Pheochromocytoma surgery: Difference between revisions

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** Unilateral pheochromocytoma- Unilateral [[adrenalectomy]]
** Unilateral pheochromocytoma- Unilateral [[adrenalectomy]]
** Bilateral pheochromocytomas- cortical-sparing [[adrenalectomy]].<ref name="pmid8957496">{{cite journal| author=Lee JE, Curley SA, Gagel RF, Evans DB, Hickey RC| title=Cortical-sparing adrenalectomy for patients with bilateral pheochromocytoma. | journal=Surgery | year= 1996 | volume= 120 | issue= 6 | pages= 1064-70; discussion 1070-1 | pmid=8957496 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8957496  }}</ref>
** Bilateral pheochromocytomas- cortical-sparing [[adrenalectomy]].<ref name="pmid8957496">{{cite journal| author=Lee JE, Curley SA, Gagel RF, Evans DB, Hickey RC| title=Cortical-sparing adrenalectomy for patients with bilateral pheochromocytoma. | journal=Surgery | year= 1996 | volume= 120 | issue= 6 | pages= 1064-70; discussion 1070-1 | pmid=8957496 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8957496  }}</ref>


==Surgery==
==Surgery==
*Surgical [[resection]] of pheochromocytoma is the treatment of choice for [[benign]] localized [[tumor]].
* Surgery is the mainstay of treatment for [[pheochromocytoma]].
*Patients with unilateral pheochromocytoma should undergo unilateral [[adrenalectomy]], patients with bilateral pheochromocytomas or who develop pheochromocytoma in their remaining [[adrenal gland]] should undergo cortical-sparing [[adrenalectomy]].<ref name="pmid8957496">{{cite journal| author=Lee JE, Curley SA, Gagel RF, Evans DB, Hickey RC| title=Cortical-sparing adrenalectomy for patients with bilateral pheochromocytoma. | journal=Surgery | year= 1996 | volume= 120 | issue= 6 | pages= 1064-70; discussion 1070-1 | pmid=8957496 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8957496 }}</ref> It may also be necessary to perform a complete surgical [[resection]] of the affected [[adrenal gland]].  
=== Adrenalectomy ===
* Two approaches have been used successfully for non-[[Metastasis|metastatic]] [[abdominal]] pheochromocytomas:
** [[Laparoscopic surgery|Laparoscopic transabdominal]]<nowiki/>
** [[Retroperitoneal]]<ref name="pmid21494137">{{cite journal| author=Nehs MA, Ruan DT| title=Minimally invasive adrenal surgery: an update. | journal=Curr Opin Endocrinol Diabetes Obes | year= 2011 | volume= 18 | issue= 3 | pages= 193-7 | pmid=21494137 | doi=10.1097/MED.0b013e32834693bf | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21494137  }}</ref>
*There are less complications associated with [[laparoscopic surgery]] than with [[open surgery]].
*Major intraoperative complications include:
** Intraoperative [[tumor]] capsule rupture
** [[Hypertensive crisis]]
** [[Myocardial infarctions]]
** [[Stroke|Cerebrovascular hemorrhages]]
** Hemodynamic instability after [[tumor]] resection.
** [[Hypoglycemia]] <ref name="pmid25188716">{{cite journal| author=Rafat C, Zinzindohoue F, Hernigou A, Hignette C, Favier J, Tenenbaum F et al.| title=Peritoneal implantation of pheochromocytoma following tumor capsule rupture during surgery. | journal=J Clin Endocrinol Metab | year= 2014 | volume= 99 | issue= 12 | pages= E2681-5 | pmid=25188716 | doi=10.1210/jc.2014-1975 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25188716 }}</ref>  
**Severe [[hypotension]] <ref name="pmid14734011">{{cite journal| author=Flávio Rocha M, Faramarzi-Roques R, Tauzin-Fin P, Vallee V, Leitao de Vasconcelos PR, Ballanger P| title=Laparoscopic surgery for pheochromocytoma. | journal=Eur Urol | year= 2004 | volume= 45 | issue= 2 | pages= 226-32 | pmid=14734011 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14734011  }}</ref>


