Adrenal giant cystic pheochromocytoma treated by posterior retroperitoneoscopic adrenalectomy

Almeida, Carlos Costa; Silva, Marta; Carvalho, L.F. Abreu de; Almeida, Carlos M. Costa

doi:10.1016/j.ijscr.2016.12.018

Cited by 20 publications

(17 citation statements)

References 20 publications

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“…Our analysis revealed no statistical difference in intraoperative hemodynamic instability, postoperative recovery and postoperative complications between groups; results were similar for all parameters. This indicated that the different preoperative preparation strategies had essentially no effect on patients’ intraoperative hemodynamics ( 6 ). Similarly, we found no significant difference in postoperative recovery and postoperative complications between the groups.…”

Section: Discussionmentioning

confidence: 99%

“…Classic symptoms include episodic tachycardia, sweating, headache and signs of paroxysmal hypertension ( 5 ). Surgical resection, the only curative therapy, still carries a high intraoperative risk of causing massive catecholamine release into the circulation ( 6 ). This leads to a complex series of intraoperative hemodynamic instability issues during adrenalectomy for pheochromocytomas, including rapid and severe blood pressure fluctuations that greatly increase the risk of major morbidity ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

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Preoperative selective vs non-selective α-blockade in PPGL patients undergoing adrenalectomy

Liu

Chen

et al. 2017

Endocrine Connections

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PurposePreoperative preparation for adrenalectomy for pheochromocytomas and paragangliomas (PPGL) is universally recognized as necessary, while the optimal strategy remains controversial. Our aims were to increase intraoperative hemodynamic stability, expedite postoperative recovery, decrease side effects and reduce costs for patients with PPGL undergoing adrenalectomy.MethodsWe identified 526 patients undergoing open adrenalectomy for PPGL in the West China Hospital of Sichuan University between May, 2007 and December, 2016. 149 patients received preoperative selective α-blockade with phenoxybenzamine, and 377 patients received non-selective α-blockade with prazosin, doxazosin or terazosin. There were no statistical differences between groups regarding preoperative patient and tumor characteristics. Operations were planned once hypertensive patients were well-controlled with blood pressure ≤130/85 mmHg. Intraoperatively, all patients received arterial blood pressure monitoring, and indwelling urinary catheters to record urine output. We recorded intraoperative hemodynamics, status in the postanesthesia or intensive care unit, postoperative recovery and complications.ResultsPatients in the non-selective group showed a more significant decline in postoperative systolic blood pressure than the selective group (P = 0.041). Also, patients in the non-selective group appeared to receive a long-term anti-hypertensive effect, especially for diastolic blood pressure (P = 0.037), which was a novel finding, based on the current literature.ConclusionsOur results confirmed that non-selective α-blockade produced a more significant anti-hypertensive effect than selective α-blockade. However, we found no significant difference in intraoperative hemodynamic instability, postoperative recovery and postoperative complications between groups.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Preoperative selective vs non-selective α-blockade in PPGL patients undergoing adrenalectomy

Liu

Chen

et al. 2017

Endocrine Connections

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“…Transperitoneal approach is favoured over retroperitoneoscopic because of large working space, direct access to adrenal vein and more favourable anatomy to the urologist 8. Costa Almieda et al reported a case of large adrenal cystic PCC operated by posterior retroperitoneoscopic approach and discussed its feasibility; however, narrow space and risk of rupture and spillage is the concern 9. Gupta et al reported a case of large cystic PCC operated by open approach and removed the mass with nephrectomy in view dense adhesion with renal hilum 10.…”

Section: Discussionmentioning

confidence: 99%

Simple adrenal cyst masquerading clinically silent giant cystic pheochromocytoma

Kumar

Parmar²,

Aggarwal

et al. 2019

BMJ Case Rep

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Pheochromocytoma (PCC) may present as a cystic or solid tumour. Cystic PCCs are difficult to differentiate from simple cysts in the absence of classic symptoms of PCCs. Cystic nature develops due to intralesional bleeding and necrosis. We present a case of young man without any comorbidity who was diagnosed as a simple adrenal cyst and planned for laparoscopic excision but found to be functional PCC during the time of surgery only. The patient was managed with extensive monitoring and use of multiple drugs to control blood pressure. Surgery was completed without any complication laparoscopically and postoperative period was also uneventful. Histopathology confirmed the diagnosis of cystic PCC. Our case also shows the importance of functional imaging like metaiodobenzylguanidine (MIBG) scan in doubtful cases of adrenal cysts when other biochemical markers are unremarkable to diagnosis. We emphasise the importance of meticulous preparation for any intraoperative disasters even for apparently simple adrenal cyst.

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“…Surgery for the present case was considered challenging because the tumor was extremely large (>20 cm) and adjacent to surrounding organs including the liver, kidney, and inferior vena cava. The tumor reached a maximal diameter of 27 cm at the time of surgery, being one of the largest reported cases of pheochromocytomas . Before the surgery, we held a joint conference with related departments (e.g.…”

Section: Discussionmentioning

confidence: 99%

Acute hypotension induced by suction of cystic fluid containing extremely high concentrations of catecholamines during resection of giant pheochromocytoma

et al. 2019

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Introduction: Since pheochromocytomas present with various complications due to catecholamine hypersecretion, their perioperative management needs special attention. Case presentation: A 45-year-old man visited our hospital with a complaint of abdominal swelling. Radiological and endocrinological assessments determined the tumor as a giant (>20 cm) cystic pheochromocytoma. After administration of doxazosin, the patient underwent radical surgery. Since the tumor was extremely large and fixed to surrounding structures, we punctured it and aspirated cystic fluid to improve the tumor's mobility. However, during the aspiration, the patient developed acute hypotension, which could be reversed by suction withdrawal and vasopressor administration. A similar event occurred during a second aspiration. Eventually, the tumor was successfully excised with negative surgical margin. The cystic fluid proved to contain extremely high concentrations of catecholamines, which might result in the hypotension. Conclusion: We report the first case who developed acute hypotension due to aspiration of cystic fluid from giant pheochromocytoma. Keynote messagePheochromocytomas present with various complications due to catecholamine hypersecretion, and thus their perioperative management needs special attention. We report a case who developed acute hypotension due to aspiration of tumor cystic fluid during resection of giant pheochromocytoma. The cystic fluid proved to contain extremely high concentrations of catecholamines, which might result in the hypotension. The present report would promote physicians' awareness of this possible intraoperative complication and lead to safer pheochromocytoma surgery.

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Adrenal giant cystic pheochromocytoma treated by posterior retroperitoneoscopic adrenalectomy

Cited by 20 publications

References 20 publications

Preoperative selective vs non-selective α-blockade in PPGL patients undergoing adrenalectomy

Preoperative selective vs non-selective α-blockade in PPGL patients undergoing adrenalectomy

Simple adrenal cyst masquerading clinically silent giant cystic pheochromocytoma

Acute hypotension induced by suction of cystic fluid containing extremely high concentrations of catecholamines during resection of giant pheochromocytoma

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