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Izawa M, Takeda T, Anno T, Iwasawa T, Yasumizu Y, Tanaka N, Matsumoto K, Morita S, Kosaka T, Mizuno R, Asanuma H, Oya M. Risk factors for postoperative fever after laparoscopic adrenalectomy focusing on hormones produced: a case control study. BMC Urol 2024; 24:90. [PMID: 38637748 PMCID: PMC11025189 DOI: 10.1186/s12894-024-01469-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 03/26/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Laparoscopic adrenalectomy is widely performed for a number of hormone-producing tumors and postoperative management depends on the hormones produced. In the present study, we conducted a retrospective analysis to clarify the risk factors for postoperative complications, particularly postoperative fever after laparoscopic adrenalectomy. METHODS We analyzed 406 patients who underwent laparoscopic adrenalectomy at our hospital between 2003 and 2019. Postoperative fever was defined as a fever of 38 °C or higher within 72 h after surgery. We investigated the risk factors for postoperative fever after laparoscopic adrenalectomy. RESULTS There were 188 males (46%) and 218 females (54%) with a median age of 52 years. Among these patients, tumor pathologies included 188 primary aldosteronism (46%), 75 Cushing syndrome (18%), and 80 pheochromocytoma (20%). Postoperative fever developed in 124 of all patients (31%), 30% of those with primary aldosteronism, 53% of those with pheochromocytoma, and 8% of those with Cushing syndrome. A multivariate logistic regression analysis identified pheochromocytoma and non-Cushing syndrome as independent predictors of postoperative fever. Postoperative fever was observed in 42 out of 80 cases of pheochromocytoma (53%), which was significantly higher than in cases of non-pheochromocytoma (82/326, 25%, p < 0.01). In contrast, postoperative fever developed in 6 out of 75 cases of Cushing syndrome (8%), which was significantly lower than in cases of non-Cushing syndrome (118/331, 35.6%, p < 0.01). CONCLUSION Since postoperative fever after laparoscopic adrenalectomy is markedly affected by the hormone produced by pheochromocytoma and Cushing syndrome, it is important to carefully consider the need for treatment.
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Affiliation(s)
- Mizuki Izawa
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Toshikazu Takeda
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan.
| | - Tadatsugu Anno
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Tomohiro Iwasawa
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Yota Yasumizu
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Nobuyuki Tanaka
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Kazuhiro Matsumoto
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Shinya Morita
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Takeo Kosaka
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Hiroshi Asanuma
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
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Gao TP, Green RL, Kuo LE. Adrenalectomy Outcome Variations Across Different Functional Adrenal Tumors. J Surg Res 2024; 298:201-208. [PMID: 38626717 DOI: 10.1016/j.jss.2024.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/20/2024] [Accepted: 03/21/2024] [Indexed: 04/18/2024]
Abstract
INTRODUCTION Adrenalectomy generally has favorable outcomes. It is unknown if patients with functional adrenal tumors experience different clinical outcomes than those with benign adrenal tumors, due to the presence of comorbid conditions secondary to the functional tumor. We investigated outcomes following open and laparoscopic adrenalectomy for benign nonfunctional (BNF) versus functional adrenal masses. METHODS Patients undergoing adrenalectomy were identified in the 2015-2020 National Surgical Quality Improvement Program database, then categorized as BNF, hyperaldosteronism, hypercortisolism, and pheochromocytoma. The primary outcome of interest was 30-d morbidity and secondary outcomes included 30-d mortality, 30-d readmission, and postoperative length of stay (LOS). Subgroup analysis was performed based upon surgical approach. Univariate analysis was performed, followed by multivariable logistic regression for individual outcomes that differed significantly between patients with BNF and functional neoplasm, factoring in patient demographics and operative approach with statistical significance on univariate analysis. Descriptive statistics and outcomes were analyzed using Pearson's χ2 test and Mann-Whitney U-test as appropriate. RESULTS There were 3291 patients with BNF while 484 had hyperaldosteronism, 263 hypercortisolism, and 46 pheochromocytomas. Within the laparoscopic group of 3615 (88.5%) of adrenalectomy patients, compared to BNF patients, patients with hyperaldosteronism had lower rates of postoperative morbidity (1.9% versus 5.2%, P < 0.001) and shorter LOS (1 d, interquartile range (IQR) [1-1] versus 1d IQR [1-2], P = 0.003); these persisted on multivariate analysis (OR 0.32, 95% confidence interval [CI] 0.14-0.74 and odds ratio 0.47, 95% CI 0.36-0.60, P < 0.001). Patients with hypercortisolism had higher morbidity (7.3% versus 5.2%, P < 0.001), 30-d readmission rates (5.3% versus 2.9%, P = 0.042) and longer LOS (2d, IQR [1-3] versus 1d, IQR [1-2, P < 0.001). On multivariate analysis, presence of hypercortisolism was independently associated with increased likelihood of readmission within 30 d (OR 2.20, 95% CI 1.11-2.99, P = 0.012) and longer LOS (>1 d) (OR 1.79, 95% CI 1.33-2.40, P < 0.001). Compared to BNF patients, patients with pheochromocytoma had higher rates of postoperative morbidity (6.2% versus 5.2%, P < 0.001). Within the open group of 469 (11.5% of adrenalectomy patients), there were no statistically significant differences in outcomes between patients with BNF and functional adrenal masses. CONCLUSIONS Outcomes after adrenalectomy performed for functional neoplasms differ based on surgical indication.
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Affiliation(s)
- Terry P Gao
- Department of General Surgery, Temple University Lewis Katz School of Medicine, Philadelphia Pennsylvania.
| | - Rebecca L Green
- Department of General Surgery, Temple University Lewis Katz School of Medicine, Philadelphia Pennsylvania
| | - Lindsay E Kuo
- Department of General Surgery, Temple University Lewis Katz School of Medicine, Philadelphia Pennsylvania
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Hoshi S, Onagi A, Tanji R, Honda-Takinami R, Matsuoka K, Hata J, Sato Y, Akaihata H, Kataoka M, Ogawa S, Kojima Y. Unilateral adrenalectomy for a drug-resistant bilateral primary aldosteronism with heart failure: pathophysiology and surgical indication. BMC Endocr Disord 2023; 23:243. [PMID: 37932696 PMCID: PMC10629188 DOI: 10.1186/s12902-023-01503-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 11/01/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Patients with bilateral primary aldosteronism (PA) generally are treated with antihypertensive drugs, but optimal treatment for patients with complications due to refractory hypertension has not been established. In this report, we present a case with bilateral PA who presented with persistent hypertension, despite treatment with 6 drugs, and left-dominant heart failure, which was improved after unilateral adrenalectomy. CASE PRESENTATION A 61-year-old man was admitted to our hospital because of severe left-dominant heart failure. His heart rhythm was atrial fibrillation and the left ventricle was diffusely hypertrophic and hypokinetic. Coronary arteries were normal on coronary arteriogram. Primary aldosteronism was suspected based on severe hypokalemia (2.5 mEq/L) and plasma aldosterone concentration (PAC; 1,410 pg/mL). Although computed tomography (CT) showed a single left cortical nodule, adrenal vein sampling (AVS) indicated bilateral PA. Early in the case, heart failure and hyperkalemia in this patient were improved by treatment with a combination of 6 antihypertensive drugs (spironolactone 25 mg/day, eplerenone 100 mg/day, azosemide 60 mg/day, tolvaptan 7.5 mg/day, enalapril 5 mg/day, and bisoprolol fumarate 10 mg/day); however, heart failure relapsed after four months of treatment. We hypothesized that hypertension caused by excess aldosterone was inducing the patient's heart failure. In order to reduce aldosterone secretory tissue, a laparoscopic adrenalectomy was performed for the left adrenal gland, given the higher level of aldosterone from the left gland compared to the right. Following surgery, the patient's heart failure was successfully controlled despite the persistence of high PAC. Treatment with anti-hypertensive medications was reduced to two drugs (eplerenone 100 mg/day and bisoprolol fumarate 10 mg/day). In order to elucidate the mechanism of drug resistance, immunohistochemistry (IHC) and real time-polymerase chain reaction (RT-PCR) assays were performed to assess the expression of steroidogenic factor 1 (SF-1), a regulator of steroid synthesis in adrenal tissue. IHC and RT-PCR demonstrated that the expression of SF-1 in this patient (at both the protein and mRNA levels) was higher than that observed in unilateral PA cases that showed good responsivity to drug treatment. CONCLUSIONS Unilateral adrenalectomy to reduce aldosterone secretory tissue may be useful for patients with drug-refractory, bilateral PA. Elevated expression of SF-1 may be involved in drug resistance in PA.
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Affiliation(s)
- Seiji Hoshi
- Departments of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan.
| | - Akifumi Onagi
- Departments of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Ryo Tanji
- Departments of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Ruriko Honda-Takinami
- Departments of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kanako Matsuoka
- Departments of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Junya Hata
- Departments of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuichi Sato
- Departments of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hidenori Akaihata
- Departments of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Masao Kataoka
- Departments of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Soichiro Ogawa
- Departments of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yoshiyuki Kojima
- Departments of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
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Olcucuoglu E, Senel S, Uzun E, Ceviz K, Gultekin H, Arabaci HB, Koudonas A, Aydin C. Clinical predictors and significance of adherent periadrenal fat in laparoscopic adrenalectomy. BMC Urol 2023; 23:176. [PMID: 37915035 PMCID: PMC10621091 DOI: 10.1186/s12894-023-01348-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/22/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Adrenalectomy requires the anatomic preparation of the adrenal gland in the fat-rich retroperitoneal space. In the literature, it was shown that the retroperitoneal fat area affects surgical outcomes in laparoscopic adrenalectomy (LA). Besides the quantity of retroperitoneal fat, its qualitative properties play hypothetically a significant role in the safety profile and perioperative parameters of LA. In this study, we aimed to evaluate the factors associated with adherent periadrenal fat. METHODS The prospectively obtained demographic, preoperative, intraoperative, and postoperative data of 44 patients who underwent laparoscopic adrenalectomy in our clinic were analyzed retrospectively. The patients were divided into two groups as adherent periadrenal fat (APAF) and non-APAF group. Periadrenal fat tissue was defined as adherent or non-adherent by the attending surgeon according to the difficulty in dissection of the adrenal gland from the surrounding fat tissue during the operation. RESULTS The rate of female gender and presence of diabetes mellitus (DM) was higher in the APAF group (respectively, p = 0.038 and p = 0.001). A ROC curve analysis showed that the cut-off point was - 97 HU for APAF. On multivariable analysis using a stepwise regression model, we identified the presence of DM (OR = 5.073; 95% Cl = 2.192-12.387; p = 0.006) and ARFD > -97 HU (OR = 3.727; 95% Cl = 1.898-11.454; p = 0.008) as an independent predictor of APAF. CONCLUSION APAF seems to affect the perioperative outcomes of LA in terms of operation duration but not perioperative complications.
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Affiliation(s)
- Erkan Olcucuoglu
- Department of Urology, Ankara City Hospital, Üniversiteler, Bilkent Blv. No:1, Ankara, Çankaya, 06800, Turkey
| | - Samet Senel
- Department of Urology, Ankara City Hospital, Üniversiteler, Bilkent Blv. No:1, Ankara, Çankaya, 06800, Turkey.
| | - Emre Uzun
- Department of Urology, Ankara City Hospital, Üniversiteler, Bilkent Blv. No:1, Ankara, Çankaya, 06800, Turkey
| | - Kazim Ceviz
- Department of Urology, Ankara City Hospital, Üniversiteler, Bilkent Blv. No:1, Ankara, Çankaya, 06800, Turkey
| | - Huseyin Gultekin
- Department of Urology, Ankara City Hospital, Üniversiteler, Bilkent Blv. No:1, Ankara, Çankaya, 06800, Turkey
| | - Hasan Batuhan Arabaci
- Department of Urology, Ankara City Hospital, Üniversiteler, Bilkent Blv. No:1, Ankara, Çankaya, 06800, Turkey
| | - Antonios Koudonas
- School of Medicine, First Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Cevdet Aydin
- Department of Endocrinology, Ankara City Hospital, Ankara, Turkey
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Gao RR, Chilukuri N, Rokhlin P, Shebrain S. Thirty day postoperative outcomes following laparoscopic adrenalectomy for functional adrenal tumors. Surg Endosc 2023; 37:7893-7900. [PMID: 37415017 DOI: 10.1007/s00464-023-10255-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Functional adrenal tumors (FATs) are rare and if left untreated, there is a substantial risk of morbidity and mortality due to uncontrolled excess hormone secretion. The three most common FATs are cortisone-producing tumors (hypercortisolism), aldosterone-producing tumors (hyperaldosteronism), and catecholamines-producing tumors (pheochromocytomas). The study aims to evaluate demographic characteristics and 30-day outcomes after laparoscopic adrenalectomy of FATs. METHODS Patients who underwent laparoscopic adrenalectomy for FATs were selected from the ACS-NSQIP database (2015-2017), and divided into three groups (hyperaldosteronism, hypercortisolism, and pheochromocytoma). Preoperative demographics, medical comorbidities, and 30-day postoperative outcomes among the three groups were analyzed using the chi-squared test, analysis of variance (ANOVA) and Kruskal-Wallis one-way analysis of variance. Multivariable logistic regression was performed to assess the effects independent variables on the likelihood of increased overall morbidity. RESULTS Of a total of 2410 patients who underwent laparoscopic adrenalectomy, 345 (14.3%) patients with FATs were included. Patients in the hypercortisolism group were younger, had higher proportion of females, had higher BMI, had a higher proportion of White ethnicity and had a higher proportion of diabetes. The hyperaldosteronism group had a higher proportion of Black ethnicity and a higher proportion of hypertension (HTN) requiring medication. Thirty day postoperative outcomes showed that the pheochromocytoma group had a higher rate of serious morbidity, overall morbidity, and highest readmission rates. There were three deaths, 1 in the pheochromocytoma and 2 in the hypercortisolism groups. Operative time (in minutes) was longer in the hypercortisolism group. Median length of stay was higher in hypercortisolism (2 days) and pheochromocytoma (1.5 day) groups. CONCLUSION Functional adrenal tumors show distinct variations in patient demographics and postoperative outcomes. It is essential to use this information during the preoperative period to optimize patients prior to intervention and counsel patients about potential postoperative outcomes.
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Affiliation(s)
- Raisa R Gao
- Department of General Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Dr., Kalamazoo, MI, 49007, USA.
| | - Nitin Chilukuri
- Department of General Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Dr., Kalamazoo, MI, 49007, USA
| | - Pnina Rokhlin
- Department of General Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Dr., Kalamazoo, MI, 49007, USA
| | - Saad Shebrain
- Department of General Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Dr., Kalamazoo, MI, 49007, USA
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Wan S, Li K, Wang C, Chen S, Wang H, Luo Y, Li X, Yang L. Which surgical approach is more favorable for pheochromocytoma of different sizes (< 6 cm vs. ≥ 6 cm)? A single retrospective center experience. World J Surg Oncol 2023; 21:285. [PMID: 37697366 PMCID: PMC10494336 DOI: 10.1186/s12957-023-03164-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/26/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND To compare the surgical effects of lateral transperitoneal approach (LTA) and posterior retroperitoneal approach (PRA) for pheochromocytoma of different sizes. METHODS Data on patients with pheochromocytoma from 2014 to 2023 were collected from our hospital. According to different surgical approaches and tumor size, all patients were divided into four groups: tumor size < 6 cm for LTA and PRA and tumor size ≥ 6 cm for LTA and PRA. We compared these two surgical methods for pheochromocytoma of different sizes. RESULTS A total of 118 patients with pheochromocytoma underwent successful laparoscopic surgery, including PRA group (n = 80) and LTA group (n = 38). In tumor size < 6 cm, the outcomes were no significant difference in LTA and PRA. In tumor size ≥ 6 cm, there was a significant difference in operation time (214.7 ± 18.9 vs. 154.3 ± 8.2, P = 0.007) and intraoperative blood loss (616.4 ± 181.3 vs. 201.4 ± 45.8, P = 0.037) between LTA and PRA. CONCLUSION LTA and PRA were performed safely with similar operative outcomes in patients with pheochromocytoma size < 6 cm. While both LTA and PRA were executed with a commendable safety profile and comparable operative results in patients afflicted by pheochromocytomas < 6 cm, the PRA technique distinctly showcased advantages when addressing large-scale pheochromocytomas (≥ 6 cm). Notably, this manifested in reduced operative time, diminished intraoperative blood loss, decreased hospitalization expenses, and a paucity of procedural complications.
