Diseases of the Adrenal Gland and Adrenalectomy

2019 ◽  
Author(s):  
Quan-Yang Duh ◽  
Frederick Thurston Drake
Keyword(s):  
Primary Aldosteronism ◽  
Cushing Syndrome ◽  
Laparoscopic Approach ◽  
Adrenal Incidentaloma ◽  
Operative Approach ◽  
Adrenal Surgery ◽  
Adrenocortical Cancer ◽  
Retroperitoneoscopic Adrenalectomy ◽  
Adrenocortical Carcinomas ◽  
Invasive Techniques

Evaluation and treatment of adrenal disease encompasses a broad range of disorders, including pheochromocytoma, primary hypercortisolism, primary aldosteronism, and malignancies such as adrenocortical carcinoma and metastases from other primary cancers. This pathophysiologic diversity and the technical challenges of operating on these bilateral organs with the attendant differences in left and right anatomy make adrenal surgery a complex but rewarding endeavor. Adrenal surgeons must be engaged in the physiologic aspects of the disease being treated, the anatomic details of lesion and laterality, and the technical considerations in selecting an operative approach and carrying it out successfully. Guidelines for the management of pheochromocytoma, primary hypercortisolism, and primary aldosteronism are reviewed in this chapter. Consensus is emerging that resection of adrenal metastases from other primary cancers can prolong survival in well-selected patients and that most are suitable for a laparoscopic approach. Most adrenal surgeons agree that large or locally aggressive adrenocortical carcinomas must be resected in an open fashion, though there is some controversy surrounding the operative approach in the setting of small or indeterminate lesions. Minimally invasive techniques have revolutionized adrenal surgery, and surgeons who wish to incorporate adrenal surgery into their practice must master either the laparoscopic or the retroperitoneoscopic approach. This review contains 8 figures, 2 tables, and 28 references. Key Words: adrenal cortex, adrenalectomy, adrenal incidentaloma, adrenal medulla, adrenocortical cancer, Cushing syndrome, laparoscopic adrenalectomy, pheochromocytoma, primary aldosteronism, retroperitoneoscopic adrenalectomy

Diseases of the Adrenal Gland and Adrenalectomy

2019 ◽  
Author(s):  
Quan-Yang Duh ◽  
Frederick Thurston Drake
Keyword(s):  
Primary Aldosteronism ◽  
Cushing Syndrome ◽  
Laparoscopic Approach ◽  
Adrenal Incidentaloma ◽  
Operative Approach ◽  
Adrenal Surgery ◽  
Adrenocortical Cancer ◽  
Retroperitoneoscopic Adrenalectomy ◽  
Adrenocortical Carcinomas ◽  
Invasive Techniques

Evaluation and treatment of adrenal disease encompasses a broad range of disorders, including pheochromocytoma, primary hypercortisolism, primary aldosteronism, and malignancies such as adrenocortical carcinoma and metastases from other primary cancers. This pathophysiologic diversity and the technical challenges of operating on these bilateral organs with the attendant differences in left and right anatomy make adrenal surgery a complex but rewarding endeavor. Adrenal surgeons must be engaged in the physiologic aspects of the disease being treated, the anatomic details of lesion and laterality, and the technical considerations in selecting an operative approach and carrying it out successfully. Guidelines for the management of pheochromocytoma, primary hypercortisolism, and primary aldosteronism are reviewed in this chapter. Consensus is emerging that resection of adrenal metastases from other primary cancers can prolong survival in well-selected patients and that most are suitable for a laparoscopic approach. Most adrenal surgeons agree that large or locally aggressive adrenocortical carcinomas must be resected in an open fashion, though there is some controversy surrounding the operative approach in the setting of small or indeterminate lesions. Minimally invasive techniques have revolutionized adrenal surgery, and surgeons who wish to incorporate adrenal surgery into their practice must master either the laparoscopic or the retroperitoneoscopic approach. This review contains 8 figures, 2 tables, and 28 references. Key Words: adrenal cortex, adrenalectomy, adrenal incidentaloma, adrenal medulla, adrenocortical cancer, Cushing syndrome, laparoscopic adrenalectomy, pheochromocytoma, primary aldosteronism, retroperitoneoscopic adrenalectomy

scholarly journals Bilateral adrenalectomy: a review of 10 years’ experience

2017 ◽  
Vol 99 (2) ◽  
pp. 119-122 ◽  
Author(s):  
D Maccora ◽  
GV Walls ◽  
GP Sadler ◽  
R Mihai
Keyword(s):  
Cushing’S Disease ◽  
Operating Time ◽  
Laparoscopic Approach ◽  
Bilateral Adrenalectomy ◽  
Cushing's Disease ◽  
Adrenocortical Cancer ◽  
Infection Level ◽  
Tertiary Referral Centre ◽  
Postoperative Haemorrhage ◽  
Retroperitoneoscopic Adrenalectomy

