Adrenal venous sampling (AVS) is the gold standard for identifying aldosterone-producing adenoma and bilateral adrenal hyperplasia. This study reports the success rate of AVS and the distribution characteristics of the right adrenal vein orifice (RAVO). The data of 166 patients with primary hyperaldosteronism who underwent AVS in Fuwai Central China Cardiovascular Hospital were retrospectively reviewed. A single experienced cardiologist with 8 years of experience in cardiovascular intervention performed AVS on the included patients and separately drew 3 mL of blood from each adrenal vein and inferior vena cava. Successful catheterization was confirmed by cortisol ratio (the ratio of the cortisol concentration of each adrenal vein to that of the peripheral vein), and the distribution characteristics of the RAVO were recorded. The success rates of right and left blood samplings were 91.0% and 94.6%, respectively. The success rate of bilateral blood samplings was 86.1%. The success of right blood samplings was higher in patients with a higher body mass index (p = 0.03). The 151 patients whose right blood samplings were successful were divided into five groups according to RAVO location. In 130 (86.1%) of the 151 patients, the RAVO was located at a level ranging from the upper segment of T11 to the lower segment of T12. Age and serum creatinine levels showed statistical significance among the five groups (p = 0.001). These findings provide a practical anatomical roadmap for operators, suggesting that focusing the initial search for the RAVO between T11 and T12, especially in younger and heavier patients, could improve cannulation efficiency and success rates.

Ganglioneuromas are benign neoplasms of the neuroblastic tumor family, primarily arising from neural crest cells within the sympathetic nervous system. They are often asymptomatic and detected incidentally upon imaging for different conditions, commonly found in the mediastinum, retroperitoneum, and adrenal glands. This case report described the diagnosis and management of a 40-year-old female with a retroperitoneal ganglioneuroma featuring mesenteric involvement. The nonspecific imaging features and clinical presentation necessitated histological examination, which ultimately confirmed the diagnosis of a ganglioneuroma of mesenteric origin. The patient underwent complete surgical resection with an uneventful recovery and remains free of recurrence 15 years post-treatment. This case underscores the importance of integrating clinical, radiological, and histological findings to differentiate GNs from other soft tissue abdominal masses.

Description of the clinical presentation and tumor behavior, its general and pathological characteristics, diagnostic and therapeutic approaches, as well as treatment outcomes in children with neuroblastoma (NB) at a single-center. Special focus was placed on the duration of the diagnostic process and the correlation between disease stage, presence of metastases, and treatment outcomes. Given the small cohort, this report is presented as a descriptive case series complemented by a focused review of the literature NB. A retrospective study was conducted for the time period from January 1st, 2010, to December 31st, 2024. The study included 13 patients (7 males, 6 females; median age: 44 months; range, 0-114) diagnosed with NB who underwent surgery and were hospitalized at the Department of Pediatric Surgery, Clinical Center of the University of Sarajevo. Demographic, clinical, biochemical, radiological, and treatment data were extracted from medical records. A narrative review of major published NB cohorts was conducted to compare our observations with existing evidence. The median age at diagnosis was 44 months. The largest number of patients were in the age group of 2-4 years, and most presented with stage four disease (according to International Neuroblastoma Staging System classification). The tumor was located in the adrenal gland in 92.3% of cases. The median survival time was 36 months. Patients had elevated serum neuron-specific enolase, urinary vanillylmandelic acid, as well as blood ferritin and lactate dehydrogenase levels. The most common symptoms were loss of appetite, presence of a palpable mass, and abdominal pain. Metastases were present in 76.9% of patients, and stage four was associated with aggressive metastatic dissemination. A multimodal approach was used in treatment. The median time from symptom onset to primary care physician consultation was 12 days, and the median time from physician consultation to diagnosis was 14 days. Relapse occurred in 46.2% of cases, most frequently in patients with stage four disease. A total of 7 patients (46.2%) survived. Advanced-stage disease at diagnosis, metastatic burden, and unfavorable outcomes, are dominating factors in our single-center experience. When compared with larger published cohorts, our findings align with global patterns. Due to inherent sample size limitations, these observations are hypothesis-generating and the need for larger, multicenter studies remains.

