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PubMed2005

Prospective, randomized comparison of transperitoneal versus retroperitoneal laparoscopic adrenalectomy.

PURPOSE: We report a prospective, randomized comparison of transperitoneal laparoscopic adrenalectomy (TLA) vs retroperitoneal laparoscopic adrenalectomy (RLA) for adrenal lesions with long-term followup. MATERIALS AND METHODS: Between December 1997 and November 1999, 57 consecutive eligible patients with surgical adrenal disease were prospectively randomized to undergo TLA (25) or RLA (32). Study exclusion criteria were patient age greater than 80 years, body mass index greater than 40, bilateral adrenalectomy and significant prior abdominal surgery in the quadrant of interest. Mean followup was 5.96 years in the 2 groups. RESULTS: The groups were matched in regard to patient age (p = 0.84), body mass index (p = 0.43), American Society of Anesthesiologists class (p = 0.81) and laterality (p = 0.12). Median adrenal mass size was 2.7 cm (range 1 to 9) in the TLA group and 2.6 cm (range 0.5 to 6) in the RLA group (p = 0.83). TLA was comparable to RLA in terms of operative time (130 vs 126.5 minutes, p = 0.64), estimated blood loss (p = 0.92), specimen weight (p = 0.81), analgesic requirements (p = 0.25), hospital stay (p = 0.56) and the complication rate (p = 0.58). One case per group was electively converted to open surgery. Pathology data on the intact extracted specimens were similar between the groups. Averaged convalescence was 4.7 weeks in the TLA group and 2.3 weeks in the RLA group (p = 0.02). During a mean followup of 6 years 2 patients in the TLA group had a late complication (port site hernia). Mortality occurred in 5 patients, including 1 with TLA and 4 with RLA, during the 6-year followup. CONCLUSIONS: For most benign adrenal lesions requiring surgery laparoscopic adrenalectomy can be performed safely and effectively by the transperitoneal or the retroperitoneal approach.

Adrenal Gland Neoplasms↗
PubMed2005

Regulatory role of the pituitary-adrenal axis in experimental colitis: effect of adrenalectomy on the clinical course and the TH1/TH2 immune profile.

BACKGROUND: The hypothalamic-pituitary-adrenal (HPA) axis plays an important role in modulating immune reactions in inflammatory bowel disease. Our aim was to assess the role of the HPA axis in the pathogenesis of immunomediated colitis in mice. METHODS: Trinitrobenzene sulfonic acid (TNBS) colitis was induced in Balb/c mice. Sham operation (sham+TNBS) or bilateral adrenalectomy (Adex+TNBS) was performed 3 days later. Control groups underwent adrenalectomy without colitis induction (Adex) or were untreated [naïve mice (Naïve)]. Mice were monitored for survival, weight loss, and macroscopic and microscopic scores of colitis. FACS analysis of CD4, CD8, natural killer T lymphocytes, and serum levels of adrenocorticotropic hormone (ACTH), corticosterone (CS), interferon-gamma (IFN-gamma), interleukin-10 (IL-10), and IL-1beta were measured. Production of prostaglandin E2 (PGE2) and binding capacity to glucocorticoid receptor (GR) in colonic mucosa were also assessed. RESULTS: By day 7 following induction of colitis there was a marked increase in ACTH and CS levels in the colitis as compared with the control group (86 +/- 6.5 pg/mL and 16 +/- 1.9 pg/mL, and 23.3 +/- 2 pg/mL and 2.8 +/- 0.8 pg/mL, respectively). There was a decrease in ACTH and CS levels by day 28 in the colitis group, but the levels were still significantly higher than the levels in controls. Adrenalectomy markedly exacerbated colitis. The macroscopic and microscopic scores increased from 2.79 +/- 0.03 and 2.0 +/- 0.1 in the sham+TNBS group to 3.3 +/- 0.3 and 3.2 +/- 0.3 in the Adex+TNBS group. Survival and weight loss correlated with these differences. A significant increase in IL-10, IFN-gamma, and PGE2 was noted in the Adex+TNBS group compared with the sham+TNBS group. Splenic CD4 lymphocytes decreased in the sham+TNBS and Adex+TNBS groups as compared with control groups (Adex and naïve). The CD8/CD4 ratio was significantly higher in the Adex+TNBS compared with the sham+TNBS group. Colitis also caused a significant decrease in the specific binding capacity of labeled dexamethasone to colonic mucosa. CONCLUSIONS: TNBS induced colitis activated the HPA axis and reduced the sensitivity of the inflamed mucosa to circulating glucocorticoids. Adrenalectomy markedly exacerbated TNBS-induced colitis. The effect was associated with changes in the peripheral CD8/CD4 ratio and with a TH1 cytokine shift. Our results suggest that adrenocortical hormones play an important role in the regulation of the immune system in experimental colitis.

