Role Of Adrenalectomy Research Articles

Management of adrenal incidentaloma: the role of adrenalectomy may be underestimated.

BackgroundTo demonstrate clinical characteristics of adrenal incidentaloma in South China and explore its comprehensive management.MethodsThe clinical data of patients with adrenal neoplasm from Jan 1998 to Dec 2012 were retrospectively analysed. Patients with suspicion of adrenal abnormalities or those in whom adrenal abnormalities were detected in the staging procedures of other cancers were excluded. Most patients with adrenal incidentaloma chose to have adrenalectomy, and some chose surveillance. The relationships between clinical features were analysed with a chi-square test and rank sum test.ResultsIn total, 634 patients with adrenal incidentaloma were studied. Their age ranged from 17 to 85 years old with a median age of 50 years. Of 478 cases with pathological results, adenoma was the most common tumour (233/478), with 84 cases of pheochromocytoma and 36 cases of adrenocortical carcinoma were 84 and 36. When the tumour size was ≤4 cm, >95 % were benign; when the tumour size was >6 cm, 33 % were malignant. For patients with a tumour size ≤4 cm, 249/376 cases had an adrenalectomy performed. Due to anxiety over a potential malignant transformation and enlargement, most patients (>80 %) under surveillance preferred to undergo adrenalectomy.ConclusionsPheochromocytoma and adrenocortical carcinoma were not rare tumours of adrenal incidentaloma, and 4 cm is a good size cutoff to use in the diagnosis of an adrenal incidentaloma. Other than surveillance, laparoscopic adrenalectomy may become the method of choice for management of small adrenal incidentaloma.Electronic supplementary materialThe online version of this article (doi:10.1186/s12893-016-0154-1) contains supplementary material, which is available to authorized users.

Laparoscopic adrenal metastasectomy: appropriate, safe, and feasible

The role of adrenalectomy in management of isolated metastatic adrenal tumors is increasingly established. Laparoscopy is becoming the preferred approach for these resections. We evaluated surgical and oncological outcomes of patients who underwent laparoscopic versus open adrenal metastasectomy and assessed the effect of such surgery on postoperative adjuvant therapy and survival. We reviewed our institutional experience with adult patients who underwent an adrenal metastasectomy from 1997 to 2013. We assessed preoperative tumor size, operating room (OR) time, status of resection margin, and length of stay (LOS), as well as oncological outcomes including the use of adjuvant chemotherapy and radiotherapy within 1 year of surgery and 5-year survival. The χ (2) test, Mann-Whitney U test, and Kaplan-Meier curve were used for statistical analysis. Thirty-eight patients were identified. Lung was the primary site of malignancy (52.6 % of cases). Of the metastasectomies, 55.2 % (n = 21) were performed laparoscopically and 44.7 % (n = 17) were open. In the laparoscopic group, median tumor size was 2.6 cm versus 4.8 cm in the open group (p = 0.09). Median OR time and complication rates were similar between the 2 groups. The laparoscopic group, however, trended toward a shorter LOS (3 days laparoscopic vs. 4 days for open; p = 0.07). At 1 year, 37 % of all patients had not required any adjuvant chemotherapy or adjuvant radiotherapy. This series confirms that adrenal metastasectomy leads to favorable oncological outcomes in select patient groups, with over one-third of patients not requiring adjuvant therapy for at least 1 year after their resection. Laparoscopic approach leads to excellent oncological resection margins without increasing OR time and with a possible reduction in LOS.

Laparoscopic adrenalectomy for isolated adrenal metastasis from cervical squamous cell carcinoma and endometrial adenocarcinoma

Metastatic spread of gynecologic neoplasms to the adrenal gland is a rare condition. There is no consensus on the role of adrenalectomy for metastatic gynecologic neoplasms, given its extremely low incidence. We present two patients who underwent laparoscopic adrenalectomy for an isolated adrenal metastasis, one originating from squamous cell carcinoma of the cervix, and the other from endometrial adenocarcinoma.

