Skip to Main Content

++

General Indications

++

  • Clinically or biochemically apparent adrenal hormonal hyperfunction.
  • Possible or certain malignant adrenal mass.
  • Adrenal mass of uncertain significance.

++

Specific Conditions and Disease States

++

  • Primary hyperaldosteronism.
    • Unilateral cortical adenoma causing Conn's syndrome.
    • Bilateral hyperplasia with unilateral dominance (established by adrenal vein sampling).
  • Hypercortisolism.
    • Unilateral cortical adenoma.
    • Refractory Cushing's syndrome (from Cushing's disease, primary adrenal hyperplasia, or ectopic adrenocorticotropic hormone [ACTH] syndrome).
  • Pheochromocytoma.
  • Unilateral cortical adenoma causing virilization.
  • Myelolipoma (in selected situations).
  • Adrenal cyst (if refractory or symptomatic).
  • Adrenocortical carcinoma.
  • Incidentaloma with indeterminate or concerning imaging characteristics.
  • Adrenal metastases of other primary cancers (in selected situations).

++

Laparoscopic Adrenalectomy

++

Absolute

++

  • Adrenocortical carcinoma (certain or likely).
  • Refractory coagulopathy.
  • Comorbidities precluding safe general anesthesia.

++

Relative

++

  • Previous ipsilateral partial adrenal resection.
  • Previous extensive upper abdominal or retroperitoneal surgery.
  • Very large adrenal tumors (> 6–8 cm).
  • Suboptimal medical preparation for pheochromocytoma resection.

++

Open Adrenalectomy

++

Absolute

++

  • Refractory coagulopathy.
  • Comorbidities precluding safe general anesthesia.

++

Relative

++

  • Suboptimal medical preparation for pheochromocytoma resection.

++

Expected Benefits

++

  • Resolution of clinical symptoms related to adrenal hypersecretory function.
  • Treatment of primary or metastatic adrenal malignancies.
  • Treatment of symptomatic benign adrenal masses.

++

Potential Risks

++

  • For laparoscopic procedure, risk of conversion to an open procedure.
  • Bleeding requiring reoperation.
  • Glucocorticoid insufficiency (most commonly following preoperative hypercortisolism, bilateral adrenalectomy, or previous contralateral adrenalectomy).
  • Recurrence of tumor.
  • Scarring.
  • Infection.
  • Failure of operation to correct hypertension or adrenal hyperfunction.
  • Need for additional tests or procedures.

++

Laparoscopic Adrenalectomy

++

  • Standard laparoscopic and open instrument trays.
  • Surgical energy device such as harmonic scalpel or LigaSure.

++

Open Adrenalectomy

++

  • Major exploratory laparotomy instrument tray.
  • Retraction system such as Bookwalter or Thompson retractor.
  • Surgical energy device such as harmonic scalpel or LigaSure.

++

General Preparation

++

  • Nothing by mouth before surgery.
  • No preoperative antibiotics are necessary before surgery except when the patient has other indications (eg, cardiac valvulopathy, orthopedic hardware).
  • Anesthesiology consultation as needed.
  • Invasive blood pressure monitoring if required for pheochromocytoma or other medical condition.
  • Deep vein thrombosis (DVT) prophylaxis (for laparoscopic cases this should include sequential compression devices).

++

Disease-Specific Preparation

++

  • Preoperative control of hypertension for patients with pheochromocytoma.
    • α-Adrenergic blockade is achieved using phenoxybenzamine, 10 mg orally three times daily, titrated upward until mild orthostatic symptoms occur.
    • Requires 7–10 days minimum preparation.
    • Phenoxybenzamine should be continued until the morning of the procedure and given with a sip of water.
    • If necessary, β-adrenergic blockade is added after α blockade is established to treat tachycardia and prevent unopposed α blockade.
  • Stress-dose steroids administered to patients having adrenalectomy for hypercortisolism (benign or malignant causes) due to suppression ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.