparotomy plus adrenalectomy were carried out. The pathology analysis reported a diagnosis of a 10 x 15 x 14 cm solid, cystic, and adherent tumor, coinciding with a pseudocyst of the adrenal gland.
UNASSIGNED: Adrenal gland cysts are rare. Computed tomography is recommended for its diagnosis and the standard of treatment is surgical intervention in the presence of symptoms.
UNASSIGNED: los quistes de glándula suprarrenal son una entidad rara, con un reporte en la incidencia de series post mortem de 0.06-0.18%. Sin embargo, la incidencia parece ir en aumento en los últimos años. La presentación de los quistes de glándula suprarrenal es habitualmente asintomática, pero en aquellos casos en que se presentan síntomas, estos suelen ser inespecíficos, lo cual hace que los quistes suprarrenales generalmente sean reconocidos como incidentalomas. El hallazgo se hace principalmente mediante tomografía computarizada. El objetivo principal de este artículo fue describir el curso clínico de una paciente con un pseudoquiste de glándula suprarrenal, que se acompaña de síntomas de compresión y dolor persistente de larga evolución en el flanco izquierdo.
UNASSIGNED: mujer de 65 años que acudió a urgencias de un hospital de segundo nivel por aumento de volumen de región abdominal con sensación de plenitud, pirosis, vómito y dolor. Se realizó tomografía computarizada que reportó masa quística; posteriormente se realizó laparotomía exploradora y adrenalectomía. El análisis de patología reportó diagnóstico de tumor de 10 x 15 x 14 cm, sólido, quístico y adherido, coincidente con pseudoquiste de glándula suprarrenal.
UNASSIGNED: los quistes de glándula suprarrenal son raros. Para su diagnóstico se recomienda realizar tomografía computarizada y el estándar de tratamiento es la intervención quirúrgica ante la presencia de sintomatología.

BACKGROUND: Adrenal infarction (AI) is a rare type of adrenal damage, which is relatively common in systemic lupus erythematosus, antiphospholipid antibody syndrome (APS) and pregnancy. The diagnosis of AI is mainly by computed tomography (CT) and magnetic resonance imaging, but is easily confused with other adrenal disease. Hence, this report details a condition of AI with systemic lupus erythematosus, APS and made a differential diagnosis from imaging.
METHODS: We report a case of a 55-year-old woman with pain in her fossa axillaries and inguinal regions. Then CT scan disclosed bilateral adrenal diseases, and the patient was diagnosed with systemic lupus erythematosus, APS and AI after additional autoimmune examinations.
METHODS: The patient was diagnosed as systemic lupus erythematosus with lupus nephritis, hematological damage and oromeningitis, APS, AI and secondary blood coagulation disorders.
METHODS: The patient was treated with methylprednisolone, hydroxychloroquine and low molecular heparin.
RESULTS: The patient relieves and remains well 1 year after treatment.
UNASSIGNED: AI can be divided hemorrhagic and non-hemorrhagic, with bilateral lesions more common. In our case, the AI was bilateral, partially involved and non-hemorrhagic, and the \"cutoff sign\" was first put forward in CT, which might assist the diagnosis.

BACKGROUND: Adrenal gland injury (AGI) associated with trauma is an uncommon and often overlooked condition. This study aimed to evaluate the frequency of AGI in individuals with severe trauma injuries and investigate the outcomes of patients with AGI.
METHODS: All patients admitted to a tertiary trauma referral center under the trauma protocol who had a computed tomography (CT) scan between January 2012 and January 2023 were analyzed retrospectively. Patients who were dead on arrival and patients with incomplete data were excluded. They were classified into two main groups, adult and pediatric, and further subcategorized by the presence or absence of radiologically evident AGI. Demographic data, mechanism of injury, injury severity scores (ISS), presence of concurrent abdominal injury, and 30-day mortality rates were compared. A separate analysis was performed for factors affecting mortality rates.
RESULTS: A total of 1,253 patients were included: 950 adults and 303 pediatric patients. In the adult group, AGI was detected in 45 (4.7%) patients and was more commonly associated with the following mechanisms of injury: motor vehicle accidents (26.7% vs. 14.3%) and pedestrian accidents (37.8% vs. 15.5%). Injury to the right side was more common (55.6%). Patients with AGI had higher rates of concurrent liver (17.8% vs. 3.9%), spleen (11.1% vs. 3.6%), and kidney injuries (15.6% vs. 1.3%). In the pediatric population, AGI was detected in 30 patients (14.8%), a significantly higher rate compared to the adult group. Similar to the adult group, AGI was more commonly associated with concurrent abdominal injuries and had a right-sided dominance (60%), but the rate of concurrent abdominal injuries was higher in the pediatric group (80% vs. 46%). The 30-day mortality was significantly higher in both adult and pediatric AGI groups compared to patients without AGI (adult: 15.6% vs. 2.9%, pediatric: 10% vs. 1.8%). In patients with AGI, major head and neck injuries and chest injuries were associated with mortality.
CONCLUSIONS: Adrenal gland injuries due to trauma are not uncommon. They are usually associated with blunt trauma and other concurrent abdominal organ injuries. The major contributors to mortality in patients with AGI were major head and neck injuries and chest injuries.