Role of adrenalectomy in recurrent Cushing's disease

Background Cushing's disease is a pituitary-dependent type of Cushing's syndrome. Treatment consists of pituitary surgery or radiotherapy, but the recurrence rate at 10 years is as high as 40%. Adrenalectomy is considered an effective treatment to refractory Cushing's disease. The objective of this study was to examine the efficacy of laparoscopic adrenalectomy and open adrenalectomy in Cushing's disease, focusing on reversing the sequelae of hypercortisolism and improving patients’ quality of life. Methods Forty-three patients (29 women, 14 men) with recurrent Cushing's disease after transsphenoidal operation underwent laparoscopic (n=32) or open (n=11) adrenalectomy from 2000 to 2008. Surgical results were evaluated for all the 43 patients. Patients completed a follow-up survey, including the short-form 36-item (SF-36) health survey. Results All the 43 patients achieved clinical reversal of hypercortisolism after adrenalectomy. Time to symptom resolution varied from a few weeks to up to 3 years. Most physical changes had resolved by a mean of 8 months after surgery. These conditions were not significantly different between the laparoscopy and open groups. Median length of hospital stay was shorter in the laparoscopy group (4 vs. 9 days; P <0.001). Median follow-up was 48.5 months. Of the 34 (79%) patients available for follow-up, 22 (65%) had adrenocorticotropic hormone levels >200 ng/ml and 6 (27%) had clinical Nelson syndrome. Four patients died by 75 months after surgery. Using SF-36, 30 (88%) patients reported they felt their health status was good to excellent compared with 1 year before adrenalectomy; however, they showed significantly lower scores in all the 8 SF-36 parameters compared with the general population. No significant difference emerged in SF-36 scores between the laparoscopy and open groups. Conclusions Adrenalectomy showed high survival and clinical benefits in recurrent Cushing's disease patients. Despite patient-reported improvement in health after adrenalectomy, patients continue to experience poor health status compared with the general population.

Long-term outcome in patients with adrenal metastases following resection of colorectal liver metastases

The prognostic significance of adrenal metastases (AMs) in patients with colorectal liver metastases (CLMs) remains unknown. The aim of this study was to determine the influence of AMs on long-term outcome and the role of adrenalectomy in patients with CLMs. All patients resected for CLMs who developed AMs at a single institution between 1992 and 2006 were included in the study. Their long-term outcome was compared with that of all other patients resected for CLMs but without AMs. Hepatectomy was performed in 796 patients, of whom 14 (1.8 per cent) developed AMs, a median of 28 months after initial diagnosis of CLMs; the remaining 782 patients (98.2 per cent) had no AMs. All 14 patients had chemotherapy, and ten went on to adrenalectomy. Median survival after diagnosis of CLMs was 50 months in patients with AMs versus 68 months in those without (P = 0.020). After diagnosis of AMs, median survival was 23 months, whether or not adrenalectomy was performed. The development of AMs after liver resection for colorectal cancer deposits carries a poor prognosis, and adrenalectomy is probably not warranted.

Management of the Adrenal Gland During Partial Nephrectomy

Nephron sparing surgery is an increasingly used alternative to Robson's radical nephroadrenalectomy. The indications for adrenalectomy in patients undergoing partial nephrectomy are not clearly defined and some surgeons perform it routinely for large and/or upper pole renal tumors. We analyzed initial management and oncological outcomes of adrenal glands after open partial nephrectomy. Institutional review board approval was obtained for this study. During partial nephrectomy the ipsilateral adrenal gland was resected if a suspicious adrenal nodule was noted on radiographic imaging, or if intraoperative findings indicated direct extension or metastasis. Concomitant adrenalectomy was performed in 48 of 2,065 partial nephrectomies (2.3%). Pathological analysis revealed direct invasion of the adrenal gland by renal cell carcinoma (1), renal cell carcinoma metastasis (2), other adrenal neoplasms (3) or benign tissue (42, 87%). During a median followup of 5.5 years only 15 patients underwent subsequent adrenalectomy (0.74%). Metachronous adrenalectomy was ipsilateral (10), contralateral (2) or bilateral (3), revealing metastatic renal cell carcinoma in 11 patients. Overall survival at 5 years in patients undergoing partial nephrectomy with or without adrenalectomy was 82% and 85%, respectively (p = 0.56). Adrenalectomy should not be routinely performed during partial nephrectomy, even for upper pole tumors. We propose concomitant adrenalectomy only if a suspicious adrenal lesion is identified radiographically or invasion of the adrenal gland is suspected intraoperatively. Using these criteria adrenalectomy was avoided in more than 97% of patients undergoing partial nephrectomy. Even using such strict criteria only 13% of these suspicious adrenal nodules contained cancer. The rarity of metachronous adrenal metastasis and the lack of an observable benefit to concomitant adrenalectomy support adrenal preservation during partial nephrectomy except as previously outlined.