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Affiliation(s)
- Shun Wan
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, 730000, China
- Gansu Province Clinical Research Center for Urology, Lanzhou, 730000, China
| | - Kunpeng Li
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, 730000, China
- Gansu Province Clinical Research Center for Urology, Lanzhou, 730000, China
| | - Chenyang Wang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, 730000, China
- Gansu Province Clinical Research Center for Urology, Lanzhou, 730000, China
| | - Siyu Chen
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, 730000, China
- Gansu Province Clinical Research Center for Urology, Lanzhou, 730000, China
| | - Huabin Wang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, 730000, China
- Gansu Province Clinical Research Center for Urology, Lanzhou, 730000, China
| | - Yao Luo
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, 730000, China
| | - Xiaoran Li
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, 730000, China.
- Gansu Province Clinical Research Center for Urology, Lanzhou, 730000, China.
| | - Li Yang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, 730000, China.
- Gansu Province Clinical Research Center for Urology, Lanzhou, 730000, China.
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Giordano A, Feroci F, Podda M, Botteri E, Ortenzi M, Montori G, Guerrieri M, Vettoretto N, Agresta F, Bergamini C. Minimally invasive versus open adrenalectomy for adrenocortical carcinoma: the keys surgical factors influencing the outcomes-a collective overview. Langenbecks Arch Surg 2023; 408:256. [PMID: 37386332 DOI: 10.1007/s00423-023-02997-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/21/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE Adrenocortical carcinoma (A.C.C.) is a rare tumour, often discovered at an advanced stage and associated with a poor prognosis. Surgery is the treatment of choice. We aimed to review the different surgical approaches trying to compare their outcome. METHODS This comprehensive review has been carried out according to the PRISMA statement. The literature search was performed in PubMed, Scopus, the Cochrane Library and Google Scholar. RESULTS Among all studies identified, 18 were selected for the review. A total of 14,600 patients were included in the studies, of whom 4421 were treated by mini-invasive surgery (M.I.S.). Ten studies reported 531 conversions from M.I.S. to an open approach (OA) (12%). Differences were reported for operative times as well as for postoperative complications more often in favour of OA, whereas differences for hospitalization time in favour of M.I.S. Some studies showed an R0 resection rate from 77 to 89% for A.C.C. treated by OA and 67 to 85% for tumours treated by M.I.S. The overall recurrence rate ranged from 24 to 29% for A.C.C. treated by OA and from 26 to 36% for tumours treated by M.I.S. CONCLUSIONS OA should still be considered the standard surgical management of A.C.C. Laparoscopic adrenalectomy has shown shorter hospital stays and faster recovery compared to open surgery. However, the laparoscopic approach resulted in the worst recurrence rate, time to recurrence and cancer-specific mortality in stages I-III ACC. The robotic approach had similar complications rate and hospital stays, but there are still scarce results about oncologic follow-up.
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Affiliation(s)
- Alessio Giordano
- Department of Surgery, General Surgery unit, S. Stefano Hospital, Azienda ASL Toscana Centro, Suor Niccolina Infermiera 20/22, 59100, Prato, Italy.
| | - Francesco Feroci
- Department of Surgery, General Surgery unit, S. Stefano Hospital, Azienda ASL Toscana Centro, Suor Niccolina Infermiera 20/22, 59100, Prato, Italy
| | - Mauro Podda
- Department of Surgery, General Surgery Unit, University Hospital of Cagliari, Cagliari, Italy
| | - Emanuele Botteri
- General Surgery Unit, ASST Spedali Civili Di Brescia, Montichiari, Italy
| | - Monica Ortenzi
- Department of General Surgery, Università Politecnica Delle Marche, Ancona, Italy
| | - Giulia Montori
- Department of General Surgery, Ulss2 Marca Trevigiana, Vittorio Veneto, Italy
| | - Mario Guerrieri
- Department of General Surgery, Università Politecnica Delle Marche, Ancona, Italy
| | - Nereo Vettoretto
- General Surgery Unit, ASST Spedali Civili Di Brescia, Montichiari, Italy
| | - Ferdinando Agresta
- Department of General Surgery, Ulss2 Marca Trevigiana, Vittorio Veneto, Italy
| | - Carlo Bergamini
- Department of Emergency, Emergency General Surgery Unit, AOU Careggi, Firenze, Italy
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Huang H, Gao L, Li Y, Tan W, Wu H, Yuan Y, Liu C. Adrenal Tuberculosis: A Case Report and Literature Review. Urol Int 2023; 107:807-813. [PMID: 37075720 DOI: 10.1159/000529711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/06/2023] [Indexed: 04/21/2023]
Abstract
Adrenal tuberculosis (TB) is a rare disease, which is difficult to diagnose because of its atypical symptoms. We reported a 41-year-old female who was admitted to hospital due to a left adrenal tumor, which was found in health examination without any symptoms. Abdominal CT showed a mass in her left adrenal. The results of blood test were normal. A retroperitoneal laparoscopic adrenalectomy was carried out, and adrenal TB was finally pathologically diagnosed. Following this, examinations focusing on TB were conducted which revealed negative results except for T-cell enzyme-linked immunospot. After the operation, the hormone level was normal. However, a wound infection occurred, which was recovered after antituberculosis treatment. In conclusion, even if there is no evidence of TB, we should be alert when diagnosing adrenal masses. Examinations of pathology, radiography, and hormone play important roles in determining the definite diagnosis of adrenal TB.
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Affiliation(s)
- Hao Huang
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China,
| | - Liang Gao
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - YaDong Li
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Tan
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hao Wu
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ye Yuan
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chuan Liu
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Quildrian SD, Nardi WS, Iriarte F, Recalde M, Califano I, Chapela J. Laparoscopic adrenalectomy for adrenal metastases of solid tumors. Surg Endosc 2023. [PMID: 36869264 DOI: 10.1007/s00464-023-09961-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 02/12/2023] [Indexed: 03/05/2023]
Abstract
INTRODUCTION In patients with history of cancer adrenal metastases can be found in up to 70% of adrenal tumors detected during follow-up. Currently, laparoscopic adrenalectomy (LA) is considered the gold standard approach for benign adrenal tumors but is still controversial in malignant disease. Depending on the patient's oncological status, adrenalectomy might be a possible treatment option. Our objective was to analyze the results of LA for adrenal metastasis from solid tumors in two referral centers. METHODS Retrospective analysis of 17 patients with non-primary adrenal malignancy treated with LA between 2007 and 2019 was performed. Demographic and primary tumor data, type of metastasis, morbidity, disease recurrence and evolution were evaluated. Patients were compared according to type of metastases: synchronous (< 6 months) vs metachronous (≥ 6 months). RESULTS 17 patients were included. Median metastatic adrenal tumor size was 4 cm (IQR, 3-5.4). We had one conversion to open surgery. Recurrence was found in 6 patients with one recurring in the adrenal bed. The median OS was 24 (IQR, 10.5-60.5) months and 5-year OS was 61.4% (95%CI: 36.7%-81.4%). Patients with metachronous metastases had better overall survival vs. patients with synchronous metastases (87% vs. 14%, p = 0.0037). CONCLUSION LA for adrenal metastases is a procedure associated with low morbidity and acceptable oncologic outcomes. Based on our results, seems reasonable to offer this procedure to carefully selected patients, mainly those with metachronous presentation. Indication of LA must be done on a case by case evaluation in the context of a multidisciplinary tumor board.
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Kawasaki Y, Ishidoya S, Morimoto R, Ono Y, Omata K, Tezuka Y, Kawamorita N, Yamashita S, Mitsuzuka K, Satoh F, Ito A. Laparoscopic Adrenalectomy Is Beneficial for the Health-Related Quality of Life of Older Patients with Primary Aldosteronism. Urol Int 2023; 107:186-192. [PMID: 34419949 DOI: 10.1159/000518165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/22/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Laparoscopic adrenalectomy (LADX) improves hypertension in patients with primary aldosteronism (PA). However, the antihypertensive impact of LADX appears restricted in older patients with PA. In this study, we evaluated the impact of LADX in older patients focusing on the health-related quality of life (HRQoL). METHODS A total of 156 patients with PA who underwent LADX in a single institution were enrolled in this prospective cohort study. The patients were divided into 2 groups, with a boundary of 60 years. The HRQoL was evaluated using the Medical Outcomes Study's 36-Item Short-Form Health Survey version 2 (SF-36v2) questionnaire before and after LADX. Demographics, clinical features, antihypertensive drugs before and after surgery, and perioperative evaluation were recorded. We compared all scale scores and summed scores between groups. Multivariate regression models were used to determine the associations between various covariables and the HRQoL. RESULTS In the older PA patients, most subscales of HRQoL at baseline were lower than the national standard values. The antihypertensive drug-free rate by LADX was only 21% in older patients, compared to 58% in younger patients. However, a significant improvement in mental HRQoL was observed after LADX (p = 0.002). The much preoperative antihypertensive drugs, lower preoperative potassium level, and smaller degree of comorbidities were predictors of improved mental HRQoL by LADX on multivariate analyses. CONCLUSION The older PA patients showed lower mental HRQOL than the national standard populations. Although antihypertensive effects were limited for these patients, LADX was beneficial as PA treatment via improvement of mental HRQoL.
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Affiliation(s)
- Yoshihide Kawasaki
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Ryo Morimoto
- Department of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshikiyo Ono
- Department of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kei Omata
- Department of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yuta Tezuka
- Department of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naoki Kawamorita
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shinichi Yamashita
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koji Mitsuzuka
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Fumitoshi Satoh
- Department of Clinical Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akihiro Ito
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
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11
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Isiktas G, Avci SN, Erten O, Ergun O, Krishnamurthy V, Shin J, Siperstein A, Berber E. Laparoscopic versus robotic adrenalectomy in severely obese patients. Surg Endosc 2023; 37:1107-1113. [PMID: 36123544 DOI: 10.1007/s00464-022-09594-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/25/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Over the last 20 years, the prevalence of severe obesity (body mass index ≥ 35 kg/m2) has almost doubled. This condition increases the challenge of laparoscopic adrenalectomy (LA) by creating problems with instrument reach, adequate exposure, and visualization. The aim was to compare perioperative outcomes of laparoscopic versus robotic adrenalectomy (RA) in severely obese patients. METHODS This was an institutional review board-approved retrospective study. Prospectively collected clinical parameters of patients who underwent LA versus RA between 2000 and 2021 at a single center were compared using Mann-Whitney U, ANOVA, Chi-square, and multivariate regression analysis. Continuous data are expressed as median (interquartile range). RESULTS For lateral transabdominal (LT) adrenalectomies, skin-to-skin operative time (OT) [164.5 (71.0) vs 198.8 (117.0) minutes, p = 0.006] and estimated blood loss [26.2 (15.0) vs 72.6 (50.0) ml, p = 0.010] were less in RA versus LA group, respectively. Positive margin rate, hospital stay and 90-day morbidity were similar between the groups (p = NS). For posterior retroperitoneal (PR) approach, operative time and perioperative outcomes were similar between LA and RA groups. Multivariate analysis demonstrated robotic versus laparoscopic technique (p = 0.006) to be an independent predictor of a shorter OT. CONCLUSION There was a benefit of robotic over the laparoscopic LT adrenalectomy regarding OT and estimated blood loss. Although limited by the small sample size, there was no difference regarding perioperative outcomes between RA and LA performed through a PR approach.
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Affiliation(s)
- Gizem Isiktas
- Department of Endocrine Surgery, Cleveland Clinic, 9500 Euclid Ave/F20, Cleveland, OH, 44195, USA
| | - Seyma Nazli Avci
- Department of Endocrine Surgery, Cleveland Clinic, 9500 Euclid Ave/F20, Cleveland, OH, 44195, USA
| | - Ozgun Erten
- Department of Endocrine Surgery, Cleveland Clinic, 9500 Euclid Ave/F20, Cleveland, OH, 44195, USA
| | - Onuralp Ergun
- Department of Endocrine Surgery, Cleveland Clinic, 9500 Euclid Ave/F20, Cleveland, OH, 44195, USA
| | - Vikram Krishnamurthy
- Department of Endocrine Surgery, Cleveland Clinic, 9500 Euclid Ave/F20, Cleveland, OH, 44195, USA
| | - Joyce Shin
- Department of Endocrine Surgery, Cleveland Clinic, 9500 Euclid Ave/F20, Cleveland, OH, 44195, USA
| | - Allan Siperstein
- Department of Endocrine Surgery, Cleveland Clinic, 9500 Euclid Ave/F20, Cleveland, OH, 44195, USA
| | - Eren Berber
- Department of Endocrine Surgery, Cleveland Clinic, 9500 Euclid Ave/F20, Cleveland, OH, 44195, USA. .,Department of General Surgery, Cleveland Clinic, 9500 Euclid Ave/F20, Cleveland, OH, 44195, USA.
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12
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De Crea C, Pennestrì F, Voloudakis N, Sessa L, Procopio PF, Gallucci P, Bellantone R, Raffaelli M. Robot-assisted vs laparoscopic lateral transabdominal adrenalectomy: a propensity score matching analysis. Surg Endosc 2022; 36:8619-8629. [PMID: 36190555 PMCID: PMC9613740 DOI: 10.1007/s00464-022-09663-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 09/18/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Laparoscopic adrenalectomy (LA) is the gold standard treatment for adrenal lesions. Robot-assisted adrenalectomy (RAA) is a safe approach, associated with higher costs in absence of clear-cut benefits. Several series reported some advantages of RAA over LA in challenging cases, but definitive conclusions are lacking. We evaluated the cost effectiveness and outcomes of robotic (R-LTA) and laparoscopic (L-LTA) approach for lateral transabdominal adrenalectomy in a high-volume center. METHODS Among 356 minimally invasive adrenalectomies (January 2012-August 2021), 286 were performed with a lateral transabdominal approach: 191 L-LTA and 95 R-LTA. The R-LTA and L-LTA patients were matched for lesion side and size, hormone secretion, and BMI with propensity score matching (PSM) analysis. Postoperative complications, operative time (OT), postoperative stay (POS), and costs were compared. RESULTS PSM analysis identified 184 patients, 92 in R-LTA and 92 in L-LTA group. The two groups were well matched. The median lesion size was 4 cm in both groups (p = 0.533). Hormonal hypersecretion was detected in 55 and 54 patients of R-LTA and L-LTA group, respectively (p = 1). Median OT was significantly longer in R-LTA group (90.0 vs 65.0 min) (p < 0.001). No conversion was registered. Median POS was similar (4.0 vs 3.0 days in the R-LTA and L-LTA) (p = 0.467). No difference in postoperative complications was found (p = 1). The cost margin analysis showed a positive income for both procedures (3137 vs 3968 € for R-LTA and L-LTA). In the multiple logistic regression analysis, independent risk factors for postoperative complications were hypercortisolism (OR = 3.926, p = 0.049) and OT > 75 min (OR = 8.177, p = 0.048). CONCLUSIONS The postoperative outcomes of R-LTA and L-TLA were similar in our experience. Despite the higher cost, RAA appears to be cost effective and economically sustainable in a high-volume center (60 adrenalectomies/year), especially if performed in challenging cases, including patients with large (> 6 cm) and/or functioning tumors.
