Displaying publications 1 - 20 of 34 in total

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  1. Fulltext An audit of management of patients with borderline increased plasma-free metanephrines
    Anas SS, Vasikaran SD
    Ann. Clin. Biochem., 2010 Nov;47(Pt 6):554-8.
    PMID: 20926470 DOI: 10.1258/acb.2010.010131
    BACKGROUND: Measurement of plasma-free metanephrine plus normetanephrine (PFM) is the best screening test for phaeochromocytoma. While clearly raised levels are diagnostic, borderline increases may be associated with factors such as stress and medications, and should prompt a repeat study after interfering factors are withdrawn.
    METHODS: PFM results reported by a teaching hospital laboratory over a 12-month period were extracted from the laboratory information system. All borderline raised results were examined for a subsequent repeat test (as recommended by attached interpretative comment) and those not repeated were followed up by examination of case-notes or questionnaires to doctors.
    RESULTS: Of 111 patients with borderline increased PFM which did not normalize on repeat measurement, 33 were from the hospital and 78 from outside locations. Hospital notes for 27 out of 33 hospital-patients (82%) could be reviewed, and 49 completed questionnaires (63% of 78 sent out) were received from outside locations. Of these 76 patients thus followed up, the test was not repeated in 55 (72%) cases with borderline increased PFM. Of 10 patients with an adrenal mass and borderline PFM, only three had PFM repeated. Of another nine patients with undetermined final diagnosis and borderline PFM, only three had the test repeated.
    CONCLUSION: Seventy-two per cent of borderline increased PFM results were not followed up with appropriate repeat testing, potentially leading to missed detection of phaeochromocytoma. A stronger interpretative comment may encourage appropriate repeat testing in more cases with borderline increased PFM and suspected phaeochromocytoma.
    Matched MeSH terms: Adrenal Gland Neoplasms/blood; Adrenal Gland Neoplasms/diagnosis
  2. Huge adrenal haemangioma
    Hisham AN, Samad SA, Sharifah NA
    Australas Radiol, 1998 Aug;42(3):250-1.
    PMID: 9727258
    Adrenal tumours are either functioning or non-functioning. Non-functioning adrenal tumours are generally asymptomatic and usually of enormous proportions at the time of presentation. A case is presented here of a patient with a huge right adrenal haemangioma which was successfully treated surgically. This unusual tumour was 25 cm in diameter, was well encapsulated and weighed 4 kg. The literature pertaining to this interesting case is reviewed.
    Matched MeSH terms: Adrenal Gland Neoplasms/surgery
  3. Screening for phaeochromocytoma in patients with acute cerebrovascular disease: Is it necessary?
    Mohamed Zainuddin N, Sthaneshwar P, Ratnasingam J
    Malays J Pathol, 2020 Aug;42(2):203-207.
    PMID: 32860372
    INTRODUCTION: Phaeochromocytoma may present with uncontrolled hypertension leading to haemorrhagic stroke (HS), ischaemic stroke (IS) and transient ischaemic attack (TIA). False elevation in the levels of CATS/ METS has been reported in acute cerebrovascular disease. Our aim was to analyse the frequency and pattern of elevations of CATS/METS in patients with acute cerebrovascular disease and to determine associated factors.

    MATERIALS AND METHODS: This is a retrospective study of 112 samples of CATS/ METS received by the laboratory over a two-year period, from patients with acute cerebrovascular disease. CATS/METS were measured using LC/MS/MS method. Clinical details and CATS/METS level were obtained from the database. Mann-Whitney U test and Kruskal Wallis test were used for statistical analysis. These statistical analyses were performed using SPSS v.20.0 (IBM Corp., Armonk, NY, USA).

