Surgery of the Adrenals: Difference between revisions
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# Change of gloves, gowns, and instruments after removal of the tumor and prior to closure of the abdomen. | # Change of gloves, gowns, and instruments after removal of the tumor and prior to closure of the abdomen. | ||
== Surgery for | == Surgery for Pheochromocytoma == | ||
* '''Early ligation of the main adrenal vein and minimal manipulation of the affected adrenal are important.''' | * '''Early ligation of the main adrenal vein and minimal manipulation of the affected adrenal are important.''' | ||
** '''Catecholamine release can be caused by thermal injury to the adrenal in the absence of pheochromocytoma''' | ** '''Catecholamine release can be caused by thermal injury to the adrenal in the absence of pheochromocytoma''' | ||
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* '''Postoperatively, fluid administration and use of vasopressors such as phenylephrine, guided by invasive monitoring, are useful to manage hypotension. Electrolyte abnormalities and hypoglycemia should be corrected. It is not uncommon for patients to remain hypertensive postoperatively, and antihypertensive management should be continued.''' | * '''Postoperatively, fluid administration and use of vasopressors such as phenylephrine, guided by invasive monitoring, are useful to manage hypotension. Electrolyte abnormalities and hypoglycemia should be corrected. It is not uncommon for patients to remain hypertensive postoperatively, and antihypertensive management should be continued.''' | ||
== Partial | == Partial Adrenalectomy == | ||
* '''Unilateral adrenalectomy is often well tolerated and should be considered as the gold standard in the treatment of functioning or malignant adrenal tumors.''' | * '''Unilateral adrenalectomy is often well tolerated and should be considered as the gold standard in the treatment of functioning or malignant adrenal tumors.''' | ||
* '''Indications for partial adrenalectomy (3):''' | * '''<span style="color:#ff0000">Indications for partial adrenalectomy (3):''' | ||
*# '''Bilateral adrenal tumors''' | *# '''<span style="color:#ff0000">Bilateral adrenal tumors''' | ||
*# '''Solitary adrenal gland''' | *# '''<span style="color:#ff0000">Solitary adrenal gland''' | ||
*# '''Familial syndromes (such as von Hippel-Lindau disease, familial pheochromocytoma, and multiple endocrine neoplasia type IIA)''' | *# '''<span style="color:#ff0000">Familial syndromes (such as von Hippel-Lindau disease, familial pheochromocytoma, and multiple endocrine neoplasia type IIA)''' | ||
** '''Patients with bilateral adrenalectomy will require lifelong adrenal replacement therapy.''' | ** '''Patients with bilateral adrenalectomy will require lifelong adrenal replacement therapy.''' | ||
*** Fixed daily dosing of steroids is associated with overdosing, which may result in osteoporosis, obesity, and Cushing syndrome, and with underdosing in times of stress. Life-threatening Addisonian crisis can occur. | *** Fixed daily dosing of steroids is associated with overdosing, which may result in osteoporosis, obesity, and Cushing syndrome, and with underdosing in times of stress. Life-threatening Addisonian crisis can occur. | ||
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* The amount of adrenal tissue that must be left behind after partial adrenalectomy to avoid insufficiency is not known. | * The amount of adrenal tissue that must be left behind after partial adrenalectomy to avoid insufficiency is not known. | ||
== Ablative | == Ablative Therapy for Adrenal Tumours == | ||
* Current indications for ablative therapy for adrenal tumors include patients with small tumors not keen on or suitable for surgery and palliation of painful metastases not amenable to resection. | * Current indications for ablative therapy for adrenal tumors include patients with small tumors not keen on or suitable for surgery and palliation of painful metastases not amenable to resection. | ||