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Affiliation(s)
- Carmela De Crea
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di Ricerca in Chirurgia Endocrina e dell'Obesità, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Francesco Pennestrì
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
- Centro di Ricerca in Chirurgia Endocrina e dell'Obesità, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy.
| | - Nikolaos Voloudakis
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Sessa
- Centro di Ricerca in Chirurgia Endocrina e dell'Obesità, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
- Centro Malattie Endocrine e Obesità, Fondazione Gemelli Giglio Cefalù, Cefalù, Palermo, Italy
| | - Priscilla Francesca Procopio
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di Ricerca in Chirurgia Endocrina e dell'Obesità, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Pierpaolo Gallucci
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Rocco Bellantone
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di Ricerca in Chirurgia Endocrina e dell'Obesità, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Marco Raffaelli
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di Ricerca in Chirurgia Endocrina e dell'Obesità, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
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Cicek M, Kazan HO, Atis RG, Yildirim A. Primary Epithelioid Angiomyolipoma of Adrenal Gland: Case Report and Literature Review. Prague Med Rep 2022; 123:199-205. [PMID: 36107449 DOI: 10.14712/23362936.2022.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Angiomyolipomas (AMLs) are mesenchymal tumours derived from perivascular epithelioid cells. Although AMLs are generally known as benign and extremely rare epithelioid variants of AML, they may be potentially aggressive. Here we present an adrenal epithelioid AML and the literature review. A 64-year-old female patient was diagnosed with a left adrenal mass detected incidentally on ultrasonography. Preoperative abdominal CT (computed tomography) showed a 95×68 mm heterogeneous contrast enhancement mass lesion in the left adrenal gland. The lesion was hormone inactive in the endocrinological evaluation, and left laparoscopic adrenalectomy was performed. The patient was discharged on the 2nd postoperative day. Pathology was reported as epithelioid subtype AML. The patient has no local recurrence or metastasis in the 18-month follow-up period and imaging. Adrenal epithelioid AML is an extremely rare and potentially aggressive variant. According to the literature, open or laparoscopic adrenalectomy seems to be suitable option for disease management.
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Affiliation(s)
- Muhammet Cicek
- Department of Urology, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey.
| | | | - Ramazan Gokhan Atis
- Department of Urology, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Asif Yildirim
- Department of Urology, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
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14
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Gan L, Peng L, Li J, Meng C, Li K, Wu J, Zhang Z, Li Y. Comparison of the effectiveness and safety of robotic-assisted and laparoscopic in adrenalectomy: A systematic review and meta-analysis. Int J Surg 2022; 105:106853. [PMID: 36075556 DOI: 10.1016/j.ijsu.2022.106853] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/12/2022] [Accepted: 08/19/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare the safety and effectiveness of robot-assisted adrenalectomy (RA) and laparoscopic adrenalectomy (LA). METHODS We performed a systematic review and cumulative meta-analysis of the primary outcomes of interest according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the Methodological Quality of Systematic Reviews) Guidelines. Five databases, including Medline, PubMed, Cochrane Library, Scopus, and Web of Science, were systematically searched. The search timeframe was set from the creation of the database to December 2021. RESULTS There were 26 studies including 2985 patients. Our study found that the robotic technique was superior to conventional laparoscopy for estimated blood loss (WMD = -18.25, 95% CI [-27.85, -8.65], P < 0.01), length of stay (WMD = -0.45, 95% CI [-0.57, -0.33], P < 0.01), and conversion to open (OR = 0.31, 95% CI [0.12, 0.78], P = 0.01), while complications and readmissions were comparable. Interestingly, there was no difference in operative time between the two surgical modalities, but subgroup analysis found that the retroperitoneal route robotic technique took longer (WMD = 14.64, 95% CI [0.04, 29.24], P < 0.05), whereas the study of the mixed surgical modality (RA versus LA with mixed transabdominal and retroperitoneal surgical routes) found that the robot required less time (WMD = -12.29, 95% CI [-22.86, -1.72], P < 0.05). For pheochromocytoma, RA was superior to LA in terms of length of stay (WMD = -0.49, 95% CI [-0.83, -0.15], P < 0.01), with no difference in other indicators. CONCLUSION robotic-assisted adrenalectomy is a superior technique to conventional laparoscopy in managing adrenal tumors, even in the case of a specific adrenal tumor - pheochromocytoma.
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15
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Gan L, Meng C, Li K, Lei Peng, Li J, Wu J, Li Y. Safety and effectiveness of minimally invasive adrenalectomy versus open adrenalectomy in patients with large adrenal tumors (≥5 cm): A meta-analysis and systematic review. Int J Surg 2022; 104:106779. [PMID: 35870758 DOI: 10.1016/j.ijsu.2022.106779] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/29/2022] [Accepted: 07/07/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND This systematic review and meta-analysis compared the safety and effectiveness of minimally invasive adrenalectomy (MIA) with open adrenalectomy (OA) in patients with large adrenal tumors (≥5 cm). MATERIALS AND METHODS We performed a systematic review and cumulative meta-analysis of the primary outcomes according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the methodological quality of systematic reviews) Guidelines. Five databases including Medline, PubMed, Cochrane Library, Scopus, and Web of Science were systematically searched. The time frame of the search was set from the creation of the database to March 2022. RESULTS Ten studies including 898 patients were included. Compared to OA, MIA is superior for length of stay [LOS WMD = -3.52, 95% CI (-4.61, -2.43), P < 0.01], drainage time [DT WMD = -0.68, 95% CI (-1.27, -0.09), P < 0.05] and fasting time [FT WMD = -0.95, 95% CI (-1.35, -0.55), P < 0.01], estimated blood loss [EBL WMD = -314.22, 95% CI (-494.76, -133.69), P < 0.01] and transfusion [WMD = -416.73, 95% CI (-703.75, -129.72), P < 0.01], while operative time (OT) and complications are not statistically different. For pheochromocytoma, MIA remains superior for LOS [WMD = -3.10, 95% CI (-4.61, -1.60), P < 0.01] and EBL [WMD = -273.65, 95% CI (-457.44, -89.86), P < 0.01], while OT and complications are not significantly different. CONCLUSION MIA offers advantages over OA in the management of large adrenal tumors, including in the case of a specific large adrenal tumor - large pheochromocytoma.
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Affiliation(s)
- Lijian Gan
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, China
| | - Chunyang Meng
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, China
| | - Kangsen Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, China
| | - Lei Peng
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, China
| | - Jinze Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ji Wu
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, China
| | - Yunxiang Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, China.
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Hsieh SJ, Chung SD, Chang CY. Cystic pheochromocytoma leading to multisystem crisis: A silent and hazardous neoplasm. Asian J Surg 2022; 45:2054-2055. [PMID: 35525694 DOI: 10.1016/j.asjsur.2022.04.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/21/2022] [Indexed: 11/02/2022] Open
Affiliation(s)
- Shang-Ju Hsieh
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Shiu-Dong Chung
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chao-Yuan Chang
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
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Wang J, Yang B, Sun S, Zhang Y. Perioperative factors influencing the difficulty of retroperitoneal laparoscopic adrenalectomy: a single-center retrospective study. BMC Urol 2022; 22:22. [PMID: 35177059 PMCID: PMC8851746 DOI: 10.1186/s12894-022-00976-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/08/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose Identifying patients in whom adrenalectomy may be more difficult can help with surgical decision-making. This study investigated the perioperative factors affecting the difficulty of retroperitoneal laparoscopic adrenalectomy (RLA). Methods Sixty-eight patients who underwent RLA at our hospital between December 1, 2020 and May 1, 2021 were included. The difficulty of RLA was assessed by operating time and intraoperative blood loss. We analyzed the relationship between surgical difficulty and patient sex, age, and body mass index, pathological type, tumor side, tumor size, distance from the lower pole of the adrenal tumor to the upper pole of the kidney (DAK), and distance from the lower pole of the adrenal tumor to the renal pedicle (DARP). Results Mean operating time was 105.38 ± 33.31 min and mean intraoperative blood loss was 32.28 ± 22.88 ml. Univariate linear regression analysis showed that age (P = 0.047), tumor size (P = 0.002), DAK (P = 0.002), and DARP (P < 0.001) were significantly correlated with a longer operating time. Univariate logistic regression analysis showed that DARP (P = 0.001), DAK (P = 0.001), tumor size (P = 0.002), and age (P = 0.033) were significantly correlated with a longer operating time. Multivariate logistic regression indicated that DARP (OR 5.341; 95% CI 1.704–16.739; P = 0.004), and tumor size (OR 4.433; 95% CI 1.434–13.709; P = 0.010) were independent predictors of operating time. Conclusion Age, tumor size, DAK, and DARP were predictors of the difficulty of RLA. Older age, lower DARP and DAK, and a larger tumor size were associated with a longer operating time. DARP and tumor size were independent predictors of surgical difficulty.
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Affiliation(s)
- Jinyao Wang
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China.,Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Bin Yang
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China. .,Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Shiwei Sun
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
| | - Yangang Zhang
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China.,Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
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Alberici L, Ingaldi C, Ricci C, Selva S, Di Dalmazi G, Vicennati V, Pagotto U, Casadei R, Minni F. Minimally invasive adrenalectomy: a comprehensive systematic review and network meta-analysis of phase II/III randomized clinical controlled trials. Langenbecks Arch Surg 2022; 407:285-296. [PMID: 35022834 PMCID: PMC8847275 DOI: 10.1007/s00423-022-02431-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/02/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE The best approach for minimally invasive adrenalectomy is still under debate. METHODS A systematic search of randomized clinical trials was carried out. A frequentist random-effects network meta-analysis was made reporting the surface under the cumulative ranking (SUCRA). The primary endpoint regarded both in-hospital mortality and morbidity. The secondary endpoints were operative time (OP), blood loss (BL), length of stay (LOS), conversion, incisional hernia, and disease recurrence rate. RESULTS Eight studies were included, involving 359 patients clustered as follows: 175 (48.7%) in the TPLA arm; 55 (15.3%) in the RPLA arm; 10 (2.8%) in the Ro-TPLA arm; 25 (7%) in the TPAA arm; 20 (5.6%) in the SILS-LA arm; and 74 (20.6%) in the RPA arm. The RPLA had the highest probability of being the safest approach (SUCRA 69.6%), followed by RPA (SUCRA 63.0%). TPAA, Ro-TPLA, SILS-LA, and TPLA have similar probability of being safe (SUCRA values 45.2%, 43.4%, 43.0%, and 38.5%, respectively). Analysis of the secondary endpoints confirmed the superiority of RPA regarding OP, BL, LOS, and incisional hernia rate. CONCLUSIONS The best choice for patients with adrenal masses candidate for minimally invasive surgery seems to be RPA. An alternative could be RPLA. The remaining approaches could have some specific advantages but do not represent the first minimally invasive choice.
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Affiliation(s)
- Laura Alberici
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia
| | - Carlo Ingaldi
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia
- Department of Internal Medicine and Surgery, DIMEC) Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Claudio Ricci
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia.
- Department of Internal Medicine and Surgery, DIMEC) Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy.
- Dipartimento Di Scienze Mediche E Chirurgiche (DIMEC), Chirurgia Generale-Minni, Alma Mater Studiorum-Università Di Bologna, IRCCS, Policlinico S.Orsola-Malpighi, Via Massarenti n.9 40138, Bologna, Italy.
| | - Saverio Selva
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia
| | - Guido Di Dalmazi
- Department of Internal Medicine and Surgery, DIMEC) Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
- Unit of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia
| | - Valentina Vicennati
- Department of Internal Medicine and Surgery, DIMEC) Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
- Unit of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia
| | - Uberto Pagotto
- Department of Internal Medicine and Surgery, DIMEC) Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
- Unit of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia
| | - Riccardo Casadei
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia
- Department of Internal Medicine and Surgery, DIMEC) Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Francesco Minni
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia
- Department of Internal Medicine and Surgery, DIMEC) Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
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Yuan Q, Lu S, Cui X, Zhang Y, Xie Y, Zhang Y, Yan W, Ji Z, Huang Y. Transmuscular quadratus lumborum block for postoperative pain and recovery after laparoscopic adrenalectomy: a randomized controlled trial. BMC Anesthesiol 2021; 21:274. [PMID: 34753425 PMCID: PMC8576881 DOI: 10.1186/s12871-021-01494-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 10/25/2021] [Indexed: 01/07/2023] Open
Abstract
Background To investigate the role of transmuscular quadratus lumborum block (TMQLB) for postoperative pain control, patient satisfaction and recovery in laparoscopic adrenalectomy. Methods
Seventy-two patients aged between 18 and 70 years with an ASA I-II and scheduled for laparoscopic adrenalectomy were randomized to receive a single-shot TMQLB with 0.4 ml/kg 0.5 % ropivacaine or 0.4 ml/kg 0.9 % saline as placebo. The primary endpoint was pain on movement at 12 h after surgery evaluated by the numeric rating scale (NRS, 0–10). P-values < 0.05 was considered statistically significant. The secondary outcomes included pain at rest and pain on movement evaluated by the NRS, and postoperative recovery related parameters. Results NRS on movement at 12 h after surgery was lower in the TMQLB group compared with the control (median 2 vs. 3, p = 0.024). Intraoperative fentanyl consumption was lower in the TMQLB group (247.08 ± 63.54 vs. 285.44 ± 74.70, p = 0.022). The rate of using postoperative rescue tramadol was also lower in the TMQLB group (5.6 vs. 27.8 %, p = 0.027). Similar incidences of nausea and vomiting were observed (11.1 vs. 25 %, p = 0.220). Patient satisfaction of pain service was better in the TMQLB group (83.3 vs. 25 %, p < 0.001) with shorter time to ambulation (16.5 vs. 21 h, p = 0.004) and flatus (18.5 vs. 23.5 h, p = 0.006). Conclusions TMQLB showed better control of postoperative pain on movement for laparoscopic adrenalectomy with improved patients’ satisfaction of anesthesia, shorter time to ambulation and flatus. Trial registration This study was registered at Clinicaltrials.gov (NCT03942237; registration date: 08/05/2019; enrollment date: 10/05/2019).