INTRODUCTIONThe 2012 British Association of Endocrine and Thyroid Surgeons audit report showed that only 86 of 1359 patients who underwent adrenalectomy had a bilateral operation; thus the experience with this procedure remains limited.METHODSRetrospective review of patients undergoing bilateral adrenalectomy in a tertiary referral centre.RESULTSBetween November 2005 and January 2016, bilateral adrenalectomy was performed in 23 patients (6 male, 17 female, age 43 ± 4 years) diagnosed with Cushing’s disease (n = 13), hereditary phaeochromocytomas (n = 6), adrenocortical cancer (n = 2), colorectal metastatic disease (n = 1) and adrenocortical adenomas (n = 1). A laparoscopic transperitoneal approach was used in 17 patients, with one conversion to open. Three patients had open adrenalectomies for adrenocortical cancer and for simultaneous phaeochromocytomas and pancreatic neuroendocrine tumours in a patient with Von Hippel-Lindau syndrome. Three patients with Cushing’s had a bilateral retroperitoneoscopic operation. The mean operating time was 195 ± 16 minutes for laparoscopic operations (n = 16), 243 ± 44 minutes for open adrenalectomies (n = 4) and 151 ± 12 minutes for retroperitoneal operations. It was significantly shorter for Cushing’s disease than for phaeochromocytomas (162 ± 8 vs. 257 ± 39 minutes, P < 0.01). Median length of hospital stay was 5 days. Postoperative complications (Clavien-Dindo classification) included one chest infection (level 2), one postoperative haemorrhage and two chest drains for pneumothorax (level 3), two postoperative cardiac arrests (level 4) and one late cancer death from complications related to uncontrolled hypercortisolism (level 5).DISCUSSIONSynchronous bilateral adrenalectomy remains an infrequent operation. The laparoscopic approach is feasible in the majority of patients. It is likely that the retroperitoneoscopic adrenalectomy will become the standard approach for bilateral operations.

Conus-level combined dorsal and ventral lumbar rhizotomy for treatment of mixed hypertonia: technical note and complications

2021 ◽  
Vol 27 (1) ◽  
pp. 102-107
Author(s):  
Ranbir Ahluwalia ◽  
Patrick Bass ◽  
Laura Flynn ◽  
Elizabeth Martin ◽  
Heather Riordan ◽  
...  
Keyword(s):  
Effective Treatment ◽  
Lower Extremities ◽  
Technical Note ◽  
Operative Approach ◽  
Less Invasive ◽  
Ventral Roots ◽  
Technical Challenges ◽  
Invasive Techniques ◽  
Csf Leaks

Combined dorsal and ventral rhizotomy is an effective treatment for patients with concurrent spasticity and dystonia, with the preponderance of complaints relating to their lower extremities. This operative approach provides definitive relief of hypertonia and should be considered after less-invasive techniques have been exhausted. Previously, the surgery has been described through an L1–S1 laminoplasty. In this series, 7 patients underwent a conus-level laminectomy for performing a lumbar dorsal and ventral rhizotomy. Technical challenges included identifying the appropriate-level ventral roots and performing the procedure in children with significant scoliosis. Techniques are described to overcome these obstacles. The technique was found to be safe, with no infections, CSF leaks, or neurogenic bladders.

