title: Laparoscopic adrenalectomy for nonfamilial adrenal medullary hyperplasia.
abstract: OBJECTIVE
  Sporadic adrenomedullary hyperplasia (AMH) is characterized by a medical history of hypertension, excessive catecholamine excretion, and histomorphometric evidence of increased adrenomedullary tissue relative to the cortex in the absence of multiple endocrine neoplasia. The aim of this study was to perform a retrospective analysis of patients after laparoscopic adrenalectomy for AMH, an early form of sporadic adrenal medulla-related endocrine hypertension, as well as to update our understanding of the clinical features and management of this clinicomorphologic entity.
  
  
  METHODS
  We performed a retrospective review of the medical records of patients operated on between 2007 and 2011 at Reina Sofia University General Hospital, Murcia, Spain, with a diagnosis of AMH. Patient characteristics, diagnostic studies, surgical procedures, and histologic findings were analyzed.
  
  
  RESULTS
  Seven hypertensive patients with intermittent adrenergic crises were found to have AMH (3 men and 4 women; mean age, 44 years). Catecholamine levels were increased. Radiologic studies included 1 or more of the following: magnetic resonance imaging, computed tomography, positron emission tomography imaging with fluorodeoxyglucose, dihydroxyphenylalanine-positron emission tomography-computed tomography, Octreoscan (Mallinckrodt Pharmaceuticals, St. Louis, MO, USA) and (123)I-metaiodobenzylguanidine scintigraphy. Laparoscopic adrenalectomy was performed in all cases. One patient underwent bilateral adrenalectomy because of persistent symptomatology after unilateral adrenalectomy. Surgery was associated with normalization of catecholamine hypersecretion and complete disappearance of symptoms, as well as the reduction or abstention of antihypertensive therapy.
  
  
  CONCLUSIONS
  Sporadic AMH is a clinicomorphologic entity that may mimic pheochromocytoma clinically. Recent advances in diagnostic and surgical methods have changed the management and outcome of this unusual disease. Laparoscopic adrenalectomy may be recommended as the gold standard in the treatment of this entity. Definitive diagnosis is provided by histologic study.
authors.affiliation: General and Digestive Surgery Department, General University "Reina Sofía" Hospital, Avda Intendente Jorge Palacios 3, 30003 Murcia, Spain. miguel_ruizmarin@yahoo.es.
authors.forename: Miguel Ruiz
authors.initials: MR
authors.lastname: Marín
authors.forename: Maria Fe Candel
authors.initials: MF
authors.lastname: Arenas
authors.forename: Francisco Miguel González
authors.initials: FM
authors.lastname: Valverde
authors.forename: Emilio Terol
authors.initials: ET
authors.lastname: Garaulet
authors.forename: María Maestre
authors.initials: MM
authors.lastname: Maderuelo
authors.forename: Amparo Meoro
authors.initials: AM
authors.lastname: Avilés
authors.forename: Francisco Pastor
authors.initials: FP
authors.lastname: Quirante
authors.forename: Antonio Albarracín Marín
authors.initials: AA
authors.lastname: Blázquez
mesh_terms: D000307:Adrenal Gland Diseases / Q000175:diagnosis / Q000601:surgery*; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D010673:Pheochromocytoma / Q000175:diagnosis; D012189:Retrospective Studies
references.citation: Acta Pathol Jpn. 1990 Sep;40(9):683-6
references.pmid: 2260475
references.citation: JAMA. 2002 Mar 20;287(11):1427-34
references.pmid: 11903030
references.citation: Surgeon. 2011 Dec;9(6):300-4
references.pmid: 22041640
references.citation: N Engl J Med. 2002 May 9;346(19):1459-66
references.pmid: 12000816
references.citation: World J Surg. 1990 May-Jun;14(3):308-15; discussion 316
references.pmid: 2368434
references.citation: Best Pract Res Clin Endocrinol Metab. 2006 Sep;20(3):483-99
references.pmid: 16980207
references.citation: Clin Endocrinol (Oxf). 1997 Nov;47(5):613-7
references.pmid: 9425401
references.citation: Mayo Clin Proc. 1975 Jan;50(1):3-10
references.pmid: 1110583
references.citation: Hum Pathol. 1980 Nov;11(6):650-7
references.pmid: 7450738
references.citation: J Clin Oncol. 2011 Mar 10;29(8):e200-2
references.pmid: 21172883
references.citation: J Visc Surg. 2011 Sep;148(4):e250-61
references.pmid: 21820984
references.citation: Endokrynol Pol. 2011;62(6):512-6
references.pmid: 22144217
references.citation: Fam Cancer. 2005;4(1):61-8
references.pmid: 15883712
references.citation: J Endocrinol Invest. 2008 May;31(5):450-8
references.pmid: 18560264