Skip to main content
SpringerLink
Log in

Perioperative Management

  • Chapter
  • First Online:
Surgery of the Adrenal Gland

  • 1179 Accesses

Abstract

The advance in treatment of adrenal glands disease has been characterized by improvements in surgical technique and optimization of perioperative therapeutic protocols appropriate for the endocrinological dysfunction discovered. Laparoscopic adrenalectomy has become the standard of care for many conditions requiring removal of the adrenal gland. The advantage of the laparoscopic approach lies in the fact that it allows precise, hemostatic dissection of the gland in a minimally invasive fashion and results in short hospital stays. Preoperative preparation of the patients with adrenal dysfunction is based on the careful preoperative evaluation of the type and the severity of the disturbance. The most important indications for adrenalectomy consist in Cushing’s syndrome, caused by hypersecretion of glucocorticoids produced in fasciculata adrenal cortex, Conn’s syndrome, caused by hypersecretion of aldosterone produced by glomerulosa adrenal cortex, and pheochromocytomas, arisen from adrenal medulla and secreting catecholamines. Preoperative preparation for pheochromocytoma removal is focused on optimization of anti-hypertensive therapy. The use of α-blocker drugs has allowed the reduction in perioperative morbidity and mortality observed since the first adrenalectomy for pheochromocytoma.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Weatherill D, Spence AA (1984) Anaesthesia and disorders of the adrenal cortex. Br J Anaesth 56:741–749

    Article  PubMed  CAS  Google Scholar 

  2. Tritos NA, Biller BM, Swearingen B (2011) Management of Cushing disease. Nat Rev Endocrinol 7:279–289

    Article  PubMed  CAS  Google Scholar 

  3. Carroll TB, Findling JW (2010) The diagnosis of Cushing’s syndrome. Rev Endocr Metab Disord 11:147–153

    Article  PubMed  Google Scholar 

  4. Acosta E, Pantoja JP, Gamino R et al (1999) Laparoscopic versus open adrenalectomy in Cushing’s syndrome and disease. Surgery 126:1111–1116

    Article  PubMed  CAS  Google Scholar 

  5. Kalezić N, Malenković V, Zivaljević V et al (2011) Contemporary approach to preoperative preparation of patients with adrenal cortex hormones dysfunction. Acta Chir Iugosl 58:117–122

    Article  PubMed  Google Scholar 

  6. Gupta PK, Natarajan B, Pallati PK et al (2011) Outcomes after laparoscopic adrenalectomy. Surg Endosc 25:784–794

    Article  PubMed  Google Scholar 

  7. Winship SM, Winstanley JH, Hunter JM (1999) Anaesthesia for Conn’s syndrome. Anaesthesia 54:569–574

    Article  PubMed  CAS  Google Scholar 

  8. Bravo EL (2004) Pheochromocytoma: current perspectives in the pathogenesis, diagnosis, and management. Arq Bras Endocrinol Metabol 48:746–750

    Article  PubMed  Google Scholar 

  9. Bravo EL, Tagle R (2003) Pheochromocytoma: state-of-the-art and future prospects. Endocr Rev 24:539–553

    Article  PubMed  CAS  Google Scholar 

  10. Pacak K (2007) Preoperative management of the pheochromocytoma patient. J Clin Endocrinol Metab 92:4069–4079

    Article  PubMed  CAS  Google Scholar 

  11. Bravo EL (2002) Pheochromocytoma: an approach to antihypertensive management. Ann NY Acad Sci 970:1–10

    Article  PubMed  CAS  Google Scholar 

  12. Sprung J, O’Hara JF Jr, Gill IS et al (2000) Anesthetic aspects of laparoscopic and open adrenalectomy for pheochromocytoma. Urology 55:339–343

    Article  PubMed  CAS  Google Scholar 

  13. Breslin DS, Farling PA, Mirakhur RK (2003) The use of remifentanil in the anaesthetic management of patients undergoing adrenalectomy: a report of three cases. Anaesthesia 58:358–362

    Article  PubMed  CAS  Google Scholar 

  14. Prys-Roberts C (2000) Phaeochromocytoma-recent progress in its management. Br J Anaesth 85:44–57

    Article  PubMed  CAS  Google Scholar 

  15. Kinney MA, Warner ME, vanHeerden JA et al (2000) Perianesthetic risks and outcomes of pheochromocytoma and paraganglioma resection. Anesth Analg 91:1118–1123

