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Partial adrenalectomy in patients with multiple adrenal tumors

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Abstract

Most adrenal tumors are found incidentally and appear as small solitary nodules on abdominal imaging. Occasionally, work-up demonstrates multifocal or bilateral adrenal tumors. Certain patients are predisposed to multiple lesions, such as those with hereditary forms of pheochromocytoma as seen in von Hippel-Lindau disease, multiple endocrine neoplasia type II, and von Recklinghausen’s disease. Partial rather than total adrenalectomy should be considered for these patients in an attempt to preserve endogenous adrenocortical function. Partial adrenalectomy has also been used to resect other types of adrenal tumors, especially in patients with a solitary adrenal gland. A discussion of the indications for partial adrenalectomy and of the surgical technique follows.

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References and Recommended Reading

  1. Oelkers W: Adrenal insufficiency. N Engl J Med 1996, 335:1206–1212.

    Article  PubMed  CAS  Google Scholar 

  2. Zelissen PM, Croughs RJM, Van Rijk PP, et al.: Effect of glucocorticoid replacement therapy on bone mineral density in patients with Addison’s disease Ann Intern Med 1994, 120:207–210.

    PubMed  CAS  Google Scholar 

  3. Lairmore TC, Ball DW, Baylin SB, Wells Jr SA: Management of pheochromocytomas in patients with multiple endocrine neoplasia type 2 syndromes Ann Surg 1993, 217:595–603.

    Article  PubMed  CAS  Google Scholar 

  4. Telenius-Berg M, Ponder MA, Berg B, et al.: Quality of life after bilateral adrenalectomy in MEN-2 Henry Ford Hosp Med J 1989, 37:160.

    PubMed  CAS  Google Scholar 

  5. Janetschek G, Lhotta K, Gasser R, et al.: Adrenal-sparing laparoscopic surgery for aldosterone-producing adenoma J Endourol 1997, 11:145–148.

    Article  PubMed  CAS  Google Scholar 

  6. Van Heerden JA, Sizemore GW, Carney JA, et al.: Surgical management of the adrenal glands in the multiple endocrine neoplasia type II syndrome World J Surg 1984, 8:612–621.

    Article  PubMed  Google Scholar 

  7. Lee JE, Curley SA, Gagel RF, et al.: Cortical-sparing adrenalectomy for patients with bilateral pheochromocytoma Surgery 1996, 120:1064–1070.

    Article  PubMed  CAS  Google Scholar 

  8. Walther MM, Keiser HR, Choyke PL, et al.: Management of hereditary pheochromocytoma in von Hippel Lindau kindreds with partial adrenalectomy J Urol 1999, 161:395–398. A series including 14 partial adrenalectomies for VHL-related pheochromocytomas with 18-month follow-up (138 months). Three of 15 patients had eventual recurrences without developing metastatic disease.

    Article  PubMed  CAS  Google Scholar 

  9. Nakada T, Kubota Y, Sasagawa I, et al.: Therapeutic outcome of primary aldosteronism: adrenalectomy versus enucleation of aldosterone-producing adenoma J Urol 1995, 153:1775–1780.

    Article  PubMed  CAS  Google Scholar 

  10. Ito Y, Fujimoto Y, Obara T, Kodama T: Clinical significance of associated nodular lesions of the adrenal in patients with aldosteronoma World J Surg 1990, 14:330–334.

    Article  PubMed  CAS  Google Scholar 

  11. Sasagawa I, Suzuki H, Tateno T, et al.: Retroperitoneoscopic partial adrenalectomy using an endoscopic stapling device in patients with adrenal tumor Urol Int 1998, 61:101–103.

    Article  PubMed  CAS  Google Scholar 

  12. Suzuki K, Sugiyama T, Saisu K, et al.: Retroperitoneoscopic partial adrenalectomy for aldosterone-producing adenoma using an ultrasonically activated scalpel Br J Urol 1998, 82:138–139.

    PubMed  CAS  Google Scholar 

  13. Walz MK, Peitgen K, Saller B, et al.: Subtotal adrenalectomy by the posterior retroperitoneoscopic approach World J Surg 1998, 22:621–627. A series of retroperitoneoscopic partial adrenalectomy for a variety of adrenal pathologies, with a nice diagram detailing tumor location and size for each individual case.

    Article  PubMed  CAS  Google Scholar 

  14. Imai T, Tanaka Y, Kikumori T, et al.: Laparoscopic partial adrenalectomy Surg Endosc 1999, 13:343–345. A small laparoscopic series in which the vascular stapler was used to come across adrenal parenchyma without complication.

    Article  PubMed  CAS  Google Scholar 

  15. Weigel RJ, Wells SA, Gunnells JC, Leight GS: Surgical treatment of primary hyperaldosteronism Ann Surg 1994, 219:347–352.

    Article  PubMed  CAS  Google Scholar 

  16. Van Heerden JA, Sizemore GW, Carney JA, et al.: Bilateral subtotal adrenal resection for bilateral pheochromocytomas in multiple endocrine neoplasia, type IIa: A case report Surgery 1985, 98:363–365.

    PubMed  Google Scholar 

  17. Hamberger B, Telenius-Berg M, Cedermark B, et al.: Subtotal adrenalectomy in multiple endocrine neoplasia type 2 Henry Ford Hosp Med J 1987, 35:127–128.