Practice points for surgical oncology

2016 ◽  
pp. 163-172
Author(s):  
Petra G. Boelens ◽  
C.B.M. van den Broek ◽  
Cornelis J.H. van de Velde
Keyword(s):  
Locally Advanced ◽  
Laparoscopic Approach ◽  
Oncologic Outcome ◽  
Surgical Oncology ◽  
Infectious Complications ◽  
Minimal Invasive ◽  
Locoregional Recurrence Rate ◽  
Cancer Types ◽  
Minimal Invasive Techniques ◽  
Invasive Techniques

Cancer surgery remains the cornerstone of curative cancer treatment for most solid cancers. Staging, resectability and timing of surgery should be discussed in a multidisciplinary team. Complete resection offers the best prognosis at many stages. Anatomical planes of surgery need to be taught and respected to reduce locoregional recurrence rate. Age, comorbidities, and patient preferences are important to consider before surgical treatment is advised. Minimal invasive techniques have shown equivalence in oncologic outcome for certain cancer types and established benefits in short-term outcomes. A laparoscopic approach is even sometimes possible. It remains important to select patients for these techniques according to medical history, staging, and fitness. In specialized centres locally advanced disease can be treated by a multimodal approach. The quality of surgery can be improved using standardized audit structures to monitor and feed back on outcome of surgery such as resected margins, infectious complications, and disease-free and overall survival.

PS01.070: EVALUATION OF THE EFFECTIVENESS OF ROBOTIC FUNDOPLICATIONS IN THE TREATMENT OF GERD

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 69-69
Author(s):  
Mikhail Koshkin ◽  
Oleg Vasnev ◽  
Alexandr Belousov ◽  
Mikhail Mikhnevich ◽  
Magomet Baychorov ◽  
...  
Keyword(s):  
Operative Time ◽  
Conflicts Of Interest ◽  
Nissen Fundoplication ◽  
Laparoscopic Approach ◽  
Laparoscopic Group ◽  
Short Term ◽  
Antireflux Operations ◽  
Davinci System ◽  
Invasive Techniques ◽  
Median Operative Time

Abstract Background Surgical treatment is one of the most effective options for treatment of gastroesofageal reflux disease. Laparoscopic approach became is a ‘gold standard’ over the time demonstrating all advantages of minimally invasive techniques over the open procedures. However the utility of robotic antireflux operations still remains controversial. Methods Since the January till the December of 2017 thirty operations were operated on. Mean age was 57,2 (35–76), among them 21 (70%) were female and 9 (30%) were males. Mean BMI was 29,4 (24,1–41,0). Laparoscopic procedures were performed in15 patients (1st group), robotic procedures with DaVinci system were performed in 15 patients of the second group. Chernousov modified Nissen fundoplication was performed in 25 patients, Toupet fundoplication was used for 4 patients, Nissen type was performed in 4 cases. Results The median operative time in laparoscopic group was 125 min (80–200 min), in robotic group - 124 min (90–210 min). There were no statistical differences between two groups (P = 0,93).Blood loss was minimal in both groups. Mean postoperative hospital stay was 4 days (2–7 days) in the 1st group and 4 days (2–6 days) in the second. There were no statistical differences between two groups (P = 0,19). Postoperative course was uneventful in all patients of both groups. Conclusion Robotic antireflux operations are safe and effective in treatment of patients with reflux-esophagitis. There were no statistically significant differences in short-term results of laparoscopic and robotic operations. Disclosure All authors have declared no conflicts of interest.

scholarly journals Hypertension, hypokalemia, and left adrenal tumor mimicking primary aldosteronism in a patient with 17α-hydroxylase deficiency

2019 ◽  
Vol 7 (1) ◽  
pp. 6
Author(s):  
Shu-Heng Huang ◽  
Daw-Yang Hwang ◽  
Shang-Jyh Hwang
Keyword(s):  
Primary Aldosteronism ◽  
Adrenal Tumor ◽  
Laboratory Data ◽  
Adrenal Incidentaloma ◽  
Plasma Renin ◽  
Secondary Hypertension ◽  
Hydroxylase Deficiency ◽  
Secondary Sexual Characteristics ◽  
Sexual Characteristics ◽  
Secondary Sexual