Clear cell sarcoma (CCS) and malignant melanoma share overlapping immunohistochemical profiles, particularly SOX10 and HMB45 positivity, making histopathological differentiation challenging. Distinguishing between these entities is clinically essential due to their differing prognoses and therapeutic approaches. This case highlights how fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography ([18] F-FDG PET/CT) contributed decisively to establishing the diagnosis of CCS by following a pathologist-recommended diagnostic algorithm. A 70-year-old male presented with a progressively enlarging left scapular mass. Tru-cut biopsy revealed a malignant neoplasm positive for SOX10 and HMB45, with immunohistochemistry insufficient to differentiate CCS from metastatic melanoma. The pathology report recommended a search for a primary cutaneous melanoma, indicating that in the absence of such a lesion, the diagnosis should favor CCS. Whole-body [18] F-FDG PET/CT demonstrated extensive metastatic disease involving the lungs, left adrenal gland, T11 vertebra, scapula, and a large presacral mass. Critically, no hypermetabolic cutaneous, mucosal, or nodal lesions suggestive of a primary melanoma were identified. Comprehensive dermatological evaluation was also negative for suspicious melanocytic lesions. Based on the diagnostic algorithm, histopathology, plus exclusion of a primary melanoma, the PET/CT findings supported the diagnosis of metastatic CCS. This case demonstrates that [18] F-FDG PET/CT can serve as a diagnostic tool when histopathology alone is inconclusive. The absence of a primary melanoma on whole-body [18] F-FDG PET/CT and clinical examination was the decisive factor favoring CCS over melanoma of unknown primary. This case underscores the limitations of MRI, which often describes CCS as a well-defined, benign-appearing mass, potentially delaying accurate diagnosis.

Adult adrenal neuroblastoma is an extremely rare malignancy, accounting for less than 1% of neuroblastoma cases. We report the case of a 27-year-old male with a right adrenal mass, diagnosed as poorly differentiated neuroblastoma. Despite adrenalectomy and adjuvant chemotherapy, the disease metastasized to retroperitoneal lymph-nodes and liver, leading to death from neoplastic progression. This report highlights the rarity, diagnostic complexity and poor prognosis of adult adrenal neuroblastoma.

Objective: This study compared fetal adrenal gland ultrasound parameters between pregnancies complicated by fetal growth restriction (FGR) diagnosed according to Delphi consensus criteria and gestational-age-matched normally grown controls, and interpreted their apparent discriminatory performance cautiously. Methods: This prospective single-center case-control study with a cross-sectional ultrasound assessment enrolled 60 singleton pregnancies (30 FGR, 30 controls) between 24 and 41 weeks' gestation. Controls were recruited contemporaneously from the same unit and had normal fetal biometry and Doppler findings. All examinations were performed using a Voluson E8 system by a single experienced operator; operator blinding to group status was not feasible in routine clinical practice. Standard fetal biometry and Doppler indices (umbilical artery [UA] PI, middle cerebral artery [MCA] PI, uterine artery [UtA] PI) were recorded and the cerebroplacental ratio (CPR) was calculated. Fetal adrenal assessment included the total adrenal gland volume, fetal zone (FZ) width, and middle adrenal artery (MAA) Doppler PI. Results: Maternal age, body mass index, and gestational age at scan were similar between groups (p > 0.05). Compared with controls, the FGR group had higher UA PI and UtA PI and lower MCA PI and CPR (all p < 0.001). Absolute adrenal gland volume was lower in FGR (0.46 ± 0.03 vs. 0.68 ± 0.04 cm[3]; mean difference -0.22 cm[3], 95% CI -0.24 to -0.20; p < 0.001), and FZ width was smaller (median 4.70 vs. 6.55 mm; Hodges-Lehmann shift -1.80 mm, 95% CI -2.00 to -1.70; p < 0.001). MAA PI was higher in FGR (2.44 ± 0.14 vs. 1.79 ± 0.12; mean difference 0.65, 95% CI 0.58-0.72; p < 0.001). In this selected case-control dataset, adrenal volume, FZ width, and MAA PI each showed apparent complete separation (empirical AUC = 1.00); however, these findings should be interpreted cautiously because absolute adrenal measures were not adjusted for fetal size and such performance may reflect spectrum effects in a relatively small sample. Conclusions: In pregnancies with Delphi-defined FGR, absolute fetal adrenal volume and fetal zone width were lower, and MAA PI was higher than in controls. These findings should be considered hypothesis-generating and require external validation in larger multicenter cohorts using standardized and size-adjusted measurement approaches before clinical implementation.

Adrenocortical carcinomas (ACCs) are rare, aggressive tumors often discovered incidentally. These malignancies may present with abnormal hormone secretion or, as in some cases, as non-functioning masses causing discomfort. We present a case of brain metastasis in a patient with a giant ACC. A 50-year-old man presented with headache and dizziness. A computed tomography (CT) scan showed an intracranial lesion within the parenchyma measuring 73*60*46 mm with left internal temporal involvement, abundant vasogenic edema and compressing the lateral left ventricle. Further imaging investigations identified a large necrotic tissue mass measuring 15 cm, located on both sides of the right diaphragmatic dome, in the middle posterior region. Hormonal workup was conducted and excluded a functional adrenal tumor. A CT-guided biopsy was performed, confirming ACC. Despite medical management, the patient's condition deteriorated rapidly, with the cerebral metastasis proving fatal. This case underscores the challenges posed by advanced ACC, particularly when associated with atypical metastatic sites. Giant ACC, though rare, presents significant diagnostic and therapeutic challenges. Surgical excision with appropriate oncologic management can lead to favorable outcomes. This report contributes to the limited literature on cerebral metastases in ACC, aiming to enhance awareness among clinicians managing this rare entity.