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Affiliation(s)
- Qing Yuan
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, China
| | - Sufang Lu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, China
| | - Xulei Cui
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, China.
| | - Yuelun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, China
| | - Yi Xie
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, China
| | - Yushi Zhang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, China
| | - Weigang Yan
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, China
| | - Zhigang Ji
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, China
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Inoue S, Goto K, Ikeda K, Hieda K, Hayashi T, Teishima J. Longitudinal analysis of retroperitoneoscopic adrenalectomy regarding cosmesis outcomes: comparison of lateral transperitoneal and reduced port laparoscopic adrenalectomy. Updates Surg 2021; 74:757-764. [PMID: 34480272 DOI: 10.1007/s13304-021-01163-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/28/2021] [Indexed: 11/24/2022]
Abstract
The aim of this study is to compare patient-reported cosmesis and satisfaction outcomes between lateral retroperitoneoscopic adrenalectomy (LRA), laparoendoscopic single site and reduced port adrenalectomy (LESS/RP-A) and lateral transperitoneal laparoscopic adrenalectomy (LTA). A total of 26, 86 and 50 patients who underwent LRA, LESS/RP-A and LTA were included in the study. All LESS/RP-A cases were performed taking the transumbilical approach. We mailed a questionnaire to all patients 1, 3, 6, 9 and 12 months after operation. Questionnaires inquiring about cosmesis (0: very ugly, 10: very beautiful) on the basis of a visual analogue scale were administered. The mean scores of cosmesis at postoperative months 1, 3, 6, 9 and 12 were 7.11, 7.00, 6.57, 5.25 and 5.46 for the LRA group, 8.43, 8.86, 8.95, 8.46 and 9.09 for the LESS/RP-A group and 7.18, 7.74, 7.58, 7.44 and 8.09 for the LTA group. The difference in cosmesis score between the LRA and LESS/RP-A groups gradually increased after surgery, and the cosmesis score for the LRA group was significantly lower at every postoperative point. The difference in cosmesis score between the LRA and LTA groups gradually increased after surgery, and the cosmesis score for the LRA group was significantly lower at postoperative months 9 (p = 0.015) and 12 (p = 0.002). This study is the first comprehensive longitudinal analysis of patient-reported cosmesis outcomes between LRA, LESS/RP-A and LTA. LRA was the surgical procedure that resulted in lower cosmesis scores when compared with those following the LESS/RP-A and LTA procedures.
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Affiliation(s)
- Shogo Inoue
- Department of Urology, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Keisuke Goto
- Department of Urology, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kenichiro Ikeda
- Department of Urology, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Keisuke Hieda
- Department of Urology, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Tetsutaro Hayashi
- Department of Urology, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Jun Teishima
- Department of Urology, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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21
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Alberici L, Paganini AM, Ricci C, Balla A, Ballarini Z, Ortenzi M, Casole G, Quaresima S, Di Dalmazi G, Ursi P, Alfano MS, Selva S, Casadei R, Ingaldi C, Lezoche G, Guerrieri M, Minni F, Tiberio GAM. Development and validation of a preoperative "difficulty score" for laparoscopic transabdominal adrenalectomy: a multicenter retrospective study. Surg Endosc 2021; 36:3549-3557. [PMID: 34402981 PMCID: PMC9001553 DOI: 10.1007/s00464-021-08678-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/07/2021] [Indexed: 12/14/2022]
Abstract
Background A difficulty score for laparoscopic adrenalectomy (LA) is lacking in the literature. A retrospective cohort study was designed to develop a preoperative “difficulty score” for LA. Methods A multicenter study was conducted involving four Italian tertiary centers for adrenal disease. The population was randomly divided into two subsets: training group and validation one. A multicenter study was undertaken, including 964 patients. Patient, adrenal lesion, surgeon’s characteristics, and the type of procedure were studied as potential predictors of target events. The operative time (pOT), conversion rate (cLA), or both were used as indicators of the difficulty in three multivariate models. All models were developed in a training cohort (70% of the sample) and validated using 30% of patients. For all models, the ability to predict complicated postoperative course was reported describing the area under the curve (AUCs). Logistic regression, reporting odds ratio (OR) with p-value, was used. Results In model A, gender (OR 2.04, p = 0.001), BMI (OR 1.07, p = 0.002), previous surgery (OR 1.29, p = 0.048), site (OR 21.8, p < 0.001) and size of the lesion (OR 1.16, p = 0.002), cumulative sum of procedures (OR 0.99, p < 0.001), extended (OR 26.72, p < 0.001) or associated procedures (OR 4.32, p = 0.015) increased the pOT. In model B, ASA (OR 2.86, p = 0.001), lesion size (OR 1.20, p = 0.005), and extended resection (OR 8.85, p = 0.007) increased the cLA risk. Model C had similar results to model A. All scores obtained predicted the target events in validation cohort (OR 1.99, p < 0.001; OR 1.37, p = 0.007; OR 1.70, p < 0.001, score A, B, and C, respectively). The AUCs in predicting complications were 0.740, 0.686, and 0.763 for model A, B, and C, respectively. Conclusion A difficulty score based on both pOT and cLA (Model C) was developed using 70% of the sample. The score was validated using a second cohort. Finally, the score was tested, and its results are able to predict a complicated postoperative course. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08678-6.
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Affiliation(s)
- Laura Alberici
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Alessandro M Paganini
- Bariatric Surgery Unit, Department of General Surgery and Surgical Specialties "Paride Stefanini", AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Claudio Ricci
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy.
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy.
- Policlinico S.Orsola-Malpighi, Alma Mater Studiorum-Università di Bologna, Via Massarenti n.9, 40138, Bologna, Italy.
| | - Andrea Balla
- Bariatric Surgery Unit, Department of General Surgery and Surgical Specialties "Paride Stefanini", AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Zeno Ballarini
- Surgical Clinic, Department of Clinical and Experimental Sciences, The University of Brescia at ASST Spedali Civili di Brescia, Brescia, Italy
| | - Monica Ortenzi
- Clinica Chirurgica Generale e d'Urgenza, AOU Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Giovanni Casole
- Surgical Clinic, Department of Clinical and Experimental Sciences, The University of Brescia at ASST Spedali Civili di Brescia, Brescia, Italy
| | - Silvia Quaresima
- Bariatric Surgery Unit, Department of General Surgery and Surgical Specialties "Paride Stefanini", AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Guido Di Dalmazi
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Unit of Endocrinology and Diabetes Prevention and Care, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Pietro Ursi
- Bariatric Surgery Unit, Department of General Surgery and Surgical Specialties "Paride Stefanini", AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Marie Sophie Alfano
- Surgical Clinic, Department of Clinical and Experimental Sciences, The University of Brescia at ASST Spedali Civili di Brescia, Brescia, Italy
| | - Saverio Selva
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Riccardo Casadei
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Carlo Ingaldi
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Giovanni Lezoche
- Clinica Chirurgica Generale e d'Urgenza, AOU Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Mario Guerrieri
- Clinica Chirurgica Generale e d'Urgenza, AOU Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Francesco Minni
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Guido Alberto Massimo Tiberio
- Surgical Clinic, Department of Clinical and Experimental Sciences, The University of Brescia at ASST Spedali Civili di Brescia, Brescia, Italy
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Guo RQ, Li YM, Li XG. Comparison of the radiofrequency ablation versus laparoscopic adrenalectomy for aldosterone-producing adenoma: a meta-analysis of perioperative outcomes and safety. Updates Surg 2021; 73:1477-85. [PMID: 34165729 DOI: 10.1007/s13304-021-01069-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/27/2021] [Indexed: 10/21/2022]
Abstract
Radiofrequency ablation (RFA) has emerged as a new treatment for primary aldosteronism owing to aldosterone-producing adenoma (APA). We aimed to compare the perioperative outcomes and safety of RFA and laparoscopic adrenalectomy (LA) for patients with APA. We searched PubMed, EMBASE, and the Cochrane Library for all literatures published from January 2001 to September 2020 to compare RFA with LA for APA. After data extraction and quality assessments, we used Review Manager 5.4.1 and STATA 14.0 to pool the data. Four retrospective studies consisting of 170 patients were obtained. Patients who underwent RFA were associated with shorter operative time (standard mean difference (SMD): -1.98, 95% confidence interval (CI): -3.86 to 0.11, P = 0.04), less intraoperative blood loss (SMD: -0.61, 95% CI: -0.96 to -0.26, P = 0.0007), and shorter hospital stay (weight mean difference (WMD): -1.40, 95% CI: -1.71 to -1.10, P < 0.00001) than those who underwent LA. No significant differences were found in the complication rate (odds ratio (OR): 0.67, 95% CI: 0.27-1.68, P = 0.39), the incidence of hypertensive crisis (OR: 3.16, 95% CI: 0.36-27.94, P = 0.30), the conversion rate (OR: 0.44, 95% CI: 0.04-4.32, P = 0.48) or the treatment success rate (OR: 0.72, 95% CI: 0.22-2.39, P = 0.59) between the two groups. RFA could achieve clinical outcomes that approach LA for patients with APA but result in shorter operative time, less intraoperative blood loss, and shorter hospital stay. However, RFA does not appear to be able to replace the LA. Future prospective randomized trials are needed to validate these results.
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23
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Chen J, Wu J, Zhu R, Lu L, Ma XJ. Ablation versus laparoscopic adrenalectomy for the treatment of aldosterone‑producing adenoma: a meta-analysis. Abdom Radiol (NY) 2021; 46:2795-2804. [PMID: 33386911 DOI: 10.1007/s00261-020-02887-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/23/2020] [Accepted: 11/27/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To assess the relative clinical efficacy and safety of ablation and laparoscopic adrenalectomy (LA) for the treatment of adrenal aldosterone-producing adenoma (APA). MATERIALS AND METHODS Pubmed, Embase, and Cochrane Library databases were searched for relevant studies, while the meta-analysis was performed with RevMan v5.3. RESULTS After initially identifying 496 potentially relevant studies, five were ultimately included in the final meta-analysis. In total, these studies contained 128 patients that underwent LA and 91 patients that underwent ablation to treat APA. Clinical success rates were comparable between these two groups (OR: 0.55, P = 0.20), whereas the pooled decreases of systolic and diastolic blood pressure were significantly larger in the ablation group (P = 0.01 and 0.002, respectively). Pooled changes in the aldosterone-to-renin ratio (ARR), serum potassium levels, and medication use were similar in both groups (P = 0.62, 0.24, and 0.96, respectively). The average operative duration in the ablation group was somewhat shorter, but the difference was not significant (MD: - 57.99; P = 0.05), whereas the average blood loss and postoperative hospital stay duration of patients in the ablation group were decreased for patients in the ablation group compared to the LA group (P < 0.00001 and 0.00001, respectively). Major complication, minor complication, and hypertension crisis rates were comparable between these groups (P = 0.35, 0.69, and 0.09, respectively). CONCLUSIONS Ablation offers comparable efficacy to LA when treating patients with APA, but is associated with a reduced operative duration, decreased intraoperative blood loss, and faster postoperative recovery.
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Affiliation(s)
- Jin Chen
- Department of Radiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, China
| | - Juan Wu
- Department of Radiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, China
| | - Rui Zhu
- Department of Radiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, China
| | - Lu Lu
- Department of Radiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, China.
| | - Xi-Juan Ma
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, 221000, China.
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Staubitz JI, Clerici T, Riss P, Watzka F, Bergenfelz A, Bareck E, Fendrich V, Goldmann A, Grafen F, Heintz A, Kaderli RM, Karakas E, Kern B, Matter M, Mogl M, Nebiker CA, Niederle B, Obermeier J, Ringger A, Schmid R, Triponez F, Trupka A, Wicke C, Musholt TJ. [EUROCRINE®: adrenal surgery 2015-2019- surprising initial results]. Chirurg 2021; 92:448-463. [PMID: 32945919 PMCID: PMC8081706 DOI: 10.1007/s00104-020-01277-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Hintergrund Seit 2015 erfolgt in Europa mithilfe des EUROCRINE®-Registers eine systematische Dokumentation endokrin-chirurgischer Operationen. Ziel dieser ersten Auswertung war eine Darstellung der Versorgungsrealität für Nebenniereneingriffe in einem homogenen Versorgungsumfeld, entsprechend des deutschsprachigen Raums – bzw. des Präsenzgebiets der Chirurgischen Arbeitsgemeinschaft Endokrinologie (CAEK) der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV) – einschließlich einer Analyse der Adhärenz zu geltenden Therapieempfehlungen. Methodik Es erfolgte eine deskriptive Analyse der präoperativen Diagnostik, der angewandten Operationstechniken sowie der zugrunde liegenden histologischen Entitäten der zwischen den Jahren 2015 und 2019 über EUROCRINE® in Deutschland, Österreich und der Schweiz dokumentierten Nebennierenoperationen. Ergebnisse In den insgesamt 21 teilnehmenden Kliniken des deutschsprachigen EUROCRINE®-Gebiets wurden 658 Operationen an Nebennieren durchgeführt. In 90 % erfolgten unilaterale, in 3 % bilaterale Adrenalektomien und in 7 % andere Resektionsverfahren. Die in 41 % der Operationen dokumentierte histologische Hauptdiagnose war das adrenokortikale Adenom. In 15 % lagen maligne Befunde zugrunde (einschließlich 6 % Nebennierenrindenkarzinome (ACC) und 8 % Nebennierenmetastasen). 23 % der Operationen erfolgten bei Phäochromozytomen. Diese wurden zu 82 % minimal-invasiv operiert, Nebennierenrindenkarzinome lediglich zu 28 % und Nebennierenmetastasen zu 66 %. Schlussfolgerung Überraschenderweise wurden nach Nebennierenadenomen und Phäochromozytomen an dritthäufigster Stelle Nebennierenmetastasen unterschiedlicher Primärtumoren reseziert. 28 % der ACC waren für minimal-invasive Techniken vorgesehen, wobei 20 % dieser Fälle eine Konversion zur offenen Operation erforderten. Die aktuelle Analyse deckte Diskrepanzen zwischen Versorgungsrealität und Leitlinienempfehlungen auf, aus denen sich zahlreiche Fragestellungen ergeben, welche nun in ein überarbeitetes EUROCRINE®-Modul zur Dokumentation von Nebennierenoperationen einfließen werden.
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Affiliation(s)
- J I Staubitz
- Sektion Endokrine Chirurgie der Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstraße 1, Mainz, 55131, Deutschland
| | - T Clerici
- Kantonsspital St. Gallen, St. Gallen, Schweiz
| | - P Riss
- Universitätsklinik für Chirurgie, Medizinische Universität Wien, Wien, Österreich
| | - F Watzka
- Sektion Endokrine Chirurgie der Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstraße 1, Mainz, 55131, Deutschland
| | | | - E Bareck
- Abteilung für Chirurgie, KRAGES Burgenländische Krankenanstalten-Ges.m.b.H., Oberpullendorf, Österreich
| | - V Fendrich
- Klinik für Endokrine Chirurgie, Schön Klinik Hamburg Eilbek, Hamburg, Deutschland
| | - A Goldmann
- Viszeral- und Thoraxchirurgie, Kantonsspital Winterthur, Winterthur, Schweiz
| | - F Grafen
- Chirurgische Klinik, Spital Limmattal, Schlieren, Schweiz
| | - A Heintz
- Allgemein- und Viszeralchirurgie, Katholisches Klinikum Mainz, Mainz, Deutschland
| | - R M Kaderli
- Viszerale Chirurgie, Universitätsspital Bern, Bern, Schweiz
| | - E Karakas
- Klinik für Allgemein‑, Visceral- und Endokrine Chirurgie, Krankenhaus Maria Hilf Krefeld, Krefeld, Deutschland
| | - B Kern
- Viszeralchirurgie, St. Claraspital Basel, Basel, Schweiz
| | - M Matter
- Chirurgie Viscérale, Centre Hospitalier Universitaire Vaudois, Lausanne, Schweiz
| | - M Mogl
- Chirurgische Klinik, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - C A Nebiker
- Viszeralchirurgie, Kantonsspital Aarau, Aarau, Schweiz
| | - B Niederle
- Abteilung für Chirurgie, Franziskus Spital Wien, Wien, Österreich
| | - J Obermeier
- Klinik für Chirurgie, Klinikum Dortmund gGmbH, Dortmund, Deutschland
| | - A Ringger
- Chirurgie, Solothurner Spitäler AG, Solothurn, Schweiz
| | - R Schmid
- Viszeralchirurgie, Spitalzentrum Biel, Biel, Schweiz
| | - F Triponez
- Chirurgie thoracique et endocrinienne, Hôpitaux Universitaires Genève, Genève, Schweiz
| | - A Trupka
- Chirurgische Klinik, Klinikum Starnberg, Starnberg, Deutschland
| | - C Wicke
- Kantonsspital Luzern, Luzern, Schweiz
| | - T J Musholt
- Sektion Endokrine Chirurgie der Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstraße 1, Mainz, 55131, Deutschland.
