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Limitations of Intraoperative Adrenal Remnant Volume Measurement in Patients Undergoing Subtotal Adrenalectomy

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Abstract

Background

Recent studies have shown that a minimum of approximately one-third of one normal adrenal gland is required for sufficient adrenocortical stress capacity. Correlation between intraoperative measurement, determination of remnant size by computed tomography (CT), and adrenocortical stress capacity has not been examined so far.

Methods

Twenty-two patients with familial pheochromocytoma (n = 13), sporadic pheochromocytoma (n = 3), and adrenocortical tumors (n = 6) who underwent unilateral or bilateral subtotal adrenalectomy (STAE, 28 adrenal remnants) were prospectively studied. Patients were examined in a multi-slice CT to determine residual adrenal tissue and by ACTH test 4 days and 3 months postoperatively.

Results

There was a slight significant correlation between intraoperative and CT calculated volumes (r = 0.77; p < 0.001). However, volumes assessed by CT were almost doubled compared with intraoperative determination (p < 0.001). Although recovery of adrenal function could be observed, no significant changes of remnant volumes could be detected within 3 months. In patients with familial pheochromocytoma, there was a significant correlation between residual adrenal volume and stimulated cortisol levels (P < 0.001). A distinct minimum of adrenal volume for intact adrenocortical stress capacity could not be exactly determined; however, in one patient with only 10% residual adrenal tissue intact stress capacity was found.

Conclusions

Residual adrenal tissue of approximately 10–15% offers intact stress capacity. However, an exact determination of the size of an adrenal remnant after STAE has limitations. CT gives larger volumes compared with intraoperative determination. For calculation of a volume–function correlation of residual adrenal tissue, in clinical practice, the determination of relative adrenal residual volume is acceptable.

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References

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

    Article  PubMed  CAS  Google Scholar 

  2. Neumann HPH, Bender BU, Reincke M, et al. (1999) Adrenal-sparing surgery for pheochromocytoma. Br J Surg 86:94–97

    Article  PubMed  CAS  Google Scholar 

  3. Walz MK, Peitgen K, Neumann HP, et al. (2002) Endoscopic treatment of solitary, bilateral, multiple, and recurrent pheochromocytomas and paragangliomas. World J Surg 26:1005–1012

    Article  PubMed  Google Scholar 

  4. Brauckhoff M, Gimm O, Thanh PN, et al. (2003) Critical size of residual adrenal tissue and recovery from impaired early postoperative adrenocortical function after subtotal bilateral adrenalectomy. Surgery 134:1020–1027

    Article  PubMed  Google Scholar 

  5. Yip L, Lee JE, Shapiro SE, et al. (2004) Surgical management of hereditary pheochromocytoma. J Am Coll Surg 198:525–534

    Article  PubMed  Google Scholar 

  6. Walz MK, Peitgen K, Saller B, et al. (1998) Subtotal adrenalectomy by the posterior retroperitoneoscopic approach. World J Surg 22:621–626

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  8. Sasagawa I, Suzuki H, Izumi T, et al. (2000) Posterior retroperitoneoscopic partial adrenalectomy using ultrasonic scalpel for aldosterone-producing adenoma. J Endourol 14:573–576

    Article  PubMed  CAS  Google Scholar 

  9. Brauckhoff M, Thanh PN, Gimm O, et al. (2003) Functional results after endoscopic subtotal cortical-sparing adrenalectomy. Surg Today 33:342–348

    Article  PubMed  Google Scholar 

  10. Brauckhoff M, Gimm O, Dralle H (2004) Preoperative and surgical therapy in sporadic and familial pheochromocytoma. Front Horm Res 31:121–144

    PubMed  Google Scholar 

  11. Cope O, Raker JW (1955) Cushing’s disease. The surgical experience in the care of 46 cases. N Engl J Med 253:165–172

    Article  PubMed  CAS  Google Scholar 

  12. Kennedy AL, Montgomery DA, Welbourn RB (1978) Hypothalamic-pituitary-adrenal function of untreated longterm survivors following subtotal adrenalectomy for Cushing’s disease. Ir J Med Sci 147:420–424