    PubMed  CAS  Google Scholar 

  16. Nguyen NT, Wolfe BM (2005) The physiologic effects of pneumoperitoneum in the morbidly obese. Ann Surg 241:219–226

    Article  PubMed  Google Scholar 

  17. Mullet CE, Viale JP, Sagnard PE et al (1993) Pulmonary CO2 elimination during surgical procedures using intra-or extraperitoneal CO2 insufflation. Anesth Analg 76:622–626

    Article  Google Scholar 

  18. Lombardi MR, De Crea C et al (2008) Endoscopic adrenalectomy: is there an optimal operative approach? Results of a single center case-control study. Surgery 144:1008–1016

    Article  PubMed  Google Scholar 

  19. Streich B, Decailliot F, Perney C et al (2003) Increased carbon dioxide absorption during retroperitoneal laparoscopy. Br J Anaesth 91:93–96

    Article  Google Scholar 

  20. Blobner M, Felber AR, Gogler S et al (1993) The resorption of carbon dioxide from the pneumoperitoneum in laparoscopic cholecystectomy. Anaesthesist 42:288–294

    PubMed  CAS  Google Scholar 

  21. Bozkurt P, Kaya G, Yeker Y et al (2002) Arterial carbon dioxide markedly increases during diagnostic laparoscopy in portal hypertensive children. Anesth Analg 95:1236–1240

    Article  PubMed  CAS  Google Scholar 

  22. Kadam PG, Marda M, Shah VR (2008) Carbon dioxide absorption during laparoscopic donor nephrectomy: a comparison between retroperitoneal and transperitoneal approaches. Transplant Proc 40:1119–1121

    Article  PubMed  CAS  Google Scholar 

  23. Kazama T, Ikeda K, Kato T et al (1996) Carbon dioxide output in laparoscopic cholecystectomy. Br J Anaesth 76:530–535

    Article  PubMed  CAS  Google Scholar 

  24. McHoney M, Corizia L, Eaton S et al (2003) Carbondioxide elimination during laparoscopy in children is age dependent. J Pediatr Surg 38:105–110

    Article  PubMed  Google Scholar 

  25. Ng CS, Gill IS, Sung GT et al (1999) Retroperitoneoscopic surgery is not associated with increased carbon dioxide absorption. J Urol 162:1268–1272

    Article  PubMed  CAS  Google Scholar 

  26. Wolf JS, Monk TG, McDougall EM et al (1995) The extraperitoenal approach and subcutaneous emphysema are associated with grater absorption of carbon dioxide during laparoscopic renal surgery. J Urol 154:959–963

    Article  PubMed  Google Scholar 

  27. Wolf JS, Clayman RV, Monk TG et al (1995) Carbon dioxide absorption during laparoscopic pelvic operation. J Am Coll Sur 180:555–560

    Google Scholar 

  28. Sasagawa I, Suzuki H, Izumi T et al (1999) Influence of carbon dioxide on respiratory function during posterior retroperitoneoscopic adrenalectomy in prone position. Eur Uro 36:413–417

    Article  CAS  Google Scholar 

  29. Tan PL, Lee TL, Twed WA (1992) Carbondioxide absorption and gas exchange during pelvic laparoscopy. Can J Anaesth 39:677–681

    Article  PubMed  CAS  Google Scholar 

  30. Giebler RM, Behrends M, Steffens T et al (2000) Intraperitoneal and retroperitoneal carbon dioxide insufflation evoke different effects on caval vein pressure gradients in humans. Anesthesiology 92:1568–1580

    Article  PubMed  CAS  Google Scholar 

  31. Junghans T, Modersohn D, Dorner F et al (2006) Systematic evaluation of different approaches for minimizing hemodynamic changes during pneumoperitoneum. Surg Endosc 20:763–769

    Article  PubMed  CAS  Google Scholar 

  32. Giebler RM, Kabatnik M, Stegen BH et al (1997) Retroperitoneal and intraperitoneal CO2 insufflation have markedly different cardiovascular effects. J Surg Res 68:153–160

    Article  PubMed  CAS  Google Scholar 

  33. Cottam DR, Nguyen NT, Eid GM et al (2005) The impact of laparoscopy on bariatric surgery. Surg Endosc 19:621–627

    Article  PubMed  CAS  Google Scholar 

  34. Weller WE, Rosati C (2008) Comparing outcomes of laparoscopic versus open bariatric surgery. Ann Surg 248:10–15

    Article  PubMed  Google Scholar 

  35. Dickstein G, Shechner C, Arad E et al (1998) Is there a role for low doses of mitotane as adjuvant therapy in adrenocortical carcinoma? J Clin Endocrinol Metab 83:3100–3103

