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Hypophysen- und Nebennierenoperationen

Pituitary and adrenal gland surgery

  • Schwerpunkt: Postoperative Syndrome und Operationsfolgen
  • Published:
Der Internist Aims and scope Submit manuscript

Zusammenfassung

Die laparoskopische Adrenalektomie und die transsphenoidale Resektion von hypophysären Tumoren haben sich als Standardverfahren mit geringer Komplikationsrate etabliert. Neben den rein chirurgischen Komplikationen ist bei diesen Operationen das Erkennen endokrinologischer Folgeerkrankungen wie der Nebenniereninsuffizienz oder der Hypophyseninsuffizienz von besonderer Bedeutung, da sie unbehandelt tödlich verlaufen können im Rahmen einer Addison-Krise oder eines hypophysären Komas. Daher sollten alle Patienten eine prä- und postoperative endokrinologische Diagnostik erhalten. Patienten mit bilateraler Adrenalektomie benötigen eine lebenslange Glukokortikoid- und Mineralokortikoidsubstitution. Patienten mit unilateraler Adrenalektomie bei Cushing-Syndrom benötigen eine passagere Glukokortikoidsubstitution. Patienten nach Hypophysenoperation sollten eine endokrinologische Funktionsdiagnostik zum Ausschluss einer Hypophysenvorder- und hinterlappeninsuffizienz erhalten und adäquat substituiert werden.

Abstract

Laparoscopic adrenalectomy and transsphenoidal pituitary surgery are currently established as the surgical procedures of choice with a low complication rate. Beyond potential surgical complications, one has to consider endocrine sequelae such as adrenal insufficiency and hypopituitarism. Without adequate endocrine treatment patients are prone to develop potentially lethal complications such as Addisonian crises or pituitary coma. Therefore, all patients should be seen by an endocrinologist before and after surgery. Patients with bilateral adrenalectomy require lifelong substitution of glucocorticoids and mineralocorticoids. Cushing’s syndrome patients with unilateral adrenalectomy need temporary substitution. After pituitary surgery, all patients require functional assessment of their pituitary function, and, if necessary, adequate replacement therapy.

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Literatur

  1. Gumbs AA, Gagner M (2006) Laparoscopic adrenalectomy. Best Pract Res Clin Endocrinol Metab 20: 483–499

    Article  PubMed  Google Scholar 

  2. Porpiglia F, Fiori C, Bovio S et al. (2004) Bilateral adrenalectomy for Cushing’s syndrome: a comparison between laparoscopy and open surgery. J Endocrinol Invest 27: 654–658

    PubMed  Google Scholar 

  3. Shen WT, Lee J, Kebebew E et al. (2006) Selective use of steroid replacement after adrenalectomy: lessons from 331 consecutive cases. Arch Surg 141: 771–774; discussion 774–776

    Article  PubMed  Google Scholar 

  4. Iihara M, Suzuki R, Kawamata A et al. (2003) Adrenal-preserving laparoscopic surgery in selected patients with bilateral adrenal tumors. Surgery 134: 1066–1072; discussion 1072–1063

    Article  PubMed  Google Scholar 

  5. Walz MK, Peitgen K, Diesing D et al. (2004) Partial versus total adrenalectomy by the posterior retroperitoneoscopic approach: early and long-term results of 325 consecutive procedures in primary adrenal neoplasias. World J Surg 28: 1323–1329

    Article  PubMed  Google Scholar 

  6. Arlt W, Callies F, Vlijmen JC van et al. (1999) Dehydroepiandrosterone replacement in women with adrenal insufficiency. N Engl J Med 341: 1013–1020

    Article  PubMed  Google Scholar 

  7. Hunt PJ, Gurnell EM, Huppert FA et al. (2000) Improvement in mood and fatigue after dehydroepiandrosterone replacement in Addison’s disease in a randomized, double blind trial. J Clin Endocrinol Metab 85: 4650–4656

    Article  PubMed  Google Scholar 

  8. Doherty GM, Nieman LK, Cutler GB Jr et al. (1990) Time to recovery of the hypothalamic-pituitary-adrenal axis after curative resection of adrenal tumors in patients with Cushing’s syndrome. Surgery 108: 1085–1090

    PubMed  Google Scholar 

  9. Chapuis Y, Pitre J, Conti F et al. (1996) Role and operative risk of bilateral adrenalectomy in hypercortisolism. World J Surg 20: 775–779; discussion 779–780

    Article  PubMed  Google Scholar 

  10. Plouin PF, Duclos JM, Soppelsa F et al. (2001) Factors associated with perioperative morbidity and mortality in patients with pheochromocytoma: analysis of 165 operations at a single center. J Clin Endocrinol Metab 86: 1480–1486

    Article  PubMed  Google Scholar 

  11. Lehnert H, Hahn K, Dralle H (2002) [Benign and malignant pheochromocytoma]. Internist 43: 196; 199–209

    Article  PubMed  Google Scholar 

  12. Sudhakar N, Ray A, Vafidis JA (2004) Complications after trans-sphenoidal surgery: our experience and a review of the literature. Br J Neurosurg 18: 507–512

    PubMed  Google Scholar 

  13. Arlt W, Allolio B (2003) Adrenal insufficiency. Lancet 361: 1881–1893

    Article  PubMed  Google Scholar 

  14. Schmidt IL, Lahner H, Mann K et al. (2003) Diagnosis of adrenal insufficiency: evaluation of the corticotropin-releasing hormone test and Basal serum cortisol in comparison to the insulin tolerance test in patients with hypothalamic-pituitary-adrenal disease. J Clin Endocrinol Metab 88: 4193–4198

    Article  PubMed  Google Scholar 

  15. Dokmetas HS, Colak R, Kelestimur F et al. (2000) A comparison between the 1-microg adrenocorticotropin (ACTH) test, the short ACTH (250 microg) test, and the insulin tolerance test in the assessment of hypothalamo-pituitary-adrenal axis immediately after pituitary surgery. J Clin Endocrinol Metab 85: 3713–3719

    Article  PubMed  Google Scholar 

  16. Klose M, Lange M, Kosteljanetz M et al. (2005) Adrenocortical insufficiency after pituitary surgery: an audit of the reliability of the conventional short synacthen test. Clin Endocrinol 63: 499–505

    Article  Google Scholar 

  17. Hartoft-Nielsen ML, Lange M, Rasmussen AK et al. (2004) Thyrotropin-releasing hormone stimulation test in patients with pituitary pathology. Horm Res 61: 53–57

    Article  PubMed  Google Scholar 

  18. Growth Hormone Research Society (1998) Consensus guidelines for the diagnosis and treatment of adults with growth hormone deficiency: summary statement of the Growth Hormone Research Society Workshop on Adult Growth Hormone Deficiency. J Clin Endocrinol Metab 83: 379–381

    Article  PubMed  Google Scholar 

  19. Aimaretti G, Corneli G, Razzore P et al. (1998) Comparison between insulin-induced hypoglycemia and growth hormone (GH)-releasing hormone + arginine as provocative tests for the diagnosis of GH deficiency in adults. J Clin Endocrinol Metab 83: 1615–1618

    Article  PubMed  Google Scholar 

  20. Hoeck HC, Jakobsen PE, Vestergaard P et al. (1999) Differences in reproducibility and peak growth hormone responses to repeated testing with various stimulators in healthy adults. Growth Horm IGF Res 9: 18–24

    Article  Google Scholar 

  21. Rosen T, Bengtsson BA (1990) Premature mortality due to cardiovascular disease in hypopituitarism. Lancet 336: 285–288

    Google Scholar 

  22. Gibney J, Wallace JD, Spinks T et al. (1999) The effects of 10 years of recombinant human growth hormone (GH) in adult GH-deficient patients. J Clin Endocrinol Metab 84: 2596–2602

    Article  PubMed  Google Scholar 

  23. Nemergut EC, Dumont AS, Barry UT et al. (2005) Perioperative management of patients undergoing transsphenoidal pituitary surgery. Anesth Analg 101: 1170–1181

    Article  PubMed  Google Scholar 

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  1. Abt. Innere Medizin II, Schwerpunkt Endokrinologie und Diabetologie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland

    F. Flohr &  J. Seufert

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  1. F. Flohr
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  2. J. Seufert
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Correspondence to J. Seufert.

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Flohr, F., Seufert, J. Hypophysen- und Nebennierenoperationen. Internist 48, 578–585 (2007). https://doi.org/10.1007/s00108-007-1854-5

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  • DOI: https://doi.org/10.1007/s00108-007-1854-5

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