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Adrenal Gland Disorders01:27

Adrenal Gland Disorders

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Adrenal gland disorders manifest when the production of adrenal hormones deviates from the norm, resulting in either excessive or insufficient concentrations.
Adrenal insufficiency, characterized by insufficient cortisol and aldosterone production, leads to conditions like Addison's disease. This disorder, affecting the adrenal cortex, exhibits symptoms such as skin bronzing, dehydration, low blood pressure, fatigue, and weight loss. Congenital adrenal hyperplasia, a genetic ailment causing...
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Under normal conditions, most adult cells remain in a non-proliferative state unless stimulated by internal or external factors to replace lost cells. Abnormal cell proliferation is a condition in which the cell's growth exceeds and is uncoordinated with normal cells. In such situations, cell division persists in the same excessive manner even after cessation of the stimuli, leading to persistent tumors. The tumor arises from the damaged cells that replicate to pass the damage to the...
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Hormones, the biochemical messengers produced by endocrine glands, are pivotal in regulating bodily functions and maintaining homeostasis. Each hormone's balance is crucial; imbalances can lead to significant physiological disruptions. Major hormones include oxytocin, cortisol, epinephrine, estrogen, testosterone, thyroxine, growth hormone, insulin, and glucagon.
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The Parathyroid Glands00:59

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The two pairs of parathyroid glands embedded within the posterior surface of the thyroid gland are restricted by a dense capsule around them. These glands comprise two distinct cell populations—parathyroid oxyphil and parathyroid principal cells- pivotal in calcium homeostasis.
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Indirect-acting adrenergic agonists potentiate the effects of endogenous catecholamines through different mechanisms without directly binding to adrenoceptors.
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Sympathetic Pathways: Collateral Ganglia and Adrenal Medulla01:27

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The sympathetic pathways of the collateral ganglia and adrenal medulla serve unique but interconnected roles in the sympathetic response.
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Biochemically 'active' pheochromocytoma can be clinically 'silent'.

Shinjan Patra1, Abhishek Choube2, Chandrakant Munjewar3

  • 1Department of Endocrinology and Metabolism, All India Institute of Medical Sciences Kalyani, Kalyani, West Bengal, India.

Endocrinology, Diabetes & Metabolism Case Reports
|November 24, 2025
PubMed
Summary

This case highlights that large adrenal masses can be pheochromocytomas, even without high blood pressure. Early diagnosis and treatment are crucial for managing this rare adrenal tumor.

Keywords:
adrenalnormotensive pheochromocytomaplasma free normetanephrinesecondary diabetes

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Area of Science:

  • Endocrinology
  • Oncology
  • Surgical Pathology

Background:

  • Pheochromocytomas are rare tumors arising from chromaffin cells, typically in the adrenal medulla.
  • Increasingly detected as incidentalomas due to advances in imaging technology.
  • Normotensive presentation occurs in up to 30% of pheochromocytoma cases, despite elevated catecholamines.

Purpose of the Study:

  • To report a case of a large, normotensive pheochromocytoma.
  • To emphasize the importance of considering pheochromocytoma in adrenal incidentalomas, regardless of blood pressure.
  • To discuss potential explanations for normotensive pheochromocytoma.

Main Methods:

  • A 55-year-old woman presented with abdominal pain and a large adrenal mass.
  • Diagnostic workup revealed markedly elevated plasma free normetanephrine.
  • Pre-operative alpha- and beta-adrenergic blockade followed by laparoscopic adrenalectomy.

Main Results:

  • A large right adrenal mass (9.5×8.5×8.7 cm) was diagnosed.
  • Histopathology confirmed pheochromocytoma with a characteristic 'zellballen' pattern.
  • The patient experienced an uneventful surgical recovery.

Conclusions:

  • Adrenal incidentalomas require thorough evaluation for pheochromocytoma, even in normotensive patients.
  • Normotension in pheochromocytoma can be attributed to factors like tumor size, dopamine secretion, and receptor desensitization.
  • Prompt diagnosis and appropriate pre-operative blockade are essential for successful surgical management.