Controversies in the Surgical Management of Renal Cancer

Renal tumors are a common cause of cancer, and renal cell carcinoma accounts for the vast majority of the renal tumors in the United States. The past two decades have produced numerous advances in the treatment of localized and metastatic renal cell carcinoma. Nephron-sparing surgery, laparoscopic nephrectomy, and energy-ablative techniques are now in the armamentarium of the urologist. The role of adrenalectomy and lymphadenectomy are better understood today than in decades past, and recent advances in the understanding of immunotherapy, cytoreductive nephrectomy, and metastatic disease have also improved treatment for this disease. As is often the case as technology and knowledge evolve, controversies regarding the surgical treatment of renal cancer exist. This article outlines some of these controversies and reviews the evidence surrounding each.

Role of Adrenalectomy in Ectopic ACTH Syndrome

Evaluation of adrenalectomy in patients diagnosed with ectopic ACTH syndrome was studied. Twenty-three clinical cases diagnosed with ectopic ACTH syndrome were analyzed at Chinese Academy of Medical Sciences and Peking Union Medical College Hospital (PUMCH). Cases consisted of 14 males and 9 females, with mean age of 38 years. All 23 cases had positive clinical, biochemical and radiology evidence for diagnosis of Cushing's syndrome. Sixteen of the 23 cases were treated with total adrenalectomy and the remaining 7 were treated without surgical intervention. Sixteen cases, having no identifiable source of ectopic hormone production, experienced resolution of presenting signs and symptoms after undergoing bilateral or unilateral total adrenalectomy; 1-year survival was 67%, 2-year survival 41% and 5-year survival 15%. In patients treated conservatively without surgical intervention, 1-year survival was 0%. In patients with no identifiable source of ectopic hormone production, bilateral adrenalectomy followed by hormone replacement treatment is effective.

The present role of adrenalectomy in breast cancer

Evidence does not support the argument that surgical adrenalectomy carries too great a risk to justify its use in the treatment of advanced breast cancer. The increasing availability of methods of measuring tumour receptors will undoubtedly increase the level of accuracy in predicting response to surgical adrenalectomy. The operation itself is well within the scope of most experienced general surgeons. In view of the good quality of life for those who respond well and the possibility of prolonging survival far beyond that achieved by other treatment methods, there seems to be no reason why it should not continue to be recommended on a carefully selective basis to certain women with advanced and progressive breast cancer.

Cushing’s Disease: The Role of Adrenalectomy and Autotransplantation

Although the authors reaffirm the place of bilateral adrenalectomy as the cornerstone of treatment for Cushing’s disease, they deplore the permanent adrenal insufficiency it engenders. In this article they describe the new technique of autotransplant of adrenal cortical tissue, which they have used successfully to alleviate adrenal insufficiency.

Role of adrenalectomy and adrenal-cortical hormones in oxygen poisoning.

ArticleRole of Adrenalectomy and Adrenal-Cortical Hormones in Oxygen PoisoningRebeca Gerschman, Daniel L. Gilbert, Sylvanus W. Nye, Perry W. Nadig, and Wallace O. FennRebeca GerschmanFrom the Department of Physiology and Vital Economics, The University of Rochester School of Medicine and Dentistry, Rochester, New York, Daniel L. GilbertFrom the Department of Physiology and Vital Economics, The University of Rochester School of Medicine and Dentistry, Rochester, New York, Sylvanus W. NyeFrom the Department of Physiology and Vital Economics, The University of Rochester School of Medicine and Dentistry, Rochester, New York, Perry W. NadigFrom the Department of Physiology and Vital Economics, The University of Rochester School of Medicine and Dentistry, Rochester, New York, and Wallace O. FennFrom the Department of Physiology and Vital Economics, The University of Rochester School of Medicine and Dentistry, Rochester, New YorkPublished Online:01 Aug 1954https://doi.org/10.1152/ajplegacy.1954.178.2.346MoreSectionsPDF (892 KB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat Previous Back to Top Next Download PDF FiguresReferencesRelatedInformation Cited ByOxygen Toxicity, Biological Defense Systems and Immunity—A Historical Perspective20 October 2008 | Journal of Nutritional Immunology, Vol. 3, No. 2Glucocorticoid response and adrenal lipid peroxidation in rats submitted to chronic hypobaric hypoxia26 September 2008 | Archives Internationales de Physiologie, de Biochimie et de Biophysique, Vol. 101, No. 3Hormonal and Local Factors Influence Antioxidant Enzyme Activity of Rat Fetal Lung Cells in Vitro2 July 2009 | Experimental Lung Research, Vol. 11, No. 1Effect of pentobarbital anesthesia on regional cerebral metabolic rate for glucose during hyperbaric oxygenation in ratBrain Research, Vol. 336, No. 2Pulmonary Oxygen ToxicityDepression of 14 CO 2 Production from [U- 14 C] Glucose in Brain Slices Under High-pressure Oxygen: Relationship Between Metabolic Rate and Tissue Sensitivity to OxygenJournal of Neurochemistry, Vol. 34, No. 2The effect of oxygen tension on the growth and metabolism of WI-38 cellsJournal of Cellular Physiology, Vol. 89, No. 2Analysis of preseizure electrocorticographic changes in rats during hyperbaric oxygenationExperimental Neurology, Vol. 46, No. 1Studies on the biochemical basis of oxygen toxicityBiochimica et Biophysica Acta (BBA) - General Subjects, Vol. 320, No. 3Decreased Pulmonary Oxygen Toxicity by Pretreatment With HypoxiaArchives of Environmental Health: An International Journal, Vol. 24, No. 2Das experimentelle LungenödemEFFECTS OF SODIUM LACTATE ON OXYGEN TOXICITY IN THE RAT*16 December 2006 | Annals of the New York Academy of Sciences, Vol. 121, No. 3EFFECTS OF SINGLE AND REPEATED EXPOSURES TO OXYGEN AT HIGH PRESSURE ON NORMAL RATSCanadian Journal of Physiology and Pharmacology, Vol. 42, No. 2Adrenocortical insufficiencyBIOLOGICAL EFFECTS OF OXYGENNeurohumoral Factors in Injury from Inhaled IrritantsArchives of Environmental Health: An International Journal, Vol. 6, No. 1New Concepts and Future Trends in Toxicology27 December 2007 | American Industrial Hygiene Association Journal, Vol. 23, No. 1EFFECTS OF 2-AMINO-2-HYDROXYMETHYL-1,3-PROPANEDIOL ON OXYGEN TOXICITY IN MICE*15 December 2006 | Annals of the New York Academy of Sciences, Vol. 92, No. 2Bio-Regulatory Activity and Nitrogen Function in Organic Compounds.. Antioxidant Properties and their Physiological SignificancePhysiologia Plantarum, Vol. 12, No. 4Sensitivity to Oxygen During Postembryonic Development of the Wasp HabrobraconScience, Vol. 127, No. 3309Adrenocortical Pathway of Lobeline Protection in Some Forms of Experimental Lung Edema of the RatDiseases of the Chest, Vol. 33, No. 3Sauerstoff-IntoxikationKlinische Wochenschrift, Vol. 33, No. 19-20 More from this issue > Volume 178Issue 2August 1954Pages 346-350 Copyright & PermissionsCopyright © 1954 by American Physiological Societyhttps://doi.org/10.1152/ajplegacy.1954.178.2.346PubMed13197581History Received 5 April 1954 Published online 1 August 1954 Published in print 1 August 1954 Metrics