Laparoscopic simultaneous bilateral adrenalectomy: Assessment of feasibility and potential indications

Kawasaki, Yoshihide; Ishidoya, Shigeto; Kaiho, Yasuhiro; Ito, Akihiro; Satoh, Fumitoshi; Morimoto, Ryo; Nakagawa, Haruo; Arai, Yoichi

doi:10.1111/j.1442-2042.2011.02846.x

Cited by 26 publications

(17 citation statements)

References 22 publications

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“…As mentioned above, immunoassays could result in clinically substantial errors in measurement, especially at high concentrations as detected in adrenal effluents, and the clinical usefulness of a novel assay using mass spectrometry has been proposed for such cases (22,23). In previous studies including ours (24,25,26,27), some PA patients were found to present autonomous adrenal cortisol overproduction. It has been also proposed that in PA associated with autonomous adrenal cortisol overproduction, plasma metanephrine measured in samples from the adrenal veins would provide a good alternative to cortisol measurement for calculating SI and LI (28).…”

Section: Discussionmentioning

confidence: 94%

Is there a role for segmental adrenal venous sampling and adrenal sparing surgery in patients with primary aldosteronism?

Satoh¹,

Morimoto²,

Seiji³

et al. 2015

European Journal of Endocrinology

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Objective and design: Adrenal venous sampling (AVS) is critical to determine the subtype of primary aldosteronism (PA). Central AVS (C-AVS) -that is, the collection of effluents from bilateral adrenal central veins (CV) -sometimes does not allow differentiation between bilateral aldosterone-producing adenomas (APA) and idiopathic hyperaldosteronism. To establish the best treatment course, we have developed segmental AVS (S-AVS); that is, we collect effluents from the tributaries of CV to determine the intra-adrenal sources of aldosterone overproduction. We then evaluated the clinical utility of this novel approach in the diagnosis and treatment of PA. Methods: We performed C-AVS and/or S-AVS in 297 PA patients and assessed the accuracy of diagnosis based on the results of C-AVS (nZ138, 46.5%) and S-AVS (nZ159, 53.5%) by comparison with those of clinicopathological evaluation of resected specimens.Results: S-AVS demonstrated both elevated and attenuated secretion of aldosterone from APA and non-tumorous segments, respectively, in patients with bilateral APA and recurrent APA. These findings were completely confirmed by detailed histopathological examination after surgery. S-AVS, but not C-AVS, also served to identify APA located distal from the CV. Conclusions: Compared to C-AVS, S-AVS served to identify APA in some patients, and its use should expand the pool of patients eligible for adrenal sparing surgery through the identification of unaffected segments, despite the fact that S-AVS requires more expertise and time. Especially, this new technique could enormously benefit patients with bilateral or recurrent APA because of the preservation of non-tumorous glandular tissue.

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Section: Discussionmentioning

confidence: 94%

Is there a role for segmental adrenal venous sampling and adrenal sparing surgery in patients with primary aldosteronism?

Satoh¹,

Morimoto²,

Seiji³

et al. 2015

European Journal of Endocrinology

Self Cite

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“…[9][10][11] In the past, some investigators questioned whether partial adrenalectomy should be performed for patients with bilateral disease. This was because of concerns related to the management of patients rendered 'adrenal free' and the fear of severe hypoadrenalism encouraged some to propose partial bilateral adrenalectomy.…”

Section: Discussionmentioning

confidence: 99%

Bilateral adrenalectomy: a review of 10 years’ experience

Maccora

Walls

Sadler

et al. 2017

annals

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INTRODUCTIONThe 2012 British Association of Endocrine and Thyroid Surgeons audit report showed that only 86 of 1359 patients who underwent adrenalectomy had a bilateral operation; thus the experience with this procedure remains limited. METHODS Retrospective review of patients undergoing bilateral adrenalectomy in a tertiary referral centre. RESULTS Between November 2005 and January 2016, bilateral adrenalectomy was performed in 23 patients (6 male, 17 female, age 43 ± 4 years) diagnosed with Cushing's disease (n = 13), hereditary phaeochromocytomas (n = 6), adrenocortical cancer (n = 2), colorectal metastatic disease (n = 1) and adrenocortical adenomas (n = 1).A laparoscopic transperitoneal approach was used in 17 patients, with one conversion to open. Three patients had open adrenalectomies for adrenocortical cancer and for simultaneous phaeochromocytomas and pancreatic neuroendocrine tumours in a patient with Von Hippel-Lindau syndrome. Three patients with Cushing's had a bilateral retroperitoneoscopic operation. The mean operating time was 195 ± 16 minutes for laparoscopic operations (n = 16), 243 ± 44 minutes for open adrenalectomies (n = 4) and 151 ± 12 minutes for retroperitoneal operations. It was significantly shorter for Cushing's disease than for phaeochromocytomas (162 ± 8 vs. 257 ± 39 minutes, P < 0.01).Median length of hospital stay was 5 days. Postoperative complications (Clavien-Dindo classification) included one chest infection (level 2), one postoperative haemorrhage and two chest drains for pneumothorax (level 3), two postoperative cardiac arrests (level 4) and one late cancer death from complications related to uncontrolled hypercortisolism (level 5). DISCUSSION Synchronous bilateral adrenalectomy remains an infrequent operation. The laparoscopic approach is feasible in the majority of patients. It is likely that the retroperitoneoscopic adrenalectomy will become the standard approach for bilateral operations.

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“…107,[109][110][111] This benefit has to be balanced with the risk of tumor recurrence, given that reoperation is associated with increased morbidity. Hereditary pheochromocytomas in von Hippel-Lindau (VHL) and multiple neoplasia type-2 (MEN-2) syndromes have been the standard diseases suitable for adrenal-sparing surgery.…”

Section: Surgical Managementmentioning

confidence: 99%

Subclinical Cushing’s syndrome: Current concepts and trends

Zografos¹,

Perysinakis²,

Vassilatou³

2014

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AbSTrAcTclinically inapparent adrenal masses which are incidentally detected have become a common problem in everyday practice. Approximately 5-20% of adrenal incidentalomas present subclinical cortisol hypersecretion which is characterized by subtle alterations of the hypothalamicpituitary-adrenal axis due to adrenal autonomy. This disorder has been described as subclinical cushing's syndrome, since there is no typical clinical phenotype. The diagnosis of subclinical cushing's syndrome is based on biochemical evaluation; however, there is still no consensus for the biochemical diagnostic criteria. An abnormal 1mg dexamethasone suppression test (DST) as initial screening test in combination with at least one other abnormal test of the hypothalamic-pituitary-adrenal axis has been advocated by most experts for the diagnosis of subclinical cushing's syndrome. DST is the main method of establishing the diagnosis, while there is inhomogeneity of the information that other tests provide. Arterial hypertension, diabetes mellitus type 2 or impaired glucose tolerance, central obesity, osteoporosis/vertebral fractures and dyslipidemia are considered as detrimental effects of chronic subtle cortisol excess, although there is no proven causal relationship between subclinical cortisol hypersecretion and these morbidities. Therapeutic strategies include careful observation along with medical treatment of morbidities potentially related to subtle cortisol hypersecretion versus laparoscopic adrenalectomy. The optimal management of patients with subclinical cushing's syndrome is not yet defined. The conservative approach is appropriate for the majority of these patients; however, the duration of follow-up and the frequency of periodical evaluation still remain open issues. Surgical resection may be beneficial for patients with hypertension, diabetes mellitus type 2 or abnormal glucose tolerance and obesity.

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Laparoscopic simultaneous bilateral adrenalectomy: Assessment of feasibility and potential indications

Cited by 26 publications

References 22 publications

Is there a role for segmental adrenal venous sampling and adrenal sparing surgery in patients with primary aldosteronism?

Is there a role for segmental adrenal venous sampling and adrenal sparing surgery in patients with primary aldosteronism?

Bilateral adrenalectomy: a review of 10 years’ experience

Subclinical Cushing’s syndrome: Current concepts and trends

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