    RESULTS: Of the 112 patients, 39% had HS, 54% had IS and 7% had TIA. A total of 29% of patients had elevated CATS/ METS. Elevated levels of CATS/METS were noted in 41% and 25% of HS and IS patients, respectively (p=0.53). Median norepinephrine, epinephrine and metanephrine levels in HS were significantly higher than IS (p< 0.05). Systolic blood pressure was higher in those who had elevated CATS/ METS (p=0.04). Only for two patients with elevated CATS/METS repeat testing was performed. Age, diastolic blood pressure and the time of sample collection in relation to the presentation, for CATS/METS were not significantly different between groups that had elevated levels of CATS/ METS versus those who did not.

    CONCLUSION: We noted that CATS/METS were elevated in one-third of patients, especially in patients with high systolic blood pressure. Increase in CATS/METS should be appropriately followed up with repeat testing. Since false elevation in CATS/METS has been reported in cerebrovascular disease, screening for phaeochromocytoma is best deferred for a month.

    Matched MeSH terms: Adrenal Gland Neoplasms/diagnosis
  4. The challenge of improving the diagnostic yield from metanephrine testing in suspected phaeochromocytoma and paraganglioma
    Samsudin I, Page MM, Hoad K, Chubb P, Gillett M, Glendenning P, et al.
    Ann. Clin. Biochem., 2018 Nov;55(6):679-684.
    PMID: 29660998 DOI: 10.1177/0004563218774590
    Background Plasma-free metanephrines (PFM) or urinary fractionated metanephrines (UFM) are the preferred biochemical tests for the diagnosis of phaeochromocytoma and paraganglioma (PPGL). Borderline increased results should be followed up to either exclude or confirm diagnosis. Methods We extracted all PFM and UFM results reported by our laboratory over a six-month period from the laboratory information system. We categorized patients with borderline increased results according to whether follow-up testing had been performed as suggested in the initial laboratory report. Questionnaires were then sent to all requesting doctors and medical notes reviewed where available. Results Two hundred and four patients with borderline increased PFM or UFM were identified. Sixty-five (38.5%) of 169 patients with borderline increased PFM had a repeat test out of which 36 were normal and 29 did not normalize. Of 35 patients with borderline increased UFM, 17 (48.6%) had subsequent PFM measurement, out of which 15 were normal. Questionnaires were returned to 106 (52%) patients. Of these, the most frequent indication for testing was hypertension ( n = 50); 15 patients had an incidental adrenal mass and two of these patients were diagnosed with a phaeochromocytoma. Conclusion Only 38% of patients with borderline increased PFM had a repeat PFM measurement. This was not significantly higher when compared with the 28% in a previous audit that we reported in 2010 ( P = 0.10). Forty-nine per cent of patients with a borderline increased UFM had a repeat UFM or PFM measurement. There remains a substantial possibility of missed detection of PPGL.
    Matched MeSH terms: Adrenal Gland Neoplasms/diagnosis*
  5. Epinephrine-secreting pheochromocytoma in a normotensive woman with adrenal incidentaloma
    Sukor N, Saidin R, Kamaruddin NA
    South. Med. J., 2007 Jan;100(1):73-4.
    PMID: 17269532
    Pheochromocytomas are rare neuroendocrine tumors that produce, metabolize, and usually secrete catecholamines. Although hypertension is a common presenting feature of pheochromocytoma, the tumors occur (or are present) in only 0.1% of patients with hypertension. The variability of symptoms and rarity of occurrence render these tumors difficult to diagnose; many are discovered incidentally during radiological examination or at autopsy. A patient is presented with a pheochromocytoma that was discovered incidentally when she presented with abdominal pain and a normal blood pressure.
    Matched MeSH terms: Adrenal Gland Neoplasms/diagnosis; Adrenal Gland Neoplasms/metabolism*; Adrenal Gland Neoplasms/surgery
  6. Fulltext Functioning adrenal adenoma in association with congenital adrenal hyperplasia
    Rohana AG, Ming W, Norlela S, Norazmi MK
    Med J Malaysia, 2007 Jun;62(2):158-9.