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Cano-Valderrama O, González-Nieto J, Abad-Cardiel M, Ochagavía S, Rünkle I, Méndez JV, García-Donaire JA, Cuesta-Hernández M, Armijo JE, Miguel-Novoa P, Torres AJ, Martell-Claros N. Laparoscopic adrenalectomy vs. radiofrequency ablation for the treatment of primary aldosteronism. A single center retrospective cohort analysis adjusted with propensity score. Surg Endosc 2021; 36:1970-1978. [PMID: 33844083 DOI: 10.1007/s00464-021-08481-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 03/28/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Laparoscopic adrenalectomy (LA) is the gold standard treatment for unilateral primary aldosteronism. However, satisfactory results have also been published with radiofrequency ablation (RFA). The aim of this study was to compare LA and RFA for the treatment of primary aldosteronism. METHODS A retrospective cohort study of the patients who underwent LA or RFA in a single center was performed. Morbidity and long-term effectiveness (cure rate and blood pressure control) were analyzed. A multivariate analysis with a propensity score was also performed. RESULTS Thirty-four patients were included in the study, 24 in the LA group and 10 in the RFA group. Hypertension had been diagnosed a median of 12 years before the intervention. Hypertension was properly controlled before the intervention in 55.9% of the patients. Hypertensive crisis was more common during RFA (4.2% vs. 70.0%, p < 0.001), although no patient suffered any complication because of these crises. LA was longer (174.6 vs. 105.5 min, p = 0.001) and had a longer length of stay (median 2 vs 1 days, p < 0.001). No severe complications were observed in any of the patients. After a median follow-up of 46.2 months, more patients had hypertension cured and blood pressure controlled in the LA group (29.2% vs. 0%, p = 0.078 and 95.5% vs. 50.0%, p = 0.006, respectively). Also, patients in the LA group were taking less antihypertensive drugs (1.8 vs. 3.0, p = 0.054) or mineralocorticoid receptor antagonists (41.7% vs. 90.0%, p = 0.020). Multivariate analysis adjusted by propensity score showed that LA had an OR = 11.3 (p = 0.138) for hypertension cure and an OR = 55.1 (p = 0.040) for blood pressure control. CONCLUSIONS Although RFA was a less invasive procedure than LA, hypertension was cured and blood pressure was properly controlled in more patients from the LA group. Patients who underwent LA were taking less antihypertensive drugs than patients who had undergone RFA.
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Affiliation(s)
- Oscar Cano-Valderrama
- Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain. .,Department of Surgery, Universidad Complutense, Madrid, Spain. .,Instituto de Investigación Sanitaria San Carlos, Madrid, Spain.
| | | | - María Abad-Cardiel
- Instituto de Investigación Sanitaria San Carlos, Madrid, Spain.,Hypertension Unit, Hospital Clínico San Carlos, Madrid, Spain.,Department of Medicine, Universidad Complutense, Madrid, Spain
| | - Santiago Ochagavía
- Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain.,Department of Surgery, Universidad Complutense, Madrid, Spain
| | - Isabelle Rünkle
- Department of Endocrinology, Hospital Clínico San Carlos, Madrid, Spain
| | - José V Méndez
- Interventional Radiology Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - José A García-Donaire
- Instituto de Investigación Sanitaria San Carlos, Madrid, Spain.,Hypertension Unit, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Javier E Armijo
- Interventional Radiology Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - Paz Miguel-Novoa
- Department of Endocrinology, Hospital Clínico San Carlos, Madrid, Spain
| | - Antonio J Torres
- Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain.,Department of Surgery, Universidad Complutense, Madrid, Spain.,Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - Nieves Martell-Claros
- Instituto de Investigación Sanitaria San Carlos, Madrid, Spain.,Hypertension Unit, Hospital Clínico San Carlos, Madrid, Spain.,Department of Medicine, Universidad Complutense, Madrid, Spain
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Al-Jalabneh T, Al-Shawabkeh O, Al-Gwairy I, Abu-Zeitoun O, Al-Njadat I, Al-Soudi M, Zarour A. Laparoscopic Versus Open Adrenalectomy: a Retrospective Comparative Study. Med Arch 2021; 75:41-44. [PMID: 34012198 PMCID: PMC8116067 DOI: 10.5455/medarh.2021.75.41-44] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/25/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Laparoscopic Adrenalectomy (LA) has rapidly become the gold standard in management of adrenal tumors as it has been found to be associated with better cosmoses, shorter hospital stay and rapid convalescence. OBJECTIVE The aim of this study was to compare laparoscopic and open approach to adrenal glands in terms of operative time, hospital stay, indications and blood loss at a tertiary medical center in Jordan. METHODS A retrospective comparative study which included all patients who underwent adrenalectomy (open or laparoscopic) from 2005 to 2015 at King Hussein Medical Center (KHMC). Patients' demographics ,outcomes and essential study variables were extracted from patients' files. Data analysis was performed using SPSS17 and Stata 10. RESULTS One hundred and three patients (mean age 44.9 years) were included, 90.2% of them underwent laparoscopic adrenalectomy. The size of the tumors ranged from 2 to 17 cm (mean 6.6 cm).The operative time, blood loss and hospital stay were significantly less in the laparoscopic group (P value <0.001). Patients in Open group had a significantly higher risk of incomplete excision of the tumors (P value=0.020). CONCLUSION Laparoscopic adrenalectomy is associated with decreased operative time, blood loss and hospital stay compared to open approach. Tumor size and its malignant potential should be no more regarded as an absolute contraindication to laparoscopic adrenal surgery.
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Affiliation(s)
- Talal Al-Jalabneh
- Laparoscopic and Bariatric Surgery, Department of Surgery, Royal Medical Services, Amman, Jordan
| | - Omar Al-Shawabkeh
- Laparoscopic and Bariatric Surgery, Department of Surgery, Royal Medical Services, Amman, Jordan
| | - Ibrahim Al-Gwairy
- Laparoscopic and Bariatric Surgery, Department of Surgery, Royal Medical Services, Amman, Jordan
| | - Omar Abu-Zeitoun
- Laparoscopic and Bariatric Surgery, Department of Surgery, Royal Medical Services, Amman, Jordan
| | - Ismaieel Al-Njadat
- Laparoscopic and Bariatric Surgery, Department of Surgery, Royal Medical Services, Amman, Jordan
| | - Majdi Al-Soudi
- Breast and Oncology Surgery, Department of Surgery, Royal Medical Services, Amman, Jordan
| | - Ahmad Zarour
- Laparoscopic and Bariatric Surgery, Department of Surgery, Royal Medical Services, Amman, Jordan
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27
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Khalil N, Bizdikian AJ, Nasr S, Fakih F, Hajj P. Suspicious adrenal incidentaloma in a patient with Congenital Adrenal Hyperplasia: A case report. Urol Case Rep 2021; 36:101569. [PMID: 33511036 PMCID: PMC7815990 DOI: 10.1016/j.eucr.2021.101569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/07/2021] [Accepted: 01/09/2021] [Indexed: 12/05/2022] Open
Abstract
Congenital Adrenal Hyperplasia has been associated with an increased prevalence of adrenal masses. It is still unknown whether incidentalomas in CAH* patients are more frequent or if the risk of adrenal carcinoma is higher than the general population. Therefore, the management CAH subjects presenting with suspicious adrenal masses remains problematic. We relate the case of a patient with CAH presenting for an adrenal incidentaloma with malignant features. The management of such cases is controversial as surgery is risky for large masses. Despite dimensions, a laparoscopic approach was used for resection. The patient remained disease free at 4 years post-operatively.
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Affiliation(s)
- Nour Khalil
- Department of Surgery, Bellevue Medical Center, Mansourieh, Lebanon
| | | | - Sarah Nasr
- Department of Pathology, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Fadi Fakih
- Department of Urology, Mount Lebanon Hospital, Beirut, Lebanon
| | - Pascal Hajj
- Department of Urology, Bellevue Medical Center, Mansourieh, Lebanon
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28
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Al-Rawashdah S, Mansi H, Pastore AL, Carbone A. Adrenal cavernous Hemangioma;A rare diagnosis of adrenal incidentaloma:A case report, and literature review. Urol Case Rep 2020; 34:101477. [PMID: 33204642 PMCID: PMC7653277 DOI: 10.1016/j.eucr.2020.101477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 10/30/2020] [Indexed: 10/26/2022] Open
Abstract
Adrenal cavernous hemangioma is an extremely rare benign tumor. To date, less than 70 cases have been reported in the literature. In most of the cases, the tumor is hormonally silent, discovered incidentally and the diagnosis is made postoperatively. Pre-operative differentiation between this benign tumor and other malignant adrenal tumors is challenging. In this article we present a case of a non-functioning adrenal incidentaloma that was managed by laparoscopic adrenalectomy. The post-operative histological diagnosis was adrenal cavernous hemangioma.
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Affiliation(s)
- Samer Al-Rawashdah
- Department of Special Surgery, Urology Unit, Faculty of Medicine, Mutah University, Karak, Jordan
| | - Hammam Mansi
- Department of Special Surgery, Urology Unit, Faculty of Medicine, Mutah University, Karak, Jordan
| | - Antonio Luigi Pastore
- Department of Medico-Surgical Sciences and Biotechnologies/Urology Unit, Sapienza University - Polo Pontino - ICOT Hospital, Via Franco Faggiana, 1668, 04100, Latina, Italy
| | - Antonio Carbone
- Department of Medico-Surgical Sciences and Biotechnologies/Urology Unit, Sapienza University - Polo Pontino - ICOT Hospital, Via Franco Faggiana, 1668, 04100, Latina, Italy
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29
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Mahajan R, Kotwal S, Mahajan A, Anjali, Manhas A. Multidisciplinary collaborative approach for management of adrenal tumors: Outcomes of minimally invasive adrenalectomy at a single center. Urologia 2020; 88:237-241. [PMID: 33040707 DOI: 10.1177/0391560320964617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Laparoscopy is currently the gold standard for the management of adrenal tumors as it is associated with less morbidity. Owing to technological advances, even large adrenal tumors are currently amenable to laparoscopic removal. In this work, we describe our multidisciplinary collaborative approach for management of adrenal tumors at a single center. MATERIAL AND METHODS Between January 2017 and January 2020, 18 patients with adrenal lesions were operated at our center. Five of these patients had incidentalomas. All patients were evaluated in coordination with endocrinologists and anesthetists. All patients underwent transperitoneal laparoscopic adrenalectomy. The surgical complications were classified as per Clavein-Dindo system. All patients with pheochromocytoma and Cushing syndrome were followed up by the endocrinologist for further evaluation and titration of glucocorticoids and antihypertensive medication. RESULTS Two out of the 18 patients had American Society of Anesthesiologists (ASA) physical status III. Out of the 18 patients, only one required conversion to open surgery. Five patients developed intraoperative hypertensive crisis while three patients developed hypotensive crisis. All patients were ambulated on the first postoperative day and were discharged on the third post operative day. None of the patients developed any major (Clavein-Dindo III-V) intra operative or post operative complications. CONCLUSION Laparoscopic adrenalectomy is the procedure of choice for adrenal tumors. A multi-disciplinary approach involving the endocrinologist, anesthesiologist, and laparoscopic surgeon can help achieve favorable outcomes.
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Affiliation(s)
- Rahul Mahajan
- Department of Urology, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Suman Kotwal
- Department of Endocrinology, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Arti Mahajan
- Department of Anesthesia, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Anjali
- Department of Anesthesia, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Amit Manhas
- Department of Anesthesia, Government Medical College, Jammu, Jammu and Kashmir, India
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30
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Fu SQ, Zhuang CS, Yang XR, Xie WJ, Gong BB, Liu YF, Liu J, Sun T, Ma M. Comparison of robot-assisted retroperitoneal laparoscopic adrenalectomy versus retroperitoneal laparoscopic adrenalectomy for large pheochromocytoma: a single-centre retrospective study. BMC Surg 2020; 20:227. [PMID: 33028297 PMCID: PMC7539373 DOI: 10.1186/s12893-020-00895-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the feasibility and safety of robot-assisted retroperitoneal laparoscopic adrenalectomy (RARLA) for large pheochromocytomas (PHEOs; size≥6 cm) compared with retroperitoneal laparoscopic adrenalectomy (RLA). METHODS Fifty-one patients who underwent adrenalectomy for large PHEOs between March 2016 and January 2019 were enrolled and divided into two groups, including 32 RLA cases and 19 RARLA cases. We compared the perioperative efficacy and long-term follow-up results between the two groups. RESULTS Preoperative data, including demographics, comorbidities and tumour characteristics, were similar between the groups. Intraoperatively, the RARLA group had a lower incidence of haemodynamic instability (26.3% vs. 56.2%, P = 0.038) and less intraoperative blood loss (100 ml vs. Two hundred milliliter, P = 0.042) than the RLA group. The groups showed no significant differences in operative time or transfusion rates. Postoperatively, the time to diet resumption, time to ambulation, time to drainage removal and postoperative hospital stay were shorter in the RARLA group than in the RLA group (1 d vs. 2 d, P = 0.027; 1 d vs. 2 d, P = 0.034; 3 d vs. 5 d, P = 0.002; 5 d vs. 6 d, P = 0.02, respectively). The groups exhibited no significant differences in the duration of anaesthetic use, complications, or long-term follow-up results for the blood pressure (BP) improvement rate. CONCLUSIONS Compared with RLA, RARLA is a safe, feasible and even optimized procedure for large PHEOs.
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Affiliation(s)
- Sheng-Qiang Fu
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi Province, China
| | - Chang-Shui Zhuang
- Union Shenzhen Hospital, Huazhong University of Science and Technology, Shenzhen, 518052, China
| | - Xiao-Rong Yang
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi Province, China
| | - Wen-Jie Xie
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi Province, China
| | - Bin-Bin Gong
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi Province, China
| | - Yi-Fu Liu
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi Province, China
| | - Ji Liu
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi Province, China
| | - Ting Sun
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi Province, China
| | - Ming Ma
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi Province, China.
