Pheochromocytoma surgery: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
|||
| Line 1: | Line 1: | ||
__NOTOC__ | __NOTOC__ | ||
{{Pheochromocytoma}} | {{Pheochromocytoma}} | ||
{{CMG}} | {{CMG}} {{AE}} {{AAM}} | ||
==Overview== | ==Overview== | ||
| Line 10: | Line 8: | ||
==Surgery== | ==Surgery== | ||
*Surgical [[resection]] of pheochromocytoma is the treatment of choice for [[benign]] localized tumor. | *Surgical [[resection]] of pheochromocytoma is the treatment of choice for [[benign]] localized tumor. | ||
*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 | *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:''' === | ||
*[[Laparoscopic surgery|Laparoscopic transabdomina]]<nowiki/>l and retroperitoneal approaches have been used successfully for | *[[Laparoscopic surgery|Laparoscopic transabdomina]]<nowiki/>l and retroperitoneal approaches have been used successfully for nonmetastatic 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> | ||
*Complications are less in laparoscopic than open surgery. Catecholamine secretion falls to normal level within a week. | *Complications are less in laparoscopic than open surgery. Catecholamine secretion falls to a normal level within a week. | ||
*Major intraoperative complications include | *Major intraoperative complications include intraoperative tumor capsule rupture, hypertensive crisis, myocardial infarctions, or cerebrovascular hemorrhages. Hyperdynamic 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]] 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> | *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: high plasma NE concentration, larger tumor size, postural hypotension after α-blockade, and a MAP above 100 mm Hg. | *Risk factors for complications during surgery: high plasma NE concentration, larger tumor size, postural hypotension after α-blockade, and a MAP above 100 mm Hg. | ||
* | *The patient should receive glucocorticoid stress coverage in bilateral adrenalectomy. | ||
==References== | ==References== | ||
Revision as of 13:25, 21 July 2017
|
Pheochromocytoma Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Pheochromocytoma surgery On the Web |
|
American Roentgen Ray Society Images of Pheochromocytoma surgery |
|
Risk calculators and risk factors for Pheochromocytoma surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ahmad Al Maradni, M.D. [2]
Overview
Surgery is the mainstay of treatment for pheochromocytoma.
Surgery
- Surgical resection of pheochromocytoma is the treatment of choice for benign localized tumor.
- 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.[1] It may also be necessary to perform a complete surgical resection of the affected adrenal gland.
Adrenalectomy:
- Laparoscopic transabdominal and retroperitoneal approaches have been used successfully for nonmetastatic abdominal pheochromocytomas.[2]
- Complications are less in laparoscopic than 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 cerebrovascular hemorrhages. Hyperdynamic instability after tumor resection is possible. Hypoglycemia can occur after tumor resection due to unopposed insulin effect after declining of catecholamines levels.[3]
- Severe hypotension can occur after removal of the gland due to decreased catecholamines level in blood and down-regulation of adrenergic receptors. It can be controlled by vasopressors induction.[4]
- Risk factors for complications during surgery: high plasma NE concentration, larger tumor size, postural hypotension after α-blockade, and a MAP above 100 mm Hg.
- The patient should receive glucocorticoid stress coverage in bilateral adrenalectomy.
References
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.