=== '''Adrenalectomy:''' ===
==Contraindications==
*[[Laparoscopic surgery|Laparoscopic transabdomina]]<nowiki/>l and [[retroperitoneal]] approaches have been used successfully for non-[[Metastasis|metastatic]] [[abdominal]] pheochromocytomas.<ref name="pmid21494137">{{cite journal| author=Nehs MA, Ruan DT| title=Minimally invasive adrenal surgery: an update. | journal=Curr Opin Endocrinol Diabetes Obes | year= 2011 | volume= 18 | issue= 3 | pages= 193-7 | pmid=21494137 | doi=10.1097/MED.0b013e32834693bf | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21494137  }}</ref>
Surgery is the mainstay of treatment for pheochromocytoma, even if it is asymptomatic.  
*There are less complications associated with [[laparoscopic surgery]] than with [[open surgery]]. [[Catecholamine]] secretion falls to a  normal level within a week.
*Major intraoperative complications include intraoperative [[tumor]] capsule rupture, [[hypertensive crisis]], [[myocardial infarctions]], or [[Stroke|cerebrovascular hemorrhages]]. Hemodynamic instability after [[tumor]] resection is possible. [[Hypoglycemia]] can occur after tumor resection due to unopposed [[insulin]] effect after declining of [[catecholamines]] levels.<ref name="pmid25188716">{{cite journal| author=Rafat C, Zinzindohoue F, Hernigou A, Hignette C, Favier J, Tenenbaum F et al.| title=Peritoneal implantation of pheochromocytoma following tumor capsule rupture during surgery. | journal=J Clin Endocrinol Metab | year= 2014 | volume= 99 | issue= 12 | pages= E2681-5 | pmid=25188716 | doi=10.1210/jc.2014-1975 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25188716  }}</ref>
*Severe [[hypotension]] can occur after removal of the gland due to decreased [[catecholamines]] level in [[blood]] and [[downregulation|down-regulation]] of [[adrenergic receptors]]. It can be controlled by [[vasopressors]] induction.<ref name="pmid14734011">{{cite journal| author=Flávio Rocha M, Faramarzi-Roques R, Tauzin-Fin P, Vallee V, Leitao de Vasconcelos PR, Ballanger P| title=Laparoscopic surgery for pheochromocytoma. | journal=Eur Urol | year= 2004 | volume= 45 | issue= 2 | pages= 226-32 | pmid=14734011 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14734011  }}</ref> 
*Risk factors for complications during surgery include:
**High [[plasma]] [[norepinephrine]] concentration 
**Larger [[tumor]] size 
**[[Postural hypotension]] after [[Alpha blocker|α-blockade]], and a [[mean arterial pressure]] above 100 mm Hg. 
*The patient should receive [[glucocorticoid]] stress coverage in bilateral [[adrenalectomy]].


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 00:08, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmad Al Maradni, M.D. [2] Mohammed Abdelwahed M.D[3]

Overview

Surgery is the mainstay of treatment for pheochromocytoma. Adrenalectomy, laparoscopic transabdominal and retroperitoneal approaches have been used successfully for non-metastatic abdominal pheochromocytomas.

Indications

Surgery

Adrenalectomy

Contraindications

Surgery is the mainstay of treatment for pheochromocytoma, even if it is asymptomatic.

References

  1. ↑ Lee JE, Curley SA, Gagel RF, Evans DB, Hickey RC (1996). "Cortical-sparing adrenalectomy for patients with bilateral pheochromocytoma". Surgery. 120 (6): 1064–70, discussion 1070-1. PMID 8957496.
  2. ↑ Nehs MA, Ruan DT (2011). "Minimally invasive adrenal surgery: an update". Curr Opin Endocrinol Diabetes Obes. 18 (3): 193–7. doi:10.1097/MED.0b013e32834693bf. PMID 21494137.
  3. ↑ Rafat C, Zinzindohoue F, Hernigou A, Hignette C, Favier J, Tenenbaum F; et al. (2014). "Peritoneal implantation of pheochromocytoma following tumor capsule rupture during surgery". J Clin Endocrinol Metab. 99 (12): E2681–5. doi:10.1210/jc.2014-1975. PMID 25188716.
  4. ↑ Flávio Rocha M, Faramarzi-Roques R, Tauzin-Fin P, Vallee V, Leitao de Vasconcelos PR, Ballanger P (2004). "Laparoscopic surgery for pheochromocytoma". Eur Urol. 45 (2): 226–32. PMID 14734011.
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