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Rodríguez-Hermosa JI, Delisau O, Planellas-Giné P, Cornejo L, Ranea A, Maldonado E, Fernández-Real JM, Codina-Cazador A. Factors associated with prolonged hospital stay after laparoscopic adrenalectomy. Updates Surg 2020; 73:693-702. [PMID: 32940830 DOI: 10.1007/s13304-020-00880-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
Laparoscopy is the standard technique for resecting adrenal tumors, but short-term outcomes such as length of stay (LOS) vary widely between centers. We aimed to identify factors associated with LOS after lateral transperitoneal laparoscopic adrenalectomy (LTLA). We analyzed consecutive patients undergoing unilateral LTLA between April 2003 and April 2020. Prolonged LOS was defined as a stay longer than the 75th percentile of the overall cohort. To identify potential factors associated with prolonged LOS, we compared collected data from patients with LOS ≤ 2 days versus LOS > 2 days and elaborated multivariate logistic regression models. We included 150 patients (73 men and 77 women, median age 54 years), with benign (n = 128) and malignant tumors (n = 22). The median LOS after LTLA was 2 days; 64 (42.7%) patients had prolonged hospitalization. Variables significantly associated with prolonged LOS in the univariate analysis included ASA III + IV (p = 0.016), pheochromocytoma (p < 0.001), learning curve (p = 0.032), surgery on Thursday or Friday (p < 0.001), 2D laparoscopy (p = 0.003), operative time (p < 0.001), estimated blood loss (p < 0.001), drainage (p < 0.001), specimen size (p = 0.011), conversions (p = 0.002), complications (p = 0.019), and hospital stay (p < 0.001). After adjustment for patient, surgical, and tumor characteristics, risk factors associated with prolonged LOS in the multivariate analysis were specimen size > 9 cm (OR:13.03, p = 0.005), surgery on Thursday or Friday (OR:6.92, p = 0.001), estimated blood loss ≥ 60 ml (OR:6.22, p = 0.021), and drainage (OR:5.29, p = 0.005). Prolonged length of stay after LTLA was associated with specimen size > 9 cm, operating on Thursday or Friday, estimated blood loss ≥ 60 mL, and drainage.
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Affiliation(s)
- José Ignacio Rodríguez-Hermosa
- Endocrine Surgery Unit, Department of Surgery, Department of Medical Sciences, Faculty of Medicine, Dr. Josep Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), University of Girona, Avda. França, s/n, 17007, Girona, Spain.
| | - Olga Delisau
- Department of Surgery, Department of Medical Sciences, Faculty of Medicine, Dr. Josep Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), University of Girona, Girona, Spain
| | - Pere Planellas-Giné
- Department of Surgery, Department of Medical Sciences, Faculty of Medicine, Dr. Josep Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), University of Girona, Girona, Spain
| | - Lídia Cornejo
- Department of Surgery, Department of Medical Sciences, Faculty of Medicine, Dr. Josep Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), University of Girona, Girona, Spain
| | - Alejandro Ranea
- Endocrine Surgery Unit, Department of Surgery, Department of Medical Sciences, Faculty of Medicine, Dr. Josep Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), University of Girona, Avda. França, s/n, 17007, Girona, Spain
| | - Eloy Maldonado
- Department of Surgery, Department of Medical Sciences, Faculty of Medicine, Dr. Josep Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), University of Girona, Girona, Spain
| | - José Manuel Fernández-Real
- Department of Endocrinology, Department of Medical Sciences, Faculty of Medicine, Dr. Josep Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), University of Girona, Girona, Spain
| | - Antoni Codina-Cazador
- Department of Surgery, Department of Medical Sciences, Faculty of Medicine, Dr. Josep Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), University of Girona, Girona, Spain
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32
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Rodríguez-Hermosa JI, Ranea A, Delisau O, Planellas-Giné P, Cornejo L, Pujadas M, Codony C, Gironès J, Codina-Cazador A. Three-dimensional (3D) system versus two-dimensional (2D) system for laparoscopic resection of adrenal tumors: a case-control study. Langenbecks Arch Surg 2020; 405:1163-1173. [PMID: 32909079 DOI: 10.1007/s00423-020-01950-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/27/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Laparoscopy is the standard technique for resecting adrenal tumors worldwide. The main drawbacks of conventional 2D laparoscopy are limited depth perception and tactile feedback. Currently available high-quality 3D laparoscopy systems might improve surgical outcomes for adrenalectomy. We compare the safety and efficacy of 3D versus 2D laparoscopy in the treatment of adrenal tumors. METHODS This case-control study analyzed prospectively collected data from patients with benign or malignant adrenal tumors treated laparoscopically at a single academic medical center between April 2003 and March 2020. We collected demographic, diagnostic, preoperative, and operative variables, and used multiple linear and logistic regression to analyze differences in various short-term outcomes between the two approaches while adjusting for potential confounders. RESULTS We included 150 patients: 128 with benign tumors and 22 with malignant tumors; 95 treated with 3D laparoscopy (case group); and 55 with 2D laparoscopy (control group). After adjustment for patient, surgical, and tumor characteristics, a 2D vision was associated with a longer operative time (β = 0.26, p = 0.002) and greater blood loss (β = 0.20, p = 0.047). There was no significant difference in rates of conversion to open surgery (odds ratio [OR] = 1.47 (95% CI 0.90-22.31); p = 0.549) or complications (3.6% vs. 2.1%; p = 0.624). CONCLUSIONS With experienced surgeons, laparoscopic adrenalectomy was safer and more feasible with the 3D system than with the 2D system, resulting in less operative blood loss and shorter operative time with no differences in rates of conversion to open surgery or postoperative complications. For adrenal tumors, 3D laparoscopy offers advantages over 2D laparoscopy.
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Affiliation(s)
- José Ignacio Rodríguez-Hermosa
- Endocrine Surgery Unit, Dr. Josep Trueta University Hospital, Girona, Spain. .,Department of Surgery, Dr. Josep Trueta University Hospital, Girona, Spain. .,Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Girona, Spain. .,Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain.
| | - Alejandro Ranea
- Endocrine Surgery Unit, Dr. Josep Trueta University Hospital, Girona, Spain.,Department of Surgery, Dr. Josep Trueta University Hospital, Girona, Spain.,Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Girona, Spain
| | - Olga Delisau
- Department of Surgery, Dr. Josep Trueta University Hospital, Girona, Spain.,Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Girona, Spain
| | - Pere Planellas-Giné
- Department of Surgery, Dr. Josep Trueta University Hospital, Girona, Spain.,Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Girona, Spain.,Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain
| | - Lídia Cornejo
- Department of Surgery, Dr. Josep Trueta University Hospital, Girona, Spain.,Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Girona, Spain
| | - Marcel Pujadas
- Department of Surgery, Dr. Josep Trueta University Hospital, Girona, Spain.,Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Girona, Spain
| | - Clara Codony
- Department of Surgery, Dr. Josep Trueta University Hospital, Girona, Spain.,Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Girona, Spain
| | - Jordi Gironès
- Endocrine Surgery Unit, Dr. Josep Trueta University Hospital, Girona, Spain.,Department of Surgery, Dr. Josep Trueta University Hospital, Girona, Spain.,Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Girona, Spain.,Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain
| | - Antoni Codina-Cazador
- Department of Surgery, Dr. Josep Trueta University Hospital, Girona, Spain.,Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Girona, Spain.,Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain
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Shekhar S, Haykal R, Kamilaris C, Stratakis CA, Hannah-Shmouni F. Curative resection of an aldosteronoma causing primary aldosteronism in the second trimester of pregnancy. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM200043. [PMID: 32755966 PMCID: PMC7424322 DOI: 10.1530/edm-20-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 07/13/2020] [Indexed: 11/21/2022] Open
Abstract
SUMMARY A 29-year-old primigravida woman with a known history of primary aldosteronism due to a right aldosteronoma presented with uncontrolled hypertension at 5 weeks of estimated gestation of a spontaneous pregnancy. Her hypertension was inadequately controlled with pharmacotherapy which lead to the consideration of surgical management for her primary aldosteronism. She underwent curative right unilateral adrenalectomy at 19 weeks of estimated gestational age. The procedure was uncomplicated, and her blood pressure normalized post-operatively. She did, however, have a preterm delivery by cesarean section due to intrauterine growth retardation with good neonatal outcome. She is normotensive to date. LEARNING POINTS Primary aldosteronism is the most common etiology of secondary hypertension with an estimated prevalence of 5-10% in the hypertensive population. It is important to recognize the subtypes of primary aldosteronism given that certain forms can be treated surgically. Hypertension in pregnancy is associated with significantly higher maternal and fetal complications. Data regarding the treatment of primary aldosteronism in pregnancy are limited. Adrenalectomy can be considered during the second trimester of pregnancy if medical therapy fails to adequately control hypertension from primary aldosteronism.
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Affiliation(s)
- Skand Shekhar
- Section on Endocrinology and Genetics, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Rasha Haykal
- Section on Endocrinology and Genetics, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Crystal Kamilaris
- Section on Endocrinology and Genetics, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Constantine A Stratakis
- Section on Endocrinology and Genetics, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Fady Hannah-Shmouni
- Section on Endocrinology and Genetics, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
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Abstract
Background Conn’s syndrome is a curable condition if identified properly. It is characterized by autonomous secretion of aldosterone from the adrenal gland cortex. Its morbidity is related to the increased risk of cardiovascular diseases. Case presentation We report the case of a 48-year-old man of African descent presenting with generalized tonic-clonic seizure and coma secondary to hypertensive encephalopathy. A biochemical evaluation revealed a very high aldosterone level and an undetectable renin level, both are compatible with primary aldosteronism. The presentation of the following confirms the diagnosis of primary aldosteronism: spontaneous hypokalemia, an undetectable renin level, and a high aldosterone level. Abdominal computed tomography revealed a left adrenal adenoma. Adrenal venous sampling confirmed lateralization of aldosterone excretion from the left adrenal gland. Our patient underwent left laparoscopic adrenalectomy that confirmed a left functional adrenal adenoma. After 12 months of follow up, his hypertension was controlled on only one antihypertensive drug which was down from four drugs preoperatively. Conclusion Conn’s syndrome, in this case, was complicated by coma secondary to seizure. Adrenalectomy normalized the hypokalemia and improved resistant hypertension. Potassium supplementation and several antihypertensives were discontinued as our patient became normokalemic and normotensive on one antihypertensive agent.
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Affiliation(s)
- Eiman Alseddeeqi
- Division of Endocrinology, Sheikh Khalifa Medical City, P.O. Box 51900, Abu Dhabi, United Arab Emirates.
| | - Ajda Altinoz
- Division of General Surgery, Tawam Hospital, Al Ain, Abu Dhabi, United Arab Emirates
| | - Najla Ben Ghashir
- Division of Pathology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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Boukhannous I, Aynaou M, Mhanna T, El Houmaidi A, Miri A, Barki A. Hemorrhagic adrenal gland lipoma: About a rare case and review of literature. Urol Case Rep 2020; 33:101294. [PMID: 33101997 PMCID: PMC7573851 DOI: 10.1016/j.eucr.2020.101294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 11/29/2022] Open
Abstract
The adrenal lipoma is an extremely rare, benign, and non-functional tumor. We present the first case of adrenal lipoma on the African continent and the youngest patient reported to date. computed tomography (CT) scan guided diagnosis and laparoscopic adrenalectomy was performed given symptomatic and large mass. Histological examination confirmed the diagnosis. At 12 months after the surgery, the patient had no evidence of recurrence.
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Affiliation(s)
- Ibrahim Boukhannous
- Department of Urology, Mohamed VI University Hospital Center, Mohamed I University, Oujda, Morocco
| | - Mohammed Aynaou
- Department of Urology, Mohamed VI University Hospital Center, Mohamed I University, Oujda, Morocco
| | - Tarik Mhanna
- Department of Urology, Mohamed VI University Hospital Center, Mohamed I University, Oujda, Morocco
| | - Amine El Houmaidi
- Department of Urology, Mohamed VI University Hospital Center, Mohamed I University, Oujda, Morocco
| | - Achraf Miri
- Department of Pathology, Mohamed VI University Hospital Center, Mohamed I University, Oujda, Morocco
| | - Ali Barki
- Department of Urology, Mohamed VI University Hospital Center, Mohamed I University, Oujda, Morocco
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Limberg J, Stefanova D, Ullmann TM, Thiesmeyer JW, Buicko JL, Finnerty BM, Zarnegar R, Fahey TJ, Beninato T. Not all laparoscopic adrenalectomies are equal: analysis of postoperative outcomes based on tumor functionality. Surg Endosc 2020; 35:2601-2606. [PMID: 32495185 DOI: 10.1007/s00464-020-07678-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/27/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Laparoscopic adrenalectomy is known to have a low complication rate; however, the influence of functional tumor subtype on postoperative outcomes is not well defined. METHODS Patients undergoing laparoscopic adrenalectomy for benign adrenal tumors between 2009 and 2017 were selected from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Patient demographics, postoperative outcomes, and length of stay were compared between tumor subtypes. RESULTS A total of 3946 patients underwent a laparoscopic adrenalectomy during the study period; 3214 (81.5%) were performed for non-functional adenomas, and 732 (18.6%) for functional tumors-467 (64%) aldosteronomas, 184 (25%) cortisol-producing adenomas, and 81 (11%) pheochromocytomas. The risk of any complication was highest for patients with Cushing's (6.5%) and lowest with Conn's syndrome (1.1%) compared to other lesions (3.7% pheochromocytoma, 5.3% adenoma, p < 0.001). Among the patients with functional tumors, those with cortisol-producing adenomas had the highest rates of both deep surgical site infection (1.6%, p = 0.026) and urinary tract infection (2.2%, p = 0.029), whereas myocardial infarction was most prevalent in patients with pheochromocytoma (2.5%, p = 0.012). When adjusted for demographic differences, BMI, and comorbidity scores, no tumor type was associated with increased complication rate; instead aldosteronoma (vs. benign adenoma) was independently predictive of fewer adverse events [0.3 (95% CI 0.1-0.7), p = 0.004] and a shorter length of hospital stay [0.6 (95% CI 0.4-0.8), p = 0.001]. The overall mortality rate was low at 0.4%, although significantly higher in Cushing's patients (2.2%, p = 0.015). CONCLUSIONS Laparoscopic adrenalectomy is a safe operation with low mortality and complication rates. However, postoperative risks differ between tumor subtype, so patients should be counseled accordingly.
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Affiliation(s)
- Jessica Limberg
- Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 1300 York Ave, New York, NY, USA.
| | - Dessislava Stefanova
- Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 1300 York Ave, New York, NY, USA
| | - Timothy M Ullmann
- Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 1300 York Ave, New York, NY, USA
| | - Jessica W Thiesmeyer
- Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 1300 York Ave, New York, NY, USA
| | - Jessica L Buicko
- Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 1300 York Ave, New York, NY, USA
| | - Brendan M Finnerty
- Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 1300 York Ave, New York, NY, USA
| | - Rasa Zarnegar
- Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 1300 York Ave, New York, NY, USA
| | - Thomas J Fahey
- Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 1300 York Ave, New York, NY, USA
| | - Toni Beninato
- Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 1300 York Ave, New York, NY, USA
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Gadelkareem RA, Moeen AM, Khalil M, Reda A, Farouk M, Abdelkawi IF, Makboul R, Mohammed N, Hameed DA. Experience of a Tertiary-Level Urology Center in Clinical Urological Events of Rare and Very Rare Incidence. V. Urological Tumors: 1. Adrenal Myelolipoma. Curr Urol 2020; 14:85-91. [PMID: 32774233 PMCID: PMC7390982 DOI: 10.1159/000499254] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 03/26/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To present our center's experience in the management of adrenal myelolipoma in the context of shifting from the open to the laparoscopic adrenalectomy approach. MATERIALS AND METHODS A retrospective search of our center's records was done for reported cases of adrenal myelolipoma during the period July 2001-June 2016. All the cases with histopathologically-documented adrenal myelolipoma diagnosis were included. Relevant demographic and clinical variables were studied with a comparison between the open and laparoscopic approaches. RESULTS Of more than 82,000 urological surgeries, 238 adrenalectomies were done with only 22 cases of myelolipoma that had a mean age and body mass index of 52.4 ± 10.3 years and 30.23 kg/m2, respectively. The main clinical presentation was accidental discovery. The largest dimension of tumors varied from 6 to 16 cm. Computed tomography described a characteristic picture of hypodense heterogeneous adrenal tumors in all cases, while magnetic resonance imaging was indicated for malignancy suspicion in only 5 cases. Adrenal tumor markers were normal in all cases. Open and transperitoneal laparoscopic adrenalectomies were used in 14 and 8 cases, respectively. The latter approach was insignificantly advantageous in the need for blood transfusion, postoperative pain degree, need for analgesia, and hospital stay duration (p = 0.22). Histo-pathological examination revealed benign adipose tissue and myeloid cells and confirmed the diagnosis of adrenal myelolipoma in all cases. CONCLUSIONS Adrenal myelolipoma is a rare non-functioning benign tumor. Laparoscopic excision seems to be a promising alternative approach to the traditional open adrenalectomy, even in the context of large tumors and obesity.
