Search Results

Pathogenesis Historically , tumours arising from the neuroendocrine cells were referred to as ‘karzinoide’ (carcinoma-like) tumours by Oberndorfer. Now they are termed neuroendocrine tumours (NETs). NETs can be either benign or malignant. In the gastrointestin...

Physiology of the endocrine pancreas The endocrine cells of the pancreas are grouped in the islets of Langerhans, which constitute approximately 1–2% of the Theodor Kocher , 1841–1917, Professor of Surgery , Berne, Switzerland, awarded the Nobel Prize in P...

SURGERY OF THE ADRENAL GLANDS Since its description in the 1990s by Gagner, laparoscopic adre - nalectomy has become the gold standard in the resection of adrenal tumours, except for tumours with signs of malignancy . Since then, the retroperitoneoscopic modi...

Small intestine Incidence Midgut carcinoids are the most common NETs with a peak age of diagnosis at 60–70 years. They are the second most common small bowel malignancy . Pathology They arise from the enterochroma ffi n cells and secrete sero tonin and substanc...

Stomach Incidence These are rare with an incidence of 0.2 per 100 /uni00A0 000 population per year. Pathology There are three types: 1 Type I polyps: associated with atrophic gastritis with high pH and gastrin levels. 2 Type II polyps/small tumours (<1 /uni00...

Treatment Medical Metyrapone or ketoconazole therapy reduces steroid synthesis and secretion by CYP11B1 inhibition and can be used to prepare patients with severe hypercortisolism preoperatively or as primary therapy if surgery is not possible. In patients wh...

ADRENAL HAEMORRHAGE Definition Adrenal haemorrhage is a serious condition that can result in adrenal insu ffi ciency , shock, acute adrenal crisis and mortality if not managed with adequate treatment. The adrenal glands are, per weight of tissue, one of the mo...

ADRENAL INSUFFICIENCY Adrenal insu ffi ciency may be primary , secondary or tertiary . Primary insu ffi ciency (Addison’s disease) is due to adreno - cortical disease, whereas secondary and tertiary insu ffi ciency arise from pituitary and hypothalamic pathology , r...

ANATOMY Adrenal glands The weight of a normal adrenal gland is approximately 4 /uni00A0 g. The adrenal glands are paired and situated in the retroperi - - toneum, near the upper poles of the kidneys, within Gerota’s - capsule. They are not symmetrical. The r...

Acute adrenal insufficiency (adrenal or Addisonian crisis) This is a medical emergency . Owing to its non-specific features (shock with some or all of the following: fever, nausea, vomiting, abdominal pain, hypoglycaemia and electrolyte imbalance), it can be di...

Adrenocortical carcinoma Definition ACC is a rare aggressive malignancy that arises from the adrenal cortex. The prognosis is variable but is generally poor, in part owing to its tendency to present at a late stage. Although most ACCs are sporadic, a minority o...

Chronic adrenal insufficiency Patients with chronic adrenal insu ffi ciency may also be di ffi cult to diagnose because symptoms appear insidiously over time. They may experience anorexia, weakness and nausea and, in the case of primary adrenal insu ffi ciency , hyp...

Congenital adrenal hyperplasia (adrenogenital syndrome) Virilisation and adrenal insu ffi ciency in children are pathog - nomonic of congenital adrenal hyperplasia (CAH). This is an autosomal recessive disorder caused by a variety of enzy - matic defects in th...

Conn’s syndrome (primary hyperaldosteronism) Definition First described in 1957 in a patient with hypertension and low serum potassium, primary hyperaldosteronism (PA) now comprises a heterogeneous group of disorders characterised by hypertension and inappropr...

Cushing’s syndrome Definition Hypercortisolism may arise as a result of excess ACTH secretion (termed pituitary dependent; Cushing’s disease), ectopic ACTH secretion from a non-pituitary tumour, exogenous corticosteroid therapy or autonomous secretion of endog...

EMBRYOLOGY There are two distinct functional units in the adrenal gland: cortex and medulla. The cortex is derived from the mesoderm. At about the fifth week of life the fetal cortex develops; this is subsequently surrounded by a second wave of mesothelial ce...

Extra-adrenal paraganglia Paraganglia are neuroendocrine cells associated with the autonomic nervous system. They can be adrenal (medulla) or extra-adrenal. Extra-adrenal paraganglia occur throughout the sympathetic nervous system and along some branches of t...

INCIDENTALOMA Definition An asymptomatic adrenal mass detected on imaging not performed for suspected adrenal disease is termed an inciden taloma. The aetiology includes benign and malignant tumours of the cortex and medulla or of extra-adrenal origin. These ...