Antioxidant Barrier and Oxidative Damage to Proteins, Lipids, and DNA/RNA in Adrenal Tumor Patients

This study is the first to assess redox balance, glutathione metabolism, and oxidative damage to RNA/DNA, proteins, and lipids in the plasma/serum and urine of patients with adrenal masses. The study included 70 patients with adrenal tumors divided into three subgroups: incidentaloma ( n = 30 ), pheochromocytoma ( n = 20 ), and Cushing’s/Conn’s adenoma ( n = 20 ), as well as 60 healthy controls. Blood and urine samples were collected before elective endoscopic adrenalectomy. Antioxidant defense capacity was significantly decreased (serum/plasma: superoxide dismutase (SOD), catalase (CAT) and reduced glutathione (GSH), uric acid (UA); urine: SOD, GSH, UA) in patients with adrenal masses. The oxidative damage to proteins (advanced glycation end products (AGE), advanced oxidation protein products (AOPP)) and lipids (lipid hydroperoxides (LOOH), and malondialdehyde (MDA)) was higher in the plasma and urine of these patients. Plasma MDA and DNA/RNA oxidation products, with high sensitivity and specificity, can help to diagnose pheochromocytoma. This biomarker differentiates patients with pheochromocytoma from Cushing’s/Conn’s adenoma as well as from heathy controls. Plasma RNA/DNA oxidation was also positively correlated with urine metanephrine. Oxidative stress can play a crucial role in adrenal tumors. However, further studies are required to clarify the role of redox signaling in adrenal masses.

Posterior retroperitoneal endoscopic adrenalectomy: benefits, disadvantages, indications, tips and tricks.

Resumen En esta revisión se analizan las potenciales ventajas e inconvenientes de la vía retroperitoneal posterior para el tratamiento quirúrgico de las lesiones suprarrenales. Entre las primeras, la reducción del tiempo operatorio, el facilitar la adrenalectomía parcial, evitar campos con adherencias o irradiación previa, facilitar la hemostasia, mejorar el confort postoperatorio del paciente y reducir la incidencia de eventraciones. Entre los segundos, trabajar en un limitado espacio, una falta de referencias anatómicas claras, no poder tratar patologías abdominales concomitantes, tener una aplicabilidad muy dependiente de la configuración antropométrica del paciente y limitada por la obesidad. Por otro lado, su utilidad está puesta en duda ante determinadas patologías renales y como tratamiento de lesiones malignas. También se valorarán las contraindicaciones relativas de este abordaje, y se revisarán los detalles técnicos a tener en cuenta en relación al posicionamiento del paciente y los puertos, la disección del espacio retroperitoneal La vía retroperitoneal posterior es un abordaje seguro, reproducible, rápido y eficaz para tratar las lesiones de la glándula suprarrenal. Correctamente indicada, permite unos resultados al menos tan buenos como los obtenidos con la vía laparoscópica transperitoneal lateral. Por ello, debería de formar parte del armamentario de las Unidades de Cirugía Endocrina que traten pacientes con enfermedades de la glándula suprarrenal.

A Case of 10-Year Survival after Adrenalectomy for Isolated Adrenal Metastasis of Breast Cancer

Isolated adrenal metastasis of breast cancer is very rare, so adrenalectomy for breast cancer metastasis is rarely performed. The case of a breast cancer patient with five-year survival after resection of a left isolated adrenal metastasis is presented. A 70-year-old woman underwent left modified radical mastectomy and axillary lymphadenectomy for invasive ductal carcinoma (T2N1M0) 9 years earlier. At regular follow-up, a left adrenal mass, 4 cm in diameter, was seen on ultrasound examination and computed tomography (CT). Endoscopic adrenalectomy was performed. Pathological examination confirmed isolated adrenal metastasis of breast cancer. After surgery, hormone therapy was given for 5 years. Ten years after adrenalectomy, no metastatic lesions in other organs have been found on CT. Adrenalectomy for a metastatic adrenal tumor of breast cancer may provide survival benefits when combined with systemic hormone therapy and chemotherapy, particularly in patients with disease confined to the adrenal glands.

Application of Accelerated Activation in Retroperitoneal Video Endoscopic Adrenalectomy for Cushing Syndrome

Purpose.To improve the immediate results of surgical treatment of endogenous hypercorticism throughoptimizing the perioperative management of patients using accelerated rehabilitation protocols.Materials and methods.A randomized prospective study of 53 patients with a body mass index 35 kg/m2 was carried out. In the control group (n=27), TIVA based on propofol was used with postoperative analgesia by systemic administration of opioids. In the accelerated rehabilitation protocol group (n=26), we used anesthesia based on low-flow inhalation of desflurane with sympatholytic mixture infusion in intra- and postoperative periods, multimodal postoperative analgesia, and use of accelerated rehabilitation protocol in the perioperative period. The time of patients' achievement of BIS90 index, time of extubation, time of achievement of 10 points by the Aldrete scale and 0 points by the Bidway test, duration of stay in the in-patient hospital, number of postoperative complications were assessed. Effectiveness of analgesia was evaluated by the time of the first analgesia requirement, consumption of narcotic analgesic, VAS and Verbal Descriptor scale.Results.The study revealed that the time of awakening and reaching 10 points by the Aldrete scale in patients of group 2 was significantly shorter than in group 1: 3 (2; 6) and 6.5 (3.5; 9) min respectively (P=0.046). They had fewer postoperative complications, shorter hospitalization time — 58 (39; 71) hours compared to the control group with 74.5 (58.5; 87) hours (P=0.032).Conclusion.Perioperative management of obese patients after retroperitoneal video endoscopic adrenalectomy with the use of accelerated rehabilitation protocols contributed to earlier mobilization, reduction of the number of complications in the early postoperative period, reduction of the duration of stay in the in-patient hospital, which together facilitates improving the immediate results of surgical treatment of endogenous hypercorticism.

Bilateral Pheochromocytoma in von Hippel-Lindau Syndrome Simultaneously Removed by Lateral Retroperitoneal Endoscopic Approach

ABSTRACT Von Hippel-Lindau (VHL) syndrome is an autosomal dominant familial neoplastic syndrome caused by mutation in VHL tumor suppressor gene localized on chromosome 3p25. The disease is characterized by abnormal vascular proliferation and increased risk of developing renal cell carcinoma, pheochromocytoma, hemangioblastoma of the central nervous system, tumors of the endolymphatic bag, cysts of the kidney, liver and pancreas, epididymal cystadenomas, neuroendocrine tumors of the pancreas, angiomas in the retina. We report a case of a bilateral pheochromocytoma, simultaneously removed by unilateral total and contralateral subtotal retroperitoneal endoscopic adrenalectomy. How to cite this article Todorov G, Grozdev K, Lukanova T, Mioljevikj-Miserliovska B, Miserliovski R. Bilateral Pheochromocytoma in von Hippel-Lindau Syndrome Simultaneously Removed by Lateral Retroperitoneal Endoscopic Approach. World J Endoc Surg 2012;4(3):102-104.