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Affiliation(s)
- Rabea A. Gadelkareem
- Assiut Urology and Nephrology Hospital, Faculty of Medicine
- *Rabea Ahmed Gadelkareem, Elgamaa Street, Faculty of Medicine, Assiut University, EG-71515 Assiut (Egypt), E-Mail
| | - Ahmed M. Moeen
- Assiut Urology and Nephrology Hospital, Faculty of Medicine
| | - Mahmoud Khalil
- Assiut Urology and Nephrology Hospital, Faculty of Medicine
| | - Ahmed Reda
- Assiut Urology and Nephrology Hospital, Faculty of Medicine
| | - Mahmoud Farouk
- Assiut Urology and Nephrology Hospital, Faculty of Medicine
| | | | - Rania Makboul
- Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Nasreldin Mohammed
- Assiut Urology and Nephrology Hospital, Faculty of Medicine
- Department of Urology, Martin-Luther University, Halle, Germany
| | - Dia A. Hameed
- Assiut Urology and Nephrology Hospital, Faculty of Medicine
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Tarallo M, Crocetti D, Fiori E, Sapienza P, Letizia C, De Toma G, Cavallaro G. Criticism of learning curve in laparoscopic adrenalectomy: a systematic review. Clin Ter 2020; 171:e178-e182. [PMID: 32141491 DOI: 10.7417/ct.2020.2209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Laparoscopic adrenalectomy (LA) has become the treatment of choice for benign adrenal lesions. Lateral Transperitoneal Laparoscopic Adrenalectomy (LTLA) is considered the gold standard. The number of LTLAs a surgeon must perform, in order to complete his learning curve, is not well defined in Literature. Moreover, the few papers dealing with the learning curve for LTLAs show controversial results and consider different evaluation parameters. METHODS The systematic review has been carried out according to PRISMA statement. The literature search included PubMed and Scopus database. Hand searching of reference lists of previous review articles and relevant studies was also performed. The search string was "learning curve AND laparoscopic adrenalectomy". RESULTS A total of 9 papers met the inclusion criteria out of 94 non duplicate citations. The aim of this systematic review is to provide a multidimensional evaluation by bringing into focus evaluation parameters of surgical performance, (operative time, intraoperative complications, conversion rate and blood loss), factors related to patient's pathology (side, size, adrenal pathology) and surgeon-specific properties. CONCLUSIONS Operative time, intraoperative bleeding, intraoperative complications and conversion rate are the main parameters that have been considered for the achievement of learning curve, and for each there are discrepancies, mainly due to the relative rarity of adrenal tumors, and so for difficulties in obtaining approper analysis that could establish an effective learning curve. So, further evaluations in larger experience are needed.
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Affiliation(s)
- M Tarallo
- Department of Surgery "P. Valdoni", Sapienza University, Rome
| | - D Crocetti
- Department of Surgery "P. Valdoni", Sapienza University, Rome
| | - E Fiori
- Department of Surgery "P. Valdoni", Sapienza University, Rome
| | - P Sapienza
- Department of Surgery "P. Valdoni", Sapienza University, Rome
| | - C Letizia
- Department of Clinical Sciences, Sapienza University, Rome, Italy
| | - G De Toma
- Department of Surgery "P. Valdoni", Sapienza University, Rome
| | - G Cavallaro
- Department of Surgery "P. Valdoni", Sapienza University, Rome
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Ildefonso-Najarro SP, Plasencia-Dueñas EA, Benites-Moya CJ, Carrion-Rojas J, Concepción-Zavaleta MJ. Pregnancy during the course of Cushing's syndrome: a case report and literature review. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM200022. [PMID: 32478666 PMCID: PMC7159255 DOI: 10.1530/edm-20-0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 03/23/2020] [Indexed: 02/05/2023] Open
Abstract
SUMMARY Cushing's syndrome is an endocrine disorder that causes anovulatory infertility secondary to hypercortisolism; therefore, pregnancy rarely occurs during its course. We present the case of a 24-year-old, 16-week pregnant female with a 10-month history of unintentional weight gain, dorsal gibbus, nonpruritic comedones, hirsutism and hair loss. Initial biochemical, hormonal and ultrasound investigations revealed hypokalemia, increased nocturnal cortisolemia and a right adrenal mass. The patient had persistent high blood pressure, hyperglycemia and hypercortisolemia. She was initially treated with antihypertensive medications and insulin therapy. Endogenous Cushing's syndrome was confirmed by an abdominal MRI that demonstrated a right adrenal adenoma. The patient underwent right laparoscopic adrenalectomy and anatomopathological examination revealed an adrenal adenoma with areas of oncocytic changes. Finally, antihypertensive medication was progressively reduced and glycemic control and hypokalemia reversal were achieved. Long-term therapy consisted of low-dose daily prednisone. During follow-up, despite favorable outcomes regarding the patient's Cushing's syndrome, stillbirth was confirmed at 28 weeks of pregnancy. We discuss the importance of early diagnosis and treatment of Cushing's syndrome to prevent severe maternal and fetal complications. LEARNING POINTS Pregnancy can occur, though rarely, during the course of Cushing's syndrome. Pregnancy is a transient physiological state of hypercortisolism and it must be differentiated from Cushing's syndrome based on clinical manifestations and laboratory tests. The diagnosis of Cushing's syndrome during pregnancy may be challenging, particularly in the second and third trimesters because of the changes in the maternal hypothalamic-pituitary-adrenal axis. Pregnancy during the course of Cushing's syndrome is associated with severe maternal and fetal complications; therefore, its early diagnosis and treatment is critical.
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Affiliation(s)
| | | | | | - Jose Carrion-Rojas
- Metabolism and Reproduction Unit, Division of Endocrinology, Guillermo Almenara Irigoyen National Hospital, Lima, Peru
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Zaman S, Patel B, Glynne P, Vanderpump M, Alsafi A, Khan S, Flora R, Palazzo F, Wernig F. A rare cause of severe Cushing's syndrome. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM200011. [PMID: 32168466 PMCID: PMC7077516 DOI: 10.1530/edm-20-0011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 02/26/2020] [Indexed: 11/08/2022] Open
Abstract
SUMMARY Ectopic adrenocorticotropic hormone (ACTH) production is an uncommon cause of Cushing's syndrome and, rarely, the source can be a phaeochromocytoma. A 55-year-old man presented following an episode of presumed gastroenteritis with vomiting and general malaise. Further episodes of diarrhoea, joint pains and palpitations followed. On examination, he was hypertensive with no clinical features to suggest hypercortisolaemia. He was subsequently found to have raised plasma normetanephrines of 3.98 nmol/L (NR <0.71) and metanephrines of 0.69 nmol/L (NR <0.36). An adrenal CT showed a 3.8 cm right adrenal nodule, which was not MIBG-avid but was clinically and biochemically consistent with a phaeochromocytoma. He was started on alpha blockade and referred for right adrenalectomy. Four weeks later, on the day of admission for adrenalectomy, profound hypokalaemia was noted (serum potassium 2.0 mmol/L) with non-specific ST-segment ECG changes. He was also diagnosed with new-onset diabetes mellitus (capillary blood glucose of 28 mmol/L). He reported to have gained weight and his skin had become darker over the course of the last 4 weeks. Given these findings, he underwent overnight dexamethasone suppression testing, which showed a non-suppressed serum cortisol of 1099 nmol/L. Baseline serum ACTH was 273 ng/L. A preliminary diagnosis of ectopic ACTH secretion from the known right-sided phaeochromocytoma was made and he was started on metyrapone and insulin. Surgery was postponed for 4 weeks. Following uncomplicated laparoscopic adrenalectomy, the patient recovered with full resolution of symptoms. LEARNING POINTS Phaeochromocytomas are a rare source of ectopic ACTH secretion. A high clinical index of suspicion is therefore required to make the diagnosis. Ectopic ACTH secretion from a phaeochromocytoma can rapidly progress to severe Cushing's syndrome, thus complicating tumour removal. Removal of the primary tumour often leads to full recovery. The limited literature suggests that the presence of ectopic Cushing's syndrome does not appear to have any long-term prognostic implications.
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Affiliation(s)
- Shamaila Zaman
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Bijal Patel
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | | | | | - Ali Alsafi
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Sairah Khan
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Rashpal Flora
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Fausto Palazzo
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Florian Wernig
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
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Cagney D, Hanrahan M, Razzaq Z, Majeed M, O'Leary DP, Redmond HP. Evolution of adrenal surgery in a tertiary referral centre. Ir J Med Sci 2020; 189:1305-10. [PMID: 32140992 DOI: 10.1007/s11845-020-02204-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/20/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic transperitoneal and retroperitoneoscopic adrenalectomy have largely replaced open adrenal surgery, particularly in benign disease. Laparoscopic surgery results in less post-operative pain, fewer surgical site complications and reduced length of hospital stay. The aim of this retrospective study was to analyse the characteristics of patients and evolution of surgical technique in adrenal surgery at Cork University Hospital over a 12-year period. METHODS All cases of adrenalectomy between January 1st, 2007 and December 31st, 2018 were retrospectively reviewed. Patient demographics, diagnosis, surgical approach, length of hospital stay, histology and complications were evaluated. Comparisons were made between open, laparoscopic transperitoneal and retroperitoneoscopic adrenalectomy cases. RESULTS There were 57 adrenalectomies performed on 55 patients over the 12-year period. Twenty-six patients (46%) were male, and the mean age was 49 years (range 14-84 years). Twenty-two (39%) right-sided adrenalectomies were performed, 33 (57%) left sided and 2 (4%) patients underwent bilateral surgery. Seventeen adrenalectomies were performed using an open transperitoneal approach, 30 via a laparoscopic transperitoneal approach and 10 using the retroperitoneoscopic technique. Adenoma and pheochromocytoma were the most common indications for surgery (42% and 40%, respectively). Seven percent were performed for malignancy and 5% for other benign indications. The complication rate for open adrenalectomy was 18% versus 10% in laparoscopic transperitoneal adrenalectomy and 0% for retroperitoneoscopic adrenalectomy. Two patients (7%) undergoing laparoscopic transperitoneal surgery required conversion to an open procedure. There were no 30-day mortalities and no disease recurrence within the study time frame. The mean length of hospital stay was 7.6 days in the open group, 5.8 days for the laparoscopic transperitoneal group and 3 days for the retroperitoneoscopic group (p = 0.03). CONCLUSIONS Adrenalectomy is a safe procedure and in our setting was primarily performed for pheochromocytoma and non-functioning adenomas. Minimally invasive adrenalectomy has become the standard of care internationally and is associated with fewer complications, shorter hospital stay and a low conversion rate.
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Tepede AA, Welch J, Lee M, Mandl A, Agarwal SK, Nilubol N, Patel D, Cochran C, Simonds WF, Weinstein LS, Jha A, Millo C, Pacak K, Blau JE. 18F-FDOPA PET/CT accurately identifies MEN1-associated pheochromocytoma. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM190156. [PMID: 32130200 PMCID: PMC7077596 DOI: 10.1530/edm-19-0156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 02/11/2020] [Indexed: 12/13/2022] Open
Abstract
SUMMARY Pheochromocytoma (PHEO) in multiple endocrine neoplasia type 1 (MEN1) is extremely rare. The incidence is reported as less than 2%. We report a case of a 76-year-old male with familial MEN1 who was found to have unilateral PHEO. Although the patient was normotensive and asymptomatic, routine screening imaging with CT demonstrated bilateral adrenal masses. The left adrenal mass grew from 2.5 to 3.9 cm over 4 years with attenuation values of 9 Hounsfield units (HU) pre-contrast and 15 HU post-contrast washout. Laboratory evaluation demonstrated an adrenergic biochemical phenotype. Both 18F-fluorodeoxyglucose (18F-FDG) PET/CT and 123I-metaiodobenzylguanidine (123I-mIBG) scintigraphy demonstrated bilateral adrenal uptake. In contrast, 18F-fluorodihydroxyphenylalanine (18F-FDOPA) PET/CT demonstrated unilateral left adrenal uptake (28.7 standardized uptake value (SUV)) and physiologic right adrenal uptake. The patient underwent an uneventful left adrenalectomy with pathology consistent for PHEO. Post-operatively, he had biochemical normalization. A review of the literature suggests that adrenal tumors >2 cm may be at higher risk for pheochromocytoma in patients with MEN1. Despite a lack of symptoms related to catecholamine excess, enlarging adrenal nodules should be biochemically screened for PHEO. 18F-FDOPA PET/CT may be beneficial for localization in these patients. LEARNING POINTS 18F-FDOPA PET/CT is a beneficial imaging modality for identifying pheochromocytoma in MEN1 patients. Adrenal adenomas should undergo routine biochemical workup for PHEO in MEN1 and can have serious peri-operative complications if not recognized, given that MEN1 patients undergo frequent surgical interventions. MEN1 is implicated in the tumorigenesis of PHEO in this patient.
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Affiliation(s)
- Aisha A Tepede
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Disease (NIDDK)
| | - James Welch
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Disease (NIDDK)
| | - Maya Lee
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Disease (NIDDK)
| | - Adel Mandl
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Disease (NIDDK)
| | - Sunita K Agarwal
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Disease (NIDDK)
| | - Naris Nilubol
- National Cancer Institute (NCI), National Institutes of Health, Bethesda, Maryland, USA
| | - Dhaval Patel
- National Cancer Institute (NCI), National Institutes of Health, Bethesda, Maryland, USA
| | - Craig Cochran
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Disease (NIDDK)
| | - William F Simonds
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Disease (NIDDK)
| | - Lee S Weinstein
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Disease (NIDDK)
| | - Abhishek Jha
- Eunice Kennedy Shriver National Institute of Child Health and Development (NICHD), National Institutes of Health, Bethesda, Maryland, USA
| | - Corina Millo
- Clinical Center PET Department (CC PET), National Institutes of Health, Bethesda, Maryland, USA
| | - Karel Pacak
- Eunice Kennedy Shriver National Institute of Child Health and Development (NICHD), National Institutes of Health, Bethesda, Maryland, USA
| | - Jenny E Blau
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Disease (NIDDK)
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Cardinali L, Skrami E, Catani E, Carle F, Ortenzi M, Balla A, Guerrieri M. Laparoscopic transperitoneal adrenalectomy: a comparative study of different techniques for vessel sealing. Surg Endosc 2021; 35:673-83. [PMID: 32072291 DOI: 10.1007/s00464-020-07432-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 02/10/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Laparoscopic adrenalectomy is the standard surgical approach to adrenal lesions. Adrenal vessel sealing is the critical surgical phase of laparoscopic adrenalectomy. This study aimed at comparing perioperative outcomes of laparoscopic transperitoneal adrenalectomy by means of radiofrequency energy-based device (LARFD) to those performed with traditional clipping device (LACD), while focusing on the different adrenal vessel control techniques. METHODS Patients who underwent adrenalectomy for adrenal disease between January 1994 and April 2019 at the Surgical Clinic, Polytechnic University of Marche were included in the study. Overall, 414 patients met inclusion criteria for study eligibility: 211 and 203 patients underwent LARFD and LACD, respectively. Multiple models of quantile regression, logistic regression and Poisson finite mixture regression were used to assess the relationship between operative time, conversion to open procedure, length of stay (LoS), surgical procedure and patient characteristics, respectively. RESULTS LARFD reduced operative time of about 12 min compared to LACD. Additional operative time-related factors were surgery side, surgery approach, conversion to open procedure and trocar number. The probability of conversion to open procedure decreased by about 76% for each added trocar, whereas it increased by about 49% for each added centimeter of adrenal lesion and by about 25% for each added year of surgery. Two patient clusters were identified based on the LoS: long-stay and short-stay. In the long-stay cluster, LoS decreased of about 30% in LARFD group and it was significantly associated with conversion to open procedure and postoperative complications, whereas in short-stay cluster only postoperative complications had a significant effect on LoS. CONCLUSION Laparoscopic transperitoneal adrenalectomy performed by means of radiofrequency energy-based device for the sealing of adrenal vessels is an effective procedure reducing operative time with potentially improved postoperative outcomes.