17α-hydroxylase deficiency (17OHD) is a rare disorder of secondary hypertension caused by congenital adrenal hyperplasia. In addition, co-occurrence of an adrenal tumor with 17OHD is extremely rare and easily misdiagnosed. A 33-year-old female with sicca syndrome, persistent hypertension, hypokalemia, and a left adrenal tumor was referred for confirmation of primary aldosteronism. However, the absence of secondary sexual characteristics, persistent growth beyond puberty, and laboratory data of low plasma renin activity, high aldosterone, low cortisol, low sex hormones, elevated adrenocorticotropic hormone, elevated luteinizing hormone, elevated follicle-stimulating hormone, and most importantly, decreased 17-hydroxypregnenolone, supported a diagnosis of 17OHD. We sequenced the CYP17A1 gene of the patient and her parents, which demonstrated genetic defects (D487-S,488-F489 deletion and Y329K418X). 17OHD was diagnosed. The left adrenal tumor was assessed, and a non-functional adrenal incidentaloma was confirmed; NP-59 adrenal cortical scintigraphy and adrenal venous sampling showed no functional activity and non-lateralization. Hormone replacements with estrogen, spironolactone, and prednisolone were given. The patient became more feminized and confident, and her hypertension was controlled. Early diagnosis and treatment of 17OHD not only can prevent delay development of secondary sexual characteristics but also help the patient maintain mental health and improve their quality of life. In addition, the concomitant presence of a left adrenal tumor makes misdiagnosis of a functional adenoma more likely, possibly causing unnecessary surgery and delay inappropriate treatment.

scholarly journals Primary aldosteronism in patients with adrenal incidentaloma: Is screening appropriate for everyone?

2018 ◽  
Vol 20 (5) ◽  
pp. 942-948 ◽  
Author(s):  
Konstantinos Stavropoulos ◽  
Konstantinos P. Imprialos ◽  
Niki Katsiki ◽  
Konstantinos Petidis ◽  
Apostolos Kamparoudis ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Adrenal Incidentaloma

DO WE HAVE TO SCREEN PATIENTS WITH ADRENAL INCIDENTALOMA FOR PRIMARY ALDOSTERONISM?

2018 ◽  
Vol 36 (Supplement 1) ◽  
pp. e303
Author(s):  
K. Stavropoulos ◽  
K. Imprialos ◽  
K. Petidis ◽  
A. Kamparoudis ◽  
P. Petras ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Adrenal Incidentaloma

scholarly journals CACNA1HM1549V Mutant Calcium Channel Causes Autonomous Aldosterone Production in HAC15 Cells and Is Inhibited by Mibefradil

Endocrinology ◽  
2016 ◽  
Vol 157 (8) ◽  
pp. 3016-3022 ◽  
Author(s):  
Esther N. Reimer ◽  
Gudrun Walenda ◽  
Eric Seidel ◽  
Ute I. Scholl
Keyword(s):  
Calcium Channel ◽  
Primary Aldosteronism ◽  
Cancer Cell Line ◽  
Fold Increase ◽  
Extracellular Potassium ◽  
Channel Blockers ◽  
Adrenocortical Cancer ◽  
Transfected Cells ◽  
Channel Inactivation ◽  
Aldosterone Production

We recently demonstrated that a recurrent gain-of-function mutation in a T-type calcium channel, CACNA1HM1549V, causes a novel Mendelian disorder featuring early-onset primary aldosteronism and hypertension. This variant was found independently in five families. CACNA1HM1549V leads to impaired channel inactivation and activation at more hyperpolarized potentials, inferred to cause increased calcium entry. We here aimed to study the effect of this variant on aldosterone production. We heterologously expressed empty vector, CACNA1HWT and CACNA1HM1549V in the aldosterone-producing adrenocortical cancer cell line H295R and its subclone HAC15. Transfection rates, expression levels, and subcellular distribution of the channel were similar between CACNA1HWT and CACNA1HM1549V. We measured aldosterone production by an ELISA and CYP11B2 (aldosterone synthase) expression by real-time PCR. In unstimulated cells, transfection of CACNA1HWT led to a 2-fold increase in aldosterone levels compared with vector-transfected cells. Expression of CACNA1HM1549V caused a 7-fold increase in aldosterone levels. Treatment with angiotensin II or increased extracellular potassium levels further stimulated aldosterone production in both CACNA1HWT- and CACNA1HM1549V-transfected cells. Similar results were obtained for CYP11B2 expression. Inhibition of CACNA1H channels with the T-type calcium channel blocker Mibefradil completely abrogated the effects of CACNA1HWT and CACNA1HM1549V on CYP11B2 expression. These results directly link CACNA1HM1549V to increased aldosterone production. They suggest that calcium channel blockers may be beneficial in the treatment of a subset of patients with primary aldosteronism. Such blockers could target CACNA1H or both CACNA1H and the L-type calcium channel CACNA1D that is also expressed in the adrenal gland and mutated in patients with primary aldosteronism.

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