    Article  PubMed  CAS  Google Scholar 

  36. Khorram-Manesh A, Ahlman H, Jansson S et al (1998) Adrenocortical carcinoma: surgery and mitotane for treatment and steroid profiles for follow-up. World J Surg 22:605–611

    Article  PubMed  CAS  Google Scholar 

  37. Terzolo M, Angeli A, Fassnacht M et al (2007) Adjuvant mitotane treatment for adrenocortical carcinoma. N Engl J Med 356:2372–2380

    Google Scholar 

  38. Schteingart DE, Doherty GM, Gauger PG et al (2005) Management of patients with adrenal cancer: recommendations of an international consensus conference. Endocr Relat Cancer 12:667–680

    Article  PubMed  CAS  Google Scholar 

  39. Haak HR, Hermans J, van de Velde CJ et al (1994) Optimal treatment of adrenocortical carcinoma with mitotane: results in a consecutive series of 96 patients. Br J Cancer 69:947–951

    Article  PubMed  CAS  Google Scholar 

  40. Berruti A, Terzolo M, Sperone P et al (2005) Etoposide, doxorubicin and cisplatin plus mitotane in the treatment of advanced adrenocortical carcinoma: a large prospective phase II trial. Endocr Relat Cancer 12:657–666

    Article  PubMed  CAS  Google Scholar 

  41. National Cancer Institute (2011) First international randomized trial in locally advanced and metastatic adrenocortical carcinoma treatment (FIRM-ACT). Etoposide, doxorubicin, cisplatin and mitotane versus streptozotocin and mitotane. National Cancer Institute (NCI), Bethesda

    Google Scholar 

  42. Scholz T, Eisenhofer G, Pacak K et al (2007) Clinical review: Current treatment of malignant pheochromocytoma. J Clin Endocrinol Metab 92:1217–1225

    Article  PubMed  CAS  Google Scholar 

  43. Gonias S, Goldsby R, Matthay KK et al (2009) Phase II study of high-dose [131I]metaiodobenzylguanidine therapy for patients with metastatic pheochromocytoma and paraganglioma. J Clin Oncol 27:4162–4168

    Article  PubMed  CAS  Google Scholar 

  44. Takahashi K, Ashizawa N, Minami T et al (1999) Malignant pheochromocytoma with multiple hepatic metastases treated by chemotherapy and transcatheter arterial embolization. Intern Med 38:349–354

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical and Surgical Critical Care, Section of Anesthesiology and Intensive Care, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Tommaso Borracci, Luca Vitali & Angelo Raffaele De Gaudio

  2. Department of Oncology, Section of Medical Oncology 1, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Lorenzo Antonuzzo & Francesco Di Costanzo

  3. Department of Anesthesia and Intensive Care, Policlinico Agostino Gemelli, Università Cattolica Del Sacro Cuore, Rome, Italy

    Liliana Sollazzi & Valter Perilli

Authors
  1. Tommaso Borracci
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Luca Vitali
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lorenzo Antonuzzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Liliana Sollazzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Valter Perilli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Francesco Di Costanzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Angelo Raffaele De Gaudio
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tommaso Borracci .

Editor information

Editors and Affiliations

  1. , Chirurgia Generale, d'Urgenza e Mini-inv, Ospedale Careggi, Largo Brambilla 3, Florence, 50134, Italy

    Andrea Valeri

  2. , Chirurgia Generale, d'Urgenza e Mini-inv, Ospedale Careggi, Largo Brambilla 3, Florence, 50134, Italy

    Carlo Bergamini

  3. , Istituto di Semeiotica Chirurgica, Policlinico Gemelli, Largo Agostino Gemelli 8, Rome, 00168, Italy

    Rocco Bellantone

  4. , Istituto di Semeiotica Chirurgica, Policlinico Gemelli, Largo Agostino Gemelli 8, Rome, 00168, Italy

    Celestino Pio Lombardi

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag Italia

About this chapter

Cite this chapter

Borracci, T. et al. (2013). Perioperative Management . In: Valeri, A., Bergamini, C., Bellantone, R., Lombardi, C. (eds) Surgery of the Adrenal Gland. Springer, Milano. https://doi.org/10.1007/978-88-470-2586-8_6

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-2586-8_6

  • Published:

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-2585-1

  • Online ISBN: 978-88-470-2586-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation