Laparoscopic Partial Adrenalectomy for the Management of Pheochromocytoma: A Case Report and Review of Literature

Abstract

Introduction: Bilateral pheochromocytoma is a rare disease necessitating surgical intervention for adequate disease control. Laparoscopic adrenalectomy is the treatment of choice for adrenal tumor since 1991. Herein, we report a case of bilateral pheochromocytoma who received right robotic adrenalectomy previously. This time he received laparoscopic partial adrenalectomy for the treatment of left pheochromocytoma. Case Report: A 35-year-old man had hypertension and was under regular medication for 3 years. He had progressively poorly controlled pressure since 2012. Magnetic resonance imaging showed bilateral adrenal mass, in favor of bilateral pheochromocytoma (right: 3.5 × 2.0 × 1.9 cm, left: 3.0 × 2.7 × 3.8 cm). Hormonal profile examinations showed elevated urinary vanillylmandelic acid, epinephrine, norepinephrine, and dopamine. Robotic right adrenalectomy was performed in 2013. Pathology analysis showed right pheochromocytoma. Elevated urinary catecholamines level was noted after operation. Left laparoscopic partial adrenalectomy was performed in 2014. Total operative time was 120 minutes and total intraoperative blood loss was 30 mL. Convalescence was uneventful and the patient was discharged under stable condition. Postoperative prednisolone was given for 5 months. Normal hormone profile was noted 6 months after the operation. Discussion: Laparoscopic, including robot-assisted, partial adrenalectomy has been increasingly used recently. The main indications for partial adrenalectomy are solitary adrenal gland, bilateral disease, and patients with familial syndromes. Pheochromocytoma has been treated with partial adrenalectomy, especially in patients with von Hippel–Lindau syndrome, familial pheochromocytoma, or multiple endocrine neoplasia type IIA. According to previous series and reviews, laparoscopic partial adrenalectomy is a feasible procedure that provides good functional and oncologic outcomes for different types of adrenal lesions. Partial adrenalectomy provides similar surgical outcomes and perioperative complications to those reported for total adrenalectomy. Besides, partial adrenalectomy provides the benefits of independence from chronic steroid replacement and low-to-nonrecurrence rate. Addisonian crisis has been reported in as much as 35% of patients after bilateral adrenalectomy with a 3% mortality rate. These data strongly support that laparoscopic partial adrenalectomy is a feasible method for pheochromocytoma in patients with a solitary adrenal remnant. Conclusion: Laparoscopic partial adrenalectomy is a feasible method for patients with pheochromocytoma. No competing financial interests exist. Runtime of video: 10 mins