Objective: ZhiZhu Kuanzhong (ZZKZ) capsule, a Chinese herbal extract, is extensively employed for the clinical management of functional dyspepsia (FD) in China. This study aimed to elucidate the therapeutic efficacy and underlying mechanisms of ZZKZ on the co-morbidity of anxiety and depression of FD. Methods: The FD model was established in Sprague-Dawley rats via neonatal gastric irritation with 0.1% iodoacetamide. Subsequently, FD rats were gavaged with ZZKZ or fluoxetine. Depression-like behaviors were evaluated using the sucrose preference test (SPT) and forced swimming test (FST), while anxiety-like behaviors were assessed via light-dark box (LDB) and open field tests (OFTs). Network pharmacology and molecular docking were conducted to explore the mechanisms of ZZKZ's action. Hippocampal levels of monoamine neurotransmitters and monoaminergic system components were evaluated by HPLC and RT-qPCR, respectively. Serum concentrations of HPA axis hormones were determined by ELISA. Results: ZZKZ administration reversed the deficits in body weight gain and food intake in FD rats. Behaviorally, ZZKZ increased sucrose consumption in SPT and prolonged swimming duration in FST, and it increased duration and entries into the central zone in OFT. According to the prediction of network pharmacology, ZZKZ treatment elevated hippocampal levels of 5-HT/NE/DA, increased expression of TPH2/TH, and decreased expression of MAOA/SERT in FD rats. Molecular docking further confirmed high-affinity binding between core ingredients of ZZKZ and TPH2/TH/MAOA/SERT. Moreover, ZZKZ administration attenuated the stress-induced elevation of serum CRH/ACTH/CORT. Conclusions: ZZKZ effectively ameliorates the disordered gut-brain interaction and mitigates anxiety-like and depression-like behaviors, which might be modulated by the hippocampal monoaminergic system and hypothalamic-pituitary-adrenal axis response.

Adrenocortical carcinoma (ACC) is a rare, aggressive malignancy with symptoms arising from mass effect or hormonal excess, particularly hypercortisolism. Accurate diagnosis requires comprehensive clinical, hormonal, radiologic, and histopathologic evaluation. Surgical resection is the only curative treatment. Treatment decisions are guided by risk stratification based on stage, Ki67 index, and resection margin status. Mitotane, the only Food and Drug Administration-approved drug for ACC, is combined with etoposide, doxorubicin, and cisplatin as the standard treatment for patients with recurrent disease. Investigational therapies include tyrosine kinase inhibitors, immune checkpoint inhibitors, image-guided locoregional therapies, radiation therapy, and cell-based therapies.

Primary aldosteronism (PA) is now recognized as a prevalent disorder that contributes to hypertension and cardiovascular disease. Updated Endocrine Society guidelines recommend universal screening for primary aldosteronism among people with hypertension using a streamlined approach to diagnosis that emphasizes the recognition of renin-independent aldosterone production and de-emphasizes the use of aldosterone suppression tests. Emerging molecular imaging modalities may further transform PA subtyping. Treatment options and efficacy for primary aldosteronism continue to expand, with surgery remaining the gold standard for lateralizing PA, while adrenal or adrenal arterial ablation, steroidal and nonsteroidal mineralocorticoid receptor antagonists, and aldosterone synthase inhibitors offer promising alternatives.

Adrenal incidentalomas are a modern-day problem, which has slowly been met by modern day technological innovations. Further characterization of adrenal masses with evolving imaging techniques, urine metabolomics, and machine learning has continued to evolve. Nevertheless, there is much to uncover regarding the natural history of adrenal nodules and consensus regarding cutoffs for intervention. Costs of routine follow-up, which include financial, psychological, and medical, need to be carefully weighed against the benefits.

Pheochromocytoma is a rare neuroendocrine tumor characterized by excessive catecholamine secretion, typically presenting with hypertension, headache, palpitations, and sweating. Giant pheochromocytomas (commonly defined as tumors with diameter >4-6cm) are even rarer and may lead to severe cardiovascular complications, including catecholamine-induced cardiomyopathy and thromboembolic events. We report the case of a 76-year-old female who presented with acute pulmonary embolism and heart failure as the initial features of a giant pheochromocytoma, with concurrent deep vein thrombosis and catecholamine- induced cardiomyopathy. Laboratory tests revealed markedly elevated catecholamine metabolites, while imaging confirmed a right adrenal mass measuring 11.1×7.9 cm, along with bilateral pulmonary artery emboli and left lower extremity deep vein thrombosis. After multidisciplinary evaluation, the patient was managed with α- and β-blockers, anticoagulation, and subsequent surgical resection of the tumor. Postoperative follow-up showed significant improvement in cardiac function and complete resolution of thrombotic events. This case demonstrates the importance of including pheochromocytoma in the differential diagnosis of patients with unexplained thromboembolism or cardiovascular collapse, particularly when an adrenal mass is identified on imaging. Early diagnosis, multidisciplinary management, and timely intervention are crucial for favorable outcomes in such complex and life-threatening presentations.