Funktionserhaltende Adrenalektomie bei Nebennierentumoren

Abstract

Organ preserving resection (subtotal adrenalectomy) or adrenocortical autotransplantation can preserve adrenocortical stress capacity in bilateral adrenal surgery. After adrenocortical autotransplantation approximately 30% of patients do not need exogenous steroids. Organ preserving surgery avoids steroid supplementation in more than 80% of cases. After organ preserving resections in secondary or familial diseases, however, there is a relevant risk of recurrent disease: the rate of ipsilateral recurrence in familial pheochromocytoma is approximately 20% during a follow-up of 20 years. Routine administration of exogenous steroids should be avoided after subtotal adrenalectomy as functional restitution of the residual tissue might be disturbed. Approximately 80% of patients, however, present with impaired adrenocortical stress capacity directly after surgery. Within a few weeks some 80% of patients show a sufficient functional restitution of the adrenocortical stress capacity. Organ preserving adrenal surgery should be performed endoscopically. The adrenal remnant should not be devascularized; the adrenal vein, however, can be divided without functional consequences. About one third of a normal adrenal gland usually provides sufficient adrenocortical function.

Revised American Thyroid Association Guidelines for the Management of Medullary Thyroid Carcinoma

“…Subtotal adrenalectomy that preserves 10%-15% of residual adrenal cortical tissue appears to offer adrenal stress capacity sufficient to obviate the need for corticosteroid supplementation in more than 80% of patients (250). The risk of recurrent PHEO, however, is 20% within 20 years after subtotal adrenalectomy (251).…”

Advances in the management of MEN2: from improved surgical and medical treatment to novel kinase inhibitors

“…Thus far, the experience has been mixed, as about half of the patients require supplemental glucocorticoids, and from 3% to 20% of patients develop a recurrent PHEO at some time after surgery. (Brauckhoff and Dralle 2012; Brauckhoff, et al 2008; Scholten, et al 2011) Cortical sparing adrenalectomy seems promising; however, long term evaluation of many patients is necessary before the worth of the technique is established.…”