Carbimazole has disadvantages on different body organs, especially the thyroid gland and, rarely, the adrenal glands. Most studies have not suggested any solution or medication for ameliorating the noxious effects of drugs on the glands. Our study focused on the production of xylooligosaccharide (XOS), which, when coadministered with carbimazole, relieves the toxic effects of the drug on the adrenal glands. In addition to accelerating the regeneration of adrenal gland cells, XOS significantly decreases the oxidative stress caused by obesity. This XOS produced by Aspergillus terreus xylanase was covalently immobilized using microbial Scleroglucan gel beads, which improved the immobilization yield, efficiency, and operational stability. Over a wide pH range (6-7.5), the covalent immobilization of xylanase on scleroglucan increased xylanase activity compared to that of its free form. Additionally, the reaction temperature was increased to 65 °C. However, the immobilized enzyme demonstrated superior thermal stability, sustaining 80.22% of its original activity at 60 °C for 120 min. Additionally, the full activity of the immobilized enzyme was sustained after 12 consecutive cycles, and the activity reached 78.33% after 18 cycles. After 41 days of storage at 4 °C, the immobilized enzyme was still active at approximately 98%. The immobilized enzyme has the capability to produce xylo-oligosaccharides (XOSs). Subsequently, these XOSs can be coadministered alongside carbimazole to mitigate the adverse effects of the drug on the adrenal glands. In addition to accelerating the regeneration of adrenal gland cells, XOS significantly decreases the oxidative stress caused by obesity.

The adrenal gland is one of the common sites of metastasis and distinguishing metastatic diseases from adrenal primary neoplasms is essential for accurate clinical management of patients. Our study aimed to elucidate the spectrum and clinicopathologic features of metastatic solid tumors to the adrenal gland at an academic institution, with special focus patients presented with solitary adrenal masses without previously known malignancies. Our departmental database (2013-2022) was retrospectively searched and 129 patients with metastatic solid tumors involving the adrenal gland were identified. The median age at the initial diagnosis of metastatic diseases was 64 years old (range, 54-70 years). The majority of the diseases were presented as unilateral (n=118) or unifocal (n=119) involvement. Most patients had known prior or concurrent malignancies (n=125), whereas adrenal gland involvement was the initial clinical presentation in 4 patients. The most common primary carcinomas included renal cell carcinoma (n=84), lung adenocarcinoma (n=21), urothelial carcinoma (n=3) and hepatocellular carcinoma (n=3). In 104 (80 %) patients with available follow up (median of 39 months, ranging 0-81 months), 43 patients died of disease. Metastatic diseases are usually exercised in the differential diagnosis when there is clinically known malignant primary. In patients without clinical known malignancies, close clinical and radiologic correlation and thorough relevant clinical work up are critical, because clinical occult malignancy may metastasize to the adrenal gland as a solitary mass at the initial presentation, although it is rare.

Laparoscopic adrenalectomy is worldwide currently considered the gold standard technique for patients suffering from benign lesions. There has been an increasing number of robotic-assisted adrenalectomies in the last decade due to the systematic further development of minimally invasive surgery resulting in the implementation of robot-assisted surgery. Interestingly, the available studies show some perioperative advantages for robotic surgery but overall the current evidence is weak and there are economic aspects that are not negligible. Therefore, further high-quality studies about robotic-assisted adrenalectomy are mandatory to strengthen the current evidence.
UNASSIGNED: Die laparoskopische Adrenalektomie ist bei benignen Raumforderungen der Nebenniere der therapeutische Goldstandard. Durch die stetige Weiterentwicklung der minimal-invasiven Chirurgie mit Einführung der roboterassistierten Chirurgie ist es in den letzten Jahren zu einem stetigen Anstieg robotisch assistierter Adrenalektomien gekommen. Die aktuelle Evidenzlage verspricht gewisse perioperative Vorteile für die Robotik, bei jedoch insgesamt als noch schwach zu wertender Evidenzlage und nicht zu ignorierenden ökonomischen Belastungen. Weitere qualitativ hochwertige Studien zur robotischen Adrenalektomie sind daher dringend notwendig.

BACKGROUND: Asthma is routinely treated with inhaled corticosteroids (ICS). Asthma patients on ICS are at increased risk of adrenal suppression, a potentially serious effect of long-term glucocorticoid exposure; however, this relationship is poorly understood. Therefore, this study aims to identify metabolite biomarkers related to adrenal suppression in asthma patients taking ICS.
METHODS: A total of 571 urine metabolites from 200 children with asthma on ICS in the Pharmacogenetics of Adrenal Suppression with Inhaled Steroids (PASS) cohort were profiled. Samples were grouped by peak plasma cortisol measurement as adrenal sufficient (>350 nmol/L) or insufficient (≤350 nmol/L) (outcome). Regression and discriminant-based statistical models combined with network analyses were utilized to assess relationships between metabolites and the outcome. Finally, prioritized metabolites were validated using data from an ancillary study of the Childhood Asthma Management (CAMP) cohort with similar characteristics to PASS.
RESULTS: Ninety metabolites were significantly associated with adrenal suppression, of which 57 also could discriminate adrenal status. While 26 metabolites (primarily steroids) were present at lower levels in the adrenal insufficient patients, 14 were significantly elevated in this group; the top metabolite, mannitol/sorbitol, was previously associated with asthma exacerbations. Network analyses identified unique clusters of metabolites related to steroids, fatty acid oxidation, and nucleoside metabolism, respectively. Four metabolites including urocanic acid, acetylcarnitine, uracil, and sorbitol were validated in CAMP cohort for adrenal suppression.
CONCLUSIONS: Urinary metabolites differ among asthma patients on ICS, by adrenal status. While steroid metabolites were reduced in patients with poor adrenal function, our findings also implicate previously unreported metabolites involved in amino acid, lipid, and nucleoside metabolism.