    PMID: 18705452 MyJurnal
    We report a case of a young hypertensive male who was first seen in 1998 with a right thalamic haemorrhage and uncontrolled hypertension. CT abdomen showed a right adrenal tumour and a hyperplastic left adrenal gland. Laparoscopic adrenalectomy performed followed by histopathological examination confirmed the diagnosis of adrenal adenoma. He subsequently presented to us again a year later with persistent hyperkalaemia and asymptomatic hyponatraemia. Further investigations strongly suggested the presence of isolated mineralocorticoid deficiency with normal cortisol levels. This was confirmed to be due to partial or late-onset congenital adrenal hyperplasia (CAH). We discuss the association of partial CAH and adrenal tumours and the unmasking of the mineralocorticoid deficiency following adrenalectomy.
    Matched MeSH terms: Adrenal Gland Neoplasms/etiology*; Adrenal Gland Neoplasms/surgery
  7. Fulltext Phaeochromocytoma during pregnancy: ultrasound and MRI appearances
    Puvaneswary M, Beckhouse M
    Med J Malaysia, 1992 Mar;47(1):81-5.
    PMID: 1387457
    Matched MeSH terms: Adrenal Gland Neoplasms/diagnosis*; Adrenal Gland Neoplasms/ultrastructure
  8. Cystic neuroblastoma with colonic fistula
    Thajunnisa bte Hassan Mohd, Yip CH
    Pediatr Radiol, 1988;18(5):406.
    PMID: 3050845
    Neuroblastoma is the most common malignant tumour in infancy originating in about 70% of cases in the adrenal gland. Haemorrhage and necrosis is often seen in neuroblastoma but cyst formation is uncommon. Fistulous communication between an adrenal cystic neuroblastoma and the large bowel has never to our knowledge been reported before.
    Matched MeSH terms: Adrenal Gland Neoplasms/complications*; Adrenal Gland Neoplasms/diagnosis
  9. Fulltext Periadrenal inflammatory myofibroblastic tumour: half a decade before cure
    Abdul Ghani R, Mohamed Shah FZ, Hanafiah M, Abdul Aziz M
    BMJ Case Rep, 2019 Feb 01;12(2).
    PMID: 30709882 DOI: 10.1136/bcr-2018-225687
    A 30-year-old ex-smoker with a background history of childhood asthma presented with worsening shortness of breath despite receiving high doses of oral corticosteroid for pemphigus vulgaris which was diagnosed 5 years earlier. A high-resolution CT examination of the thorax reported non-specific bronchiectatic changes and revealed an incidental suprarenal mass. A subsequent CT scan confirmed a large adrenal mass with areas of necrosis and calcification. Serum renin and aldosterone, urinary catecholamine and 5-hydroxyindoleacetic acid were within normal limits. Surgical intervention was delayed due to difficulty in optimising preoperative respiratory functions. He finally underwent a midline laparotomy for removal of the tumour. Histopathological examinations revealed extrapulmonary inflammatory myofibroblastic tumour arising from the periadrenal soft-tissue, with presence of normal adrenal gland. He showed immediate improvements of his asthmatic symptoms and pemphigus vulgaris following the surgery. His oral steroid was rapidly reduced and he achieved complete remission 2 months later.
    Matched MeSH terms: Adrenal Gland Neoplasms/complications; Adrenal Gland Neoplasms/diagnosis*
  10. A radiological and histological comparison of two unusual adrenal incidentalomas
    Loong S, Selvarajan S, Khor LY
    Malays J Pathol, 2019 Dec;41(3):327-331.
    PMID: 31901917
    INTRODUCTION: The increasing use of radiological imaging studies has given rise to 'incidentalomas'.

    CASE REPORT: We describe two unusual and diverse incidental adrenal gland lesions, an adenomatoid nodule and a mature ganglioneuroma. Both are deemed 'indeterminate' on radiological assessment. On histology, an adenomatoid nodule is composed of variably-dilated thin-walled cysts lined by bland flattened cells and solid areas of tubules lined by eosinophilic cells with plump nuclei and prominent nucleoli. The lining cells are immunoreactive for calretinin and WT1 while negative for CK5/6, ERG and CD31. Mature ganglioneuroma features fascicles of bland spindle cells with intermixed mature ganglion cells disposed within a background myxoid stroma with no immature neuroblastic component. These spindled Schwann cells are S100 positive.