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Traynor MD, Sada A, Thompson GB, Moir CR, Bancos I, Farley DR, Dy BM, Lyden ML, Habermann EB, McKenzie TJ. Adrenalectomy for non-neuroblastic pathology in children. Pediatr Surg Int 2020; 36:129-135. [PMID: 31691026 DOI: 10.1007/s00383-019-04589-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Adrenalectomy for non-neuroblastic pathologies in children is rare with limited data on outcomes. We reviewed our experience of adrenalectomy in this unique population. METHODS Retrospective study of children (age ≤ 18) who underwent adrenalectomy with non-neuroblastic pathology from 1988 to 2018. Clinical and operative details of patients were abstracted. Outcomes included length of stay and 30-day postoperative morbidity. RESULTS Forty children underwent 50 adrenalectomies (12 right-sided, 18 left-sided, 10 bilateral). Six patients (15%) presented with an incidental adrenal mass while 4 (10%) had masses found on screening for genetic mutations or prior malignancy. The remaining 30 (75%) presented with symptoms of hormonal excess. Nineteen patients (48%) underwent genetic evaluation and 15 (38%) had genetic predispositions. Diagnoses included 9 patients (23%) with pheochromocytoma, 8 (20%) with adrenocortical adenoma, 8 (20%) with adrenocortical carcinoma, 7 (18%) with adrenal hyperplasia, 2 (5%) with metastasis, and 6 (14%) with additional benign pathologies. Of 50 adrenalectomies, twenty-five (50%) were laparoscopic. Median hospital length of stay was 3 days (range 0-11). Post-operative morbidity rate was 17% with the most severe complication being Clavien-Dindo grade II. CONCLUSION Adrenalectomy for non-neuroblastic pathology can be done with low morbidity. Its frequent association with genetic mutations and syndromes requires surgeons to have knowledge of appropriate pre-operative testing and post-operative surveillance.
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Affiliation(s)
- Michael D Traynor
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Alaa Sada
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Geoffrey B Thompson
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Irina Bancos
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - David R Farley
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Benzon M Dy
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Melanie L Lyden
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Elizabeth B Habermann
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Travis J McKenzie
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Gambardella C, Docimo L. Retroperitoneoscopic adrenalectomy is a safe procedure? Anatomical knowledge is the key - An invited commentary on "Feasibility and safety profile of posterior retroperitoneoscopic adrenalectomy in high-risk patients - A retrospective analysis". Int J Surg 2020; 75:45-46. [PMID: 31987817 DOI: 10.1016/j.ijsu.2020.01.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 01/18/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Claudio Gambardella
- Division of General, Mini-invasive and Obesity Surgery, Master of Coloproctology and Master of Pelvi-Perineal Rehabilitation, University of Study of Campania "Luigi Vanvitelli", Naples, Italy; Department of Cardiothoracic Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Naples, Italy.
| | - Ludovico Docimo
- Division of General, Mini-invasive and Obesity Surgery, Master of Coloproctology and Master of Pelvi-Perineal Rehabilitation, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
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Seki Y, Morimoto S, Yoshida N, Bokuda K, Sasaki N, Yatabe M, Yatabe J, Watanabe D, Morita S, Hata K, Yamamoto T, Nagashima Y, Ichihara A. Primary aldosteronism in Klinefelter's syndrome: two cases. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM190126. [PMID: 31841437 PMCID: PMC6935713 DOI: 10.1530/edm-19-0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 11/28/2019] [Indexed: 11/08/2022] Open
Abstract
SUMMARY Primary aldosteronism (PA) is more common than expected. Aberrant adrenal expression of luteinizing hormone (LH) receptor in patients with PA has been reported; however, its physiological role on the development of PA is still unknown. Herein, we report two unique cases of PA in patients with untreated Klinefelter's syndrome, characterized as increased serum LH, suggesting a possible contribution of the syndrome to PA development. Case 1 was a 39-year-old man with obesity and hypertension since his 20s. His plasma aldosterone concentration (PAC) and renin activity (PRA) were 220 pg/mL and 0.4 ng/mL/h, respectively. He was diagnosed as having bilateral PA by confirmatory tests and adrenal venous sampling (AVS). Klinefelter's syndrome was suspected as he showed gynecomastia and small testes, and it was confirmed on the basis of a low serum total testosterone level (57.3 ng/dL), high serum LH level (50.9 mIU/mL), and chromosome analysis. Case 2 was a 28-year-old man who had untreated Klinefelter's syndrome diagnosed in his childhood and a 2-year history of hypertension and hypokalemia. PAC and PRA were 247 pg/mL and 0.3 ng/mL/h, respectively. He was diagnosed as having a 10 mm-sized aldosterone-producing adenoma (APA) by AVS. In the APA, immunohistochemical analysis showed co-expression of LH receptor and CYP11B2. Our cases of untreated Klinefelter's syndrome complicated with PA suggest that increased serum LH levels and adipose tissues, caused by primary hypogonadism, could contribute to PA development. The possible complication of PA in hypertensive patients with Klinefelter's syndrome should be carefully considered. LEARNING POINTS The pathogenesis of primary aldosteronism is still unclear. Expression of luteinizing hormone receptor has been reported in aldosterone-producing adenoma. Serum luteinizing hormone, which is increased in patients with Klinefelter's syndrome, might contribute to the development of primary aldosteronism.
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Affiliation(s)
- Yasufumi Seki
- Departments of Endocrinology and Hypertension, Tokyo, Japan
| | | | | | - Kanako Bokuda
- Departments of Endocrinology and Hypertension, Tokyo, Japan
| | | | - Midori Yatabe
- Departments of Endocrinology and Hypertension, Tokyo, Japan
| | - Junichi Yatabe
- Departments of Endocrinology and Hypertension, Tokyo, Japan
| | | | - Satoru Morita
- Departments of Diagnostic Imaging and Nuclear Medicine, Tokyo, Japan
| | - Keisuke Hata
- Departments of Urology, Kidney Center, Tokyo, Japan
| | - Tomoko Yamamoto
- Departments of Surgical Pathology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Yoji Nagashima
- Departments of Surgical Pathology, Tokyo Women’s Medical University, Tokyo, Japan
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Lenders NF, Greenfield JR. Urinary steroid profiling in diagnostic evaluation of an unusual adrenal mass. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM190090. [PMID: 31778357 PMCID: PMC6893307 DOI: 10.1530/edm-19-0090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/06/2019] [Indexed: 12/12/2022] Open
Abstract
SUMMARY Adrenal oncocytomas are rare tumours, with only approximately 160 cases reported in the literature. We report the use of urinary steroid profiling as part of their diagnostic evaluation and prognostication. A 45-year-old woman presented with clinical features of hyperandrogenism. Serum biochemistry confirmed androgen excess and computed tomography (CT) demonstrated a 3.2 cm adrenal tumour with density 39 HU pre-contrast. Urine steroid profiling showed elevated tetrahydro-11 deoxycortisol (THS), which is associated with adrenal malignancy. Laparoscopic adrenalectomy was performed, and histopathology diagnosed adrenal oncocytoma. Serum and urinary biochemistry resolved post-operatively and remained normal at 1-year follow-up. LEARNING POINTS Differential diagnosis of adrenal masses is challenging. Current techniques for differentiating between tumour types lack sensitivity and specificity. 24-h urinary steroid profiling is a useful tool for reflecting steroid output from adrenal glands. Gas chromatography-mass spectrometry (GC-MS) of urinary steroid metabolites has sensitivity and specificity of 90% for diagnosing adrenocortical carcinoma. Adrenal oncocytoma are rare tumours. Differentiating between benign and malignant types is difficult. Data guiding prognostication and management are sparse.
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Affiliation(s)
- N F Lenders
- Diabetes and Metabolism, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- Department of Endocrinology, St Vincent’s Hospital, Sydney, New South Wales, Australia
- St Vincent’s Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - J R Greenfield
- Diabetes and Metabolism, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- Department of Endocrinology, St Vincent’s Hospital, Sydney, New South Wales, Australia
- St Vincent’s Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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Rossini A, Perticone F, Frosio L, Schiavo Lena M, Lanzi R. Somatostatin analog challenge test in the pre-surgical management of ACTH-secreting pheochromocytoma. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM190123. [PMID: 31765327 PMCID: PMC6893305 DOI: 10.1530/edm-19-0123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 11/06/2019] [Indexed: 11/24/2022] Open
Abstract
SUMMARY ACTH-secreting pheochromocytoma is a very rare cause of Cushing's syndrome, with a high morbidity and mortality risk due to both cortisol and catecholamines excess. We report the case of a 45-year-old female patient with a 3 cm, high-density, left adrenal mass, diagnosed as an ACTH-secreting pheochromocytoma. The biochemical sensitivity of the tumor to somatostatin analogues was tested by a 100 μg s.c. octreotide administration, which led to an ACTH and cortisol reduction of 50 and 25% respectively. In addition to alpha and beta blockers, preoperative approach to laparoscopic adrenalectomy included octreotide, a somatostatin analogue, together with ketoconazole, in order to achieve an adequate pre-surgical control of cortisol release. Histopathological assessment confirmed an ACTH-secreting pheochromocytoma expressing type 2 and 5 somatostatin receptors (SSTR-2 and -5). LEARNING POINTS ACTH-secreting pheochromocytomas represent a rare and severe condition, characterized by high morbidity and mortality risk. Surgical removal of the adrenal mass is the gold standard treatment, but adequate medical therapy is required preoperatively to improve the surgical outcome and to avoid major complications. Somatostatin analogs, in addition to other medications, may represent a useful therapeutic option for the presurgical management of selected patients. In this sense, the octreotide challenge test is a useful tool to predict favorable therapeutic response to the treatment.
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Affiliation(s)
- Alessandro Rossini
- Endocrinology and Diabetes Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
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Dworak J, Wysocki M, Rzepa A, Natkaniec M, Pędziwiatr M, Budzyński A, Major P. Laparoscopic adrenalectomy - is it safe in hands of residents in training? BMC Urol 2019; 19:102. [PMID: 31660932 PMCID: PMC6816204 DOI: 10.1186/s12894-019-0538-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 10/10/2019] [Indexed: 01/10/2023] Open
Abstract
Background Laparoscopic adrenalectomy (LA) has become the “gold standard” for treating most adrenal tumors in the past decade. However, it is still considered a relatively complicated procedure requiring experience from surgeon. The aim of the study was to evaluate the safety of laparoscopic adrenalectomy performed by residents who are undergoing training in general surgery. Methods A prospectively collected database containing all 300 transperitoneal laparoscopic adrenalectomies performed in II Department of General Surgery JU MC, Krakow between January 2013 and March 2018 was retrospectively reviewed. Patients were divided into two groups; patients operated on by residents (group 1, 54 operations) and by attending general surgeons (group 2, 246 operations). We compared the course of the operation and patient hospitalization in these two groups. If the operation was completed by a different person than the one who started the procedure, we refer to this as “operator conversion”. Results We found no differences in demographic factors or comorbidities between the two groups. The mean operative time was similar in the residents’ and the specialists’ groups (p = 0.5761). Median blood loss did not differ between the groups (p = 0.4325). The overall ratio of intraoperative adverse events was similar in both groups (p = 0.8643). The difference in the ratio of perioperative complications between the groups was not statistically significant (p = 0.6442). The average mean hospital stay after surgery was 2 days for both groups. We identified 25 cases (8.33%) of operator conversion; the difference in operator conversions between two groups was not statistically significant (p = 0.1741). Conclusions Laparoscopic transperitoneal adrenalectomy performed by a supervised resident is a safe procedure. The course of the operation and patient hospitalization did not differ importantly when comparing procedures performed by residents and attending surgeons. Liberal use of operator conversions from resident to attending surgeon and from a surgeon to a senior surgeon provides reasonable safety and prevents complications. In high-volume centers performing minimally invasive techniques, closed supervision allows residents to safely perform LA.
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Affiliation(s)
- Jadwiga Dworak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland
| | - Michał Wysocki
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland
| | - Anna Rzepa
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland
| | - Michał Natkaniec
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland
| | - Andrzej Budzyński
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland.
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Melson E, Amir S, Shepherd L, Kauser S, Freestone B, Kempegowda P. Myocardial Infarction with non-obstructed coronaries - atypical presentation of pheochromocytoma. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM190089. [PMID: 31634865 DOI: 10.1530/edm-19-0089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 10/01/2019] [Indexed: 02/06/2023] Open
Abstract
SUMMARY Although pheochromocytoma classically presents with headaches, palpitations and paroxysmal hypertension, atypical presentations such as cardiomyopathy, stroke and subarachnoid haemorrhage have been infrequently documented. We present in this case report, an uncommon presentation of pheochromocytoma with myocardial infarction with normal coronary arteries (MINOCA). A 79-year-old woman presented with central crushing chest pain radiating to left arm associated with headache, palpitations, sweating and difficulty in breathing. For 2 years, she experienced brief episodes of headache, tinnitus, dizziness, palpitations, and sweating that spontaneously resolved. Clinical examination was unremarkable except for high blood pressure (210/105 mmHg). Her electrocardiogram showed T wave inversions from V1 to V6 and elevated troponins (774 ng/L at baseline and 932 ng/L 3 h from baseline (normal <16 ng/L) in keeping with a diagnosis of non-ST elevated myocardial infarction. Coronary angiography showed normal coronary arteries. Patient was hence treated as myocardial infarction with normal coronaries (MINOCA). Despite appropriate treatment for MINOCA, she continued to experience episodic headaches, palpitations, dizziness and erratic blood pressures (particularly severe hypertension shortly after beta-blocker administration). Further investigations revealed raised urine noradrenaline of 4724 nmol/24 h (<554 nmol/24 h) and urine adrenaline of 92863 nmol/24 h (<77 nmol/24 h). Computerised tomography demonstrated a well-defined rounded mass in right adrenal gland morphological of pheochromocytoma. She underwent laparoscopic right adrenalectomy with histology confirming pheochromocytoma. This case highlights the importance of thorough investigation for the underlying cause for MINOCA. In patients with unexplained erratic blood pressure control, pheochromocytoma should be considered as a differential diagnosis. LEARNING POINTS Pheochromocytoma is rare tumour that often presents with non-specific symptoms. It is important to investigate underlying cause of MINOCA. Thorough history is the key to diagnosis.
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Affiliation(s)
- Eka Melson
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sidra Amir
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Lisa Shepherd
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Samina Kauser
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Bethan Freestone
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Punith Kempegowda
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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