    Article  PubMed  CAS  Google Scholar 

  13. Irvin GL 3rd, Fishman LM, Sher JA (1983) Familial pheochromocytoma. Surgery 94:938–940

    PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  16. Walz MK (2004) Extent of adrenalectomy for adrenal neoplasm: cortical sparing (subtotal) versus total adrenalectomy. Surg Clin North Am 84:743–753

    Article  PubMed  Google Scholar 

  17. Günther G (1972) Mitoses, cell multiplication and cell displacement in the adrenal cortex. Histometric and autoradiographic studies following subtotal and unilateral epinephrectomy. Endokrinologie 60:356–378

    PubMed  Google Scholar 

  18. Engeland WC, Ennen WB, Elayaperumal A, et al. (2005) Zone-specific cell proliferation during compensatory adrenal growth in rats. Am J Physiol Endocrinol Metab 288:E298–306

    Article  PubMed  CAS  Google Scholar 

  19. Brunn J, Block U, Ruf G, et al. (1981) Volumetric analysis of thyroid lobes by real-time ultrasound. Dtsch Med Wochenschr 106:1338–1340

    PubMed  CAS  Google Scholar 

  20. Oelkers W (1996) Adrenal insufficiency. N Engl J Med 335:1206–1212

    Article  PubMed  CAS  Google Scholar 

  21. Herrick RC, Hayman LA, Taber KH, et al. (1997) Artifacts and pitfalls in MR imaging of the orbit: a clinical review. Radiographics 17:707–724

    PubMed  CAS  Google Scholar 

  22. Gottschau M (1883) Struktur und embryonale Entwicklung der Nebennieren bei Säugetieren. Arch Anat Physiol (Leipzig) 9:412–458

    Google Scholar 

  23. Estivariz EF, Lowry PJ, Jackson S (1992) Control of adrenal growth. In: James VHT (ed) The adrenal gland. Raven Press, New York, p 43–70

    Google Scholar 

  24. Bicknell AB, Lomthaisong K, Woods RJ, et al. (2001) Characterization of a serine protease that cleaves pro-gamma-melanotropin at the adrenal to stimulate growth. Cell 105:903–912

    Article  PubMed  CAS  Google Scholar 

  25. Ulrich-Lai YM, Marek DJ, Engeland WC (2002) Capsaicin-sensitive adrenal sensory fibers participate in compensatory adrenal growth in rats. Am J Physiol Regul Integr Comp Physiol 283:R877–R884

    PubMed  Google Scholar 

  26. Srougi M, Gittes RF (1978) Adrenal autotransplantation. Urol Surv 28:41–48

    PubMed  CAS  Google Scholar 

  27. Srougi M, Gittes RF, Underwood RH (1980) Influence of exogenous glucocorticoids and ACTH on experimental adrenal autografts. Invest Urol 17:265–268

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of General, Visceral, and Vascular Surgery, Martin-Luther-University of Halle-Wittenberg, Ernst-Grube-Straße 40, 06097, Halle/Saale, Germany

    Michael Brauckhoff, Kerstin Lorenz, Carsten Sekulla, Katrin Brauckhoff, Phuong Nguyen Thanh, Oliver Gimm & Henning Dralle

  2. Department of Diagnostic Radiology, Martin-Luther-University of Halle-Wittenberg, Halle-Wittenberg, Germany

    Karsten Stock, Susanne Stock & Rolf Peter Spielmann

  3. Department of Surgery, University Hospital Linköping, Linköping, Sweden

    Oliver Gimm

Authors
  1. Michael Brauckhoff
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  2. Karsten Stock
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  3. Susanne Stock
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  4. Kerstin Lorenz
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  5. Carsten Sekulla
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  6. Katrin Brauckhoff
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  7. Phuong Nguyen Thanh
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  8. Oliver Gimm
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  9. Rolf Peter Spielmann
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  10. Henning Dralle
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Corresponding author

Correspondence to Michael Brauckhoff.

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Brauckhoff, M., Stock, K., Stock, S. et al. Limitations of Intraoperative Adrenal Remnant Volume Measurement in Patients Undergoing Subtotal Adrenalectomy. World J Surg 32, 863–872 (2008). https://doi.org/10.1007/s00268-007-9402-y

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  • DOI: https://doi.org/10.1007/s00268-007-9402-y

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