    DISCUSSION: Both adenomatoid nodule and mature ganglioneuroma are rare benign adrenal tumours that need to be differentiated from other, more common adrenal lesions. The management of adrenal incidentalomas is challenging. Surgical excision is indicated if an adrenal incidentaloma is more than 4 cm in size, shows malignant features on imaging or evidence of hormone excess.

    Matched MeSH terms: Adrenal Gland Neoplasms/pathology; Adrenal Gland Neoplasms/therapy*
  11. Cystic pheochromocytoma mimicking a malignant pancreatic cyst
    Lee J, Raman K, Sachithanandan S
    Gastrointest Endosc, 2011 Sep;74(3):712-3.
    PMID: 21111418 DOI: 10.1016/j.gie.2010.09.027
    Matched MeSH terms: Adrenal Gland Neoplasms/diagnosis*; Adrenal Gland Neoplasms/surgery
  12. Fulltext Renal cell carcinoma in a von Hippel-Lindau syndrome: when should phaeochromocytoma be anticipated?
    Azarisman SM, Nor Azmi K
    Singapore Med J, 2007 Aug;48(8):779-82.
    PMID: 17657389
    A 39-year-old man was diagnosed with von Hippel-Lindau syndrome, which was associated with retinal haemangioblastoma, cervical cord haemangioblastoma and bilateral renal cell carcinoma. He subsequently underwent an arterial embolisation and cervical laminectomy, following a spinal angiogram of the cervical lesion. He also had a right radical nephrectomy, with no perioperative complications. However, on admission for the left radical nephrectomy, he was noted to have preoperative hypertension. Further investigation revealed an enlarged left adrenal gland on abdominal computed tomography scan and raised urinary catecholamines. We discuss the risk of renal cell carcinoma and phaeochromocytoma arising concomitantly in von Hippel-Lindau syndrome, and how best to investigate and manage them.
    Matched MeSH terms: Adrenal Gland Neoplasms/complications*; Adrenal Gland Neoplasms/diagnosis
  13. Fulltext Presenting features and treatment outcome of 78 Malaysian children with neuroblastoma
    Ng SM, Abdullah WA, Lin HP, Chan LL
    Southeast Asian J Trop Med Public Health, 1999 Mar;30(1):149-53.
    PMID: 10695803
    To study the distribution of presenting features and their prognostic significance in neuroblastoma treated in a single institution in Malaysia. A retrospective study was made of 78 neuroblastoma cases diagnosed and treated in the University Hospital, Kuala Lumpur, Malaysia between June 1982 and February 1997. Diagnosis was established by standard histological criteria. The presenting features were evaluated for their distribution and prognostic influence. Disease-free survival from diagnosis was the outcome variable of interest. The ages ranged from 0.1 to 11 years old (median: 3 years old). The tumor originated from the adrenal glands in 83% and the majority of cases presented in advanced stage (stage III 22%, stage IV 66%). Bone marrow was the commonest site of distant metastasis occurring in 45% of patients. The main presenting signs and symptoms in decreasing order were pallor, fever, abdominal mass, weight loss, and bone/joint pain. Univariate analysis conferred age, initial stage and Hb level as significant prognostic factors. No influence in disease-free survival was found for sex, race, primary site, urinary vanillylmandelic acid level, white cell count and platelet count. Overall 2-year disease-free survival was achieved in 27 (39%) patients. Four patients underwent bone marrow transplant, three of whom achieved 2-year disease-free survival. The results suggest that age, initial stage and hemoglobin level are significant prognostic factors based on univariate analysis. In addition, more Malaysian children presented with adrenal primary site and advanced disease compared to previous reported studies.
    Matched MeSH terms: Adrenal Gland Neoplasms/complications; Adrenal Gland Neoplasms/diagnosis*; Adrenal Gland Neoplasms/mortality; Adrenal Gland Neoplasms/pathology; Adrenal Gland Neoplasms/therapy*
  14. Unusual Bone Superscan, MIBG Superscan, and 68Ga DOTATATE PET/CT in Metastatic Pheochromocytoma
    Tan TH, Wong TH, Hassan SZ, Lee BN
    Clin Nucl Med, 2015 Nov;40(11):867-8.
    PMID: 26252329 DOI: 10.1097/RLU.0000000000000920
    A 17-year-old adolescent boy with biochemically raised 2-hour urinary metanephrine and normetanephrine as well as CT findings of retroperitoneal soft tissue mass and bony metastases was referred for further assessment. Apart from Ga DOTATATE PET/CT evaluation, pretargeted systemic radionuclide therapy assessment with I-MIBG scintigraphy showed unusual phenomenon of MIBG superscan. Postsurgically, restaging Tc-MDP bone scintigraphy showed typical bone superscan features. The MIBG superscan was better delineated on post-I-MIBG therapy images.
    Matched MeSH terms: Adrenal Gland Neoplasms/pathology; Adrenal Gland Neoplasms/radionuclide imaging*
  15. Endogenous Cushing syndrome from an ectopic adrenocorticotropic hormone production as a rare cause of ocular hypertension
    Khaw KW, Jalaludin MY, Suhaimi H, Harun F, Subrayan V
    J AAPOS, 2010 Aug;14(4):356-7.
    PMID: 20637667 DOI: 10.1016/j.jaapos.2010.04.009
    Ocular hypertension caused by endogenous Cushing syndrome from an ectopic adrenocorticotropic hormone-producing tumor is rare. We report an 11-year-old boy who presented with intraocular pressures (IOPs) of 50 mm Hg in both eyes. Surgical resection of the tumor was performed with subsequent normalization of serum cortisol and IOP levels.
    Matched MeSH terms: Adrenal Gland Neoplasms/complications*; Adrenal Gland Neoplasms/diagnosis; Adrenal Gland Neoplasms/metabolism
  16. Fulltext Pregnancy, Primary Aldosteronism, and Adrenal CTNNB1 Mutations
    Teo AE, Garg S, Shaikh LH, Zhou J, Karet Frankl FE, Gurnell M, et al.
    N Engl J Med, 2015 Oct 08;373(15):1429-36.
    PMID: 26397949 DOI: 10.1056/NEJMoa1504869
    Recent discoveries of somatic mutations permit the recognition of subtypes of aldosterone-producing adenomas with distinct clinical presentations and pathological features. Here we describe three women with hyperaldosteronism, two who presented in pregnancy and one who presented after menopause. Their aldosterone-producing adenomas harbored activating mutations of CTNNB1, encoding β-catenin in the Wnt cell-differentiation pathway, and expressed LHCGR and GNRHR, encoding gonadal receptors, at levels that were more than 100 times as high as the levels in other aldosterone-producing adenomas. The mutations stimulate Wnt activation and cause adrenocortical cells to de-differentiate toward their common adrenal-gonadal precursor cell type. (Funded by grants from the National Institute for Health Research Cambridge Biomedical Research Centre and others.).
    Matched MeSH terms: Adrenal Gland Neoplasms/genetics*; Adrenal Gland Neoplasms/metabolism; Adrenal Gland Neoplasms/pathology
  17. Fulltext Partial adrenal suppression with prolonged use of Depo-Provera
    Nur Aisyah Zainordin, Fatimah Zaherah Mohd Shah, Rohana Abdul Ghani
    Journal of Clinical and Health Sciences, 2019;4(1):64-66.
