Pheochromocytoma surgery: Difference between revisions
Jump to navigation
Jump to search
Ifrah Fatima (talk | contribs) |
Ifrah Fatima (talk | contribs) |
||
| Line 18: | Line 18: | ||
=== '''Adrenalectomy:''' === | === '''Adrenalectomy:''' === | ||
*[[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> | *[[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> | ||
*There are less complications associated with [[laparoscopic surgery]] than with [[open surgery]] | *There are less complications associated with [[laparoscopic surgery]] than with [[open surgery]]. | ||
*Major intraoperative complications include | *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]] 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> | *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: | *Risk factors for complications during surgery include: | ||
Revision as of 22:14, 28 July 2020
|
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] 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
- The mainstay of treatment for pheochromocytoma is surgery. Surgical resection is usually done for patients with either:
- Benign localized tumor
- Unilateral pheochromocytoma- Unilateral adrenalectomy
- Bilateral pheochromocytomas- cortical-sparing adrenalectomy.[1]
Surgery
- Surgery is the mainstay of treatment for pheochromocytoma.
Adrenalectomy:
- Laparoscopic transabdominal and retroperitoneal approaches have been used successfully for non-metastatic abdominal pheochromocytomas.[2]
- There are less complications associated with laparoscopic surgery than with open surgery.
- Major intraoperative complications include:
- Intraoperative tumor capsule rupture
- Hypertensive crisis
- Myocardial infarctions
- cerebrovascular hemorrhages
- Hemodynamic instability after tumor resection.
- Hypoglycemia [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 include:
- High plasma norepinephrine concentration
- Larger tumor size
- Postural hypotension after α-blockade, and a mean arterial pressure 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.