    PubMed  CAS  Google Scholar 

  18. Neumann HPH, Reincke M, Bender BU, et al.: Preserved adrenocortical function after laparoscopic bilateral adrenal sparing surgery for hereditary pheochromocytoma J Clin Endo Metab 1999, 84:2608–2610.

    Article  CAS  Google Scholar 

  19. Vargas HI, Kavoussi LR, Bartlett DL, et al.: Laparoscopic adrenalectomy: a new standard of care Urology 1997, 49:673–678.

    Article  PubMed  CAS  Google Scholar 

  20. Birnbaum J, Giuliano A, van Herle AJ: Partial adrenalectomy for pheochromocytoma with maintenance of adrenocortical function J Clin Endo Metab 1989, 69:1078–1081.

    Article  CAS  Google Scholar 

  21. Edstrom E, Grondal S, Norstrom F, et al.: Long term experience after subtotal adrenalectomy for multiple endocrine neoplasia type IIa Eur J Surg 1999, 165:431–435.

    Article  PubMed  CAS  Google Scholar 

  22. Walther MM, Herring J, Choyke PL, Linehan WM: Laparoscopic partial adrenalectomy in patients with hereditary forms of pheochromocytoma J Urol 2000, 164:14–17. The use of laparoscopic ultrasound to find small pheochromocytomas intraoperatively is documented in this small laparoscopic series of partial adrenalectomy.

    Article  PubMed  CAS  Google Scholar 

  23. Chen F, Kishida T, Yao M, et al.: Germline mutations in the von Hippel-Lindau disease tumor suppressor gene: correlation with phenotype Hum Mutat 1995, 5:66–75.

    Article  PubMed  CAS  Google Scholar 

  24. Carney JA, Sizemore GW, Sheps SG: Adrenal medullary disease in multiple endocrine neoplasia, type 2: pheochromocytoma and its precursors Am J Clin Pathol 1976, 66:279–290.

    PubMed  CAS  Google Scholar 

  25. Albanese CT, Wiener ES: Routine bilateral adrenalectomy is not warranted in childhood familial pheochromocytoma J Pediatr Surg 1993, 28:1248–1252.

    Article  PubMed  CAS  Google Scholar 

  26. Okamoto T, Obara T, Ito Y, et al.: Bilateral adrenalectomy with autotransplantation of adrenocortical tissue or unilateral adrenalectomy: treatment options for pheochromocytomas in multiple endocrine neoplasia type 2a. Endocrinol J 1996, 43:169–175.

    CAS  Google Scholar 

  27. Stewart BH, Bravo EL, Haaga J, et al.: Localization of pheochromocytoma by computed tomography N Engl J Med 1978, 299:460.

    Article  PubMed  CAS  Google Scholar 

  28. Maurea S, Cuocolo A, Reynolds JC, et al.: Iodine-131-metaiodobenzylguanidine scintigraphy in preoperative and postoperative evaluation of paragangliomas: comparison with CT and MRI J Nucl Med 1993, 34:173.

    PubMed  CAS  Google Scholar 

  29. Shapiro B, Copp JE, Sisson JC, et al.: Iodine-13 metaiodobenzylguanidine for the locating of suspected pheochromocytoma: experience in 400 cases J Nucl Med 1985, 26:576.

    PubMed  CAS  Google Scholar 

  30. Eisenhofer G, Lenders JWM, Linehan WM, et al.: Plasma normetanephrine and metanephrine for detecting pheochromocytoma in von Hippel-Lindau disease and multiple endocrine neoplasia type 2 N Engl J Med 1999, 340:1872–1879.

    Article  PubMed  CAS  Google Scholar 

  31. Graham DJ, McHenry CR: The adrenal incidentaloma Surg Oncol Clin North Am 1998, 7:749–764.

    CAS  Google Scholar 

  32. Heniford BT, Iannitti DA, Gagner M: The role of intraoperative ultrasonography during laparoscopic adrenalectomy Surgery 1997, 122:1068–1074.

    Article  PubMed  CAS  Google Scholar 

  33. Janetschek G, Finkenstedt G, Gasser R, et al.: Laparoscopic surgery for pheochromocytoma: adrenalectomy, partial resection, excision of paragangliomas J Urol 1998, 160:330–334. These authors performed laparoscopic partial adrenalectomy for sporadic and hereditary forms of pheochromocytoma. They advocate preserving the adrenal vein, and used bipolar coagulation for adrenal hemostasis.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Urologic Oncology Branch, National Cancer Institute, NIH, Urologic Oncology Branch, 2B-47, Bldg. 10, 9000 Rockville Pike, Bethesda, MD, USA

    Christian P. Pavlovich MD, W. Marston Linehan MD & McClellan M. Walther MD

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  1. Christian P. Pavlovich MD
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  2. W. Marston Linehan MD
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  3. McClellan M. Walther MD
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Pavlovich, C.P., Linehan, W.M. & Walther, M.M. Partial adrenalectomy in patients with multiple adrenal tumors. Curr Urol Rep 2, 19–23 (2001). https://doi.org/10.1007/s11934-001-0021-0

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  • DOI: https://doi.org/10.1007/s11934-001-0021-0

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