    MyJurnal
    A 49-year old patient presented with symptoms of adrenal suppression following an attempt to
    withdraw Depo-Provera or Depot Medroxyprogesterone Acetate (DMPA) injection. She had
    been receiving DMPA injections for the past 16 years for contraception. She was initially
    prescribed DMPA by her gynaecologist but later on began obtaining the medication directly
    from a private pharmacy without prior consultation from her gynaecologist. Clinically, she had
    been experiencing significant weight gain and appeared cushingoid. Blood investigations
    confirmed partial adrenal suppression with presence of an adrenal incidentaloma. This case
    reports a known side effect of DMPA but occurring at a much lower dose than previously
    described. It also highlights the need to increase the awareness of the insidious side effect of
    DMPA and to avoid unsupervised use of the drug.
    Matched MeSH terms: Adrenal Gland Neoplasms
  18. Fulltext Solitary adrenal metastasis from invasive infiltrating ductal carcinoma: A case report and review of literature
    Sangeetha Poovaneswaran, Justin Zon Ern Lee, Whei Ying Lim, Navarasi S Raja Gopal, Fauziah Mohd Dali, Ibtisam Mohamad
    International e-Journal of Science, Medicine & Education, 2013;7(1):33-36.
    MyJurnal
    Solitary adrenal metastasis is a rare presentation in breast cancer and it presents the clinician with a difficult therapeutic dilemma as there are no existing guidelines for optimal management. On literature review, we only found one published case report of solitary adrenal metastasis from infiltrating ductal carcinoma of the breast. Here we present a case of a 75 year-old lady who presented with a right breast lump which was subsequently confirmed to be infiltrating ductal carcinoma. She underwent a right mastectomy and axillary clearance. Computerised tomography (CT) staging revealed a solitary adrenal metastasis. She was treated with aromatase inhibitors and her tumour markers which were initially raised has now normalised.
    Matched MeSH terms: Adrenal Gland Neoplasms
  19. Large adrenal leiomyoma presented as adrenal incidentaloma in an AIDS patient: A rare entity
    Huei TJ, Lip HT, Rahman MS, Sarojah A
    Med J Malaysia, 2017 02;72(1):65-67.
    PMID: 28255146 MyJurnal
    The literature on adrenal gland tumour in HIV-infected patients is scarce. We report a 46-year-old Malay man with HIV and Hepatitis C infection presenting with a large nonfunctioning adrenal tumour. Computed tomography showed a large right adrenal tumour with heterogeneous enhancement and central necrosis. A high index of suspicion of a malignant tumour or pheochromocytoma led us to surgical removal of the adrenal gland. In this case report, we highlight important features to look for during pre-op evaluation of a large adrenal mass. Appropriate action should be taken when there is a suspicion of a pheochromocytoma or malignancy.
    Matched MeSH terms: Adrenal Gland Neoplasms
  20. Fulltext Dopamine-secreting phaeochromocytomas and paragangliomas: clinical features and management
    Foo SH, Chan SP, Ananda V, Rajasingam V
    Singapore Med J, 2010 May;51(5):e89-93.
    PMID: 20593136
    Most functional phaeochromocytomas/paragangliomas produce noradrenaline and/or adrenaline. Those that produce dopamine are rare. We describe the distinguishing clinical features of dopamine-secreting phaeochromocytomas and paragangliomas from those that secrete noradrenaline/adrenaline and the impact on their management. We present a case of a dopamine-secreting paraganglioma from our institution and review 14 case reports of dopamine-secreting phaeochromocytomas/paragangliomas published between 1984 and 2008. As observed in the literature, 80% of the tumours were extra-adrenal. Most patients presented with non-specific symptoms or mass effect without the classical presentation of catecholamine excess. The majority were diagnosed with urinary or plasma dopamine. Five patients had malignant tumours and 12 patients underwent surgical resection of the primary tumours. Unlike noradrenaline/adrenaline-secreting phaeochromocytomas/paragangliomas, dopamine-secreting tumours lack a classical presentation, are extra-adrenal and have a higher malignant potential. A routine inclusion of urinary or plasma dopamine as part of catecholamine screening in all suspected phaeochromocytomas and paragangliomas is recommended.
    Matched MeSH terms: Adrenal Gland Neoplasms/pathology; Adrenal Gland Neoplasms/secretion*; Adrenal Gland Neoplasms/surgery
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