Adrenalectomy↗
PubMed2005

Laparoscopic adrenalectomy and adrenal-preserving surgery.

PURPOSE OF REVIEW: The aim of this paper is to define the current role of laparoscopy in the management of surgical adrenal diseases evaluating the surgical aspects, the indications and contraindications of laparoscopic adrenalectomy, focusing also on the most innovative tendencies in the laparoscopic adrenal-preserving surgery. RECENT FINDINGS: Recent publications have described some interesting new indications that need to be confirmed by long-term follow up. The present review mainly focuses on defining the state of the art of current adrenal laparoscopic surgery. SUMMARY: Laparoscopic adrenalectomy is becoming the 'platinum standard' for the treatment of the adrenal surgical diseases and it should be considered the treatment of choice for benign adrenal diseases. In cases of malignancy and conservative surgery, adrenalectomy appears to be very promising, although a longer follow up and further studies are still needed to accurately assess the role played by these procedures. Finally, who should do laparoscopic adrenalectomy? Every patient who requires the ablation of the adrenal should receive laparoscopic opportunity. And the surgeons? Only those with advanced laparoscopic skills and a good knowledge of adrenal anatomy and pathophysiology will obtain the same excellent results currently reported in the literature.

Adrenal Gland Diseases↗
PubMed2004

Predictive value of preoperative transthoracic echocardiography in patients undergoing adrenalectomy for pheochromocytoma.

BACKGROUND: Adrenalectomy for pheochromocytoma is a life-threatening procedure. Few echocardiographic assessments have been reported in patients undergoing adrenalectomy for pheochromocytoma. METHODS: Sixty-three consecutive patients undergoing adrenalectomy for pheochromocytoma underwent routine preoperative M-mode and two-dimensional echocardiography, and Doppler examination. Abnormal echocardiographic findings were defined as left ventricular dilatation or dysfunction (left ventricular percentage fractional shortening < 30%), and/or left ventricular wall motion abnormalities, and/or left ventricular hypertrophy (left ventricular mass index > 110 g m(-2) in women and >134 g m(-2) in men) and/or valvular abnormalities. Physical characteristics, daily urinary metanephrine and normetanephrine excretions, preoperative functional limitation, pre-existing congestive heart failure, type and duration of surgery, and haemodynamic instability in the intra and postoperative periods were compared in patients with normal and abnormal echocardiographic findings. RESULTS: Twenty-four out of 63 patients were found to have abnormal preoperative echocardiography. There was no difference between patients with normal and abnormal preoperative echocardiography as regards to the investigated criteria, except for pre-existing self-reported functional limitation and chest pain suggesting coronary artery disease. CONCLUSIONS: The relevance of routine preoperative echocardiographic examination in patients scheduled for adrenalectomy for pheochromocytoma, who have no cardiac symptoms or clinical evidence of cardiac involvement, is questionable.

Adrenal Gland Neoplasms↗
PubMed2004

Long-term survival after bilateral adrenalectomy for metachronous adrenocortical cancer.

We report the case of a female patient with bilateral metachronous adrenocortical cancer who survived long-term after adrenalectomy. In 1991, the patient underwent left adrenalectomy to remove a huge adrenal mass (10 x 9 cm) displaying no hormonal abnormality. Histological diagnosis was adrenocortical cancer. A right adrenal mass (7 x 6 cm) was found 4 years after left adrenalectomy. Right adrenalectomy was performed, and histological diagnosis was again adrenocortical cancer. