Bilateral Adrenalectomy with Autotransplantation of Adrenocortical Tissue or Unilateral Adrenalectomy: Treatment Options for Pheochromocytomas in Multiple Endocrine Neoplasia Type 2A.

Okamoto, Takahiro; Obara, Takao; Ito, Yukio; Yamashita, Tomoyuki; Kanbe, Masako; Iihara, Masatoshi; Hirose, Kenzo; Yamazaki, Kimie

doi:10.1507/endocrj.43.169

Cited by 39 publications

(21 citation statements)

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“…Die autologe Transplantation von adrenokortikalem Gewebe in die Muskulatur [9,12,21,22] oder unter die Nierenkapsel [5] zeigte klinisch mit einer Substitutionsrate von über 90% kaum Erfolg. Die subtotale Adrenalektomie weist demgegenüber eine Substitutionsrate von unter 10% auf [1,5,12,14].…”

Section: Der Chirurg 7•2003 | 647unclassified

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Subtotale bilaterale Adrenalektomie mit adrenokortikalem Funktionserhalt

et al. 2003

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This study analyzed the frequency of recurrence and postoperative adrenocortical function in 16 patients who had been operated on by bilateral subtotal adrenalectomy since 1995. Bilateral pheochromocytoma was found in 13 patients, bilateral adrenal metastases in 2 patients, and bilateral micronodular adrenocortical hyperplasia with primary aldosteronism in 1 patient. An endoscopic approach was performed in four patients. The remaining 12 patients were operated on by an open approach. In ten patients, unilateral subtotal adrenalectomy with contralateral total adrenalectomy (synchronous or metachronous) was performed. Six patients underwent bilateral subtotal adrenalectomy. In all patients, a total of residual adrenal tissue of at least 1/3 of a normal adrenal gland was left in situ. 15 patients were successfully weaned from exogenous steroid substitution. During a mean follow-up period of 24 months, no recurrences were observed. Three patients died without local recurrence. The present study provided evidence for the safety and benefit of subtotal bilateral adrenalectomy, which could guarantee sufficient adrenocortical function in adrenal remnant volume of more than one-third of one adrenal gland even after dividing the main adrenal vein. At our institution, particularly in patients with inherited pheochromocytoma, subtotal adrenalectomy has become a common surgical strategy.

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Section: Der Chirurg 7•2003 | 647unclassified

“…Die Autotransplantation von Nebennierenrindengewebe unter die Nierenkapsel oder in die Skelettmuskulatur war bei Phäo-chromozytomen fast nie erfolgreich [5,12,21,22]. Kürzlich allerdings berichteten Inabnet et al über eine deutliche höhere Erfolgsrate nach adrenokortikaler Autotransplantation [9].…”

Section: Die Erhaltung Der Körpereigenen Adrenokortikalen Hormonproduunclassified

Subtotale bilaterale Adrenalektomie mit adrenokortikalem Funktionserhalt

et al. 2003

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“…10,14 However, although autotransplantation may prevent recurrence, it is unlikely to provide sufficient function. 2,15 Inabnet et al recently reported a higher frequency (29%) of successful autologous adrenocortical grafts, but the authors found sufficient adrenocortical function in only 40% of their subtotal adrenalectomized patients. 10 In contrast, we found that 90% of our patients had sufficient function of the adrenocortical remnant in a previous study.…”

Section: Discussionmentioning

confidence: 99%

Repeat Adrenocortical-Sparing Adrenalectomy for Recurrent Hereditary Pheochromocytoma

et al. 2004

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Recurrent hereditary benign pheochromocytoma after subtotal adrenalectomy may be treated successfully by repeated subtotal adrenalectomy. However, the risk of recurrence and malignancy must be weighed carefully against the risk of lifelong steroid replacement and potential Addisonian crisis. Thus, repeated subtotal adrenalectomy should be considered for selective patients who want to avoid steroid replacement.

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“…Conservative techniques such as autotransplantation of adrenocortical tissue or subtotal adrenalectomy have been proposed in some particular cases where bilateral adrenalectomy was indicated. Experience with autotransplantation has been disappointing in most studies (49). A variable rate of recurrence has been reported after subtotal adrenalectomy.…”

Section: Managementmentioning

confidence: 99%

A comprehensive approach to adrenal incidentalomas

Mantero

Albiger

2004

Arq Bras Endocrinol Metab

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Improvements in abdominal imaging techniques have increased the detection of clinically inapparent adrenal masses, or incidentalomas (AI), the appropriate diagnosis and management of which have become a common clinical problem for health care professionals. Once an adrenal mass has been detected, the clinician needs to address two questions: 1) is the tumor hormonally active? and 2) is there any chance of the mass being malignant? The majority of AI is nonhypersecretory cortical adenomas, but an endocrine evaluation can lead to the identification of subtle hormone excess. An overnight lowdose dexamethasone suppression test, fractionated urinary or plasma metanephrine assay and, in hypertensive patients, establishing the upright plasma aldosterone/plasma renin activity ratio are recommended as preliminary screening steps. Masses greater than 4cm are at greater risk of malignancy. Morphological imaging features may be helpful in the distinction between benign and malignant forms. Fine-needle aspiration biopsy is an important tool in the evaluation of oncological patients to establish any metastatic disease. Adrenalectomy is indicated by evidence of a functional adrenal mass, or a suspected malignant form. We advocate adrenalectomy of subtle hypercortisolism, especially in the presence of hypertension, obesity, diabetes or osteoporosis potentially aggravated by glucocorticoid excess. A close followup is needed, particularly in the first year after diagnosis. O aperfeiçoamento das técnicas de imagem abdominal tem aumentado a detecção de massas adrenais clinicamente não aparentes, ou incidentalomas (IA), cujo diagnóstico e manuseio apropriados têm se tornado um problema clínico comum para os profissionais da saúde. Uma vez detectada uma massa adrenal, o clínico é obrigado a formular duas questões: 1) o tumor é hormonalmente ativo? e 2) existe alguma possibilidade de a massa ser maligna?. A maioria dos IA são adenomas corticais não hipersecretores, mas uma avaliação endócrina pode resultar na identificação de um excesso hormonal sutil. Como passos preliminares de screening são recomendados um teste de supressão overnight com doses baixas de dexametasona, a dosagem de metanefrinas em urina fracionada ou no plasma e, em pacientes hipertensos, estabelecer a relação da aldosterona plasmática/atividade plasmática de renina na posição ortostática. Massas maiores que 4cm têm risco maior de malignidade. Achados morfológicos de imagem podem ser valiosos na distinção entre formas benignas e malignas. A biópsia de aspiração com agulha fina é um procedimento importante na avaliação de pacientes oncológicos para se estabelecer qualquer doença metastática. Adrenalectomia está indicada na evidência de uma massa adrenal funcionante, ou na suspeita de atualização A Comprehensive Approach to Adrenal Incidentalomas

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Bilateral Adrenalectomy with Autotransplantation of Adrenocortical Tissue or Unilateral Adrenalectomy: Treatment Options for Pheochromocytomas in Multiple Endocrine Neoplasia Type 2A.

Cited by 39 publications

References 20 publications

Subtotale bilaterale Adrenalektomie mit adrenokortikalem Funktionserhalt

Subtotale bilaterale Adrenalektomie mit adrenokortikalem Funktionserhalt

Repeat Adrenocortical-Sparing Adrenalectomy for Recurrent Hereditary Pheochromocytoma

A comprehensive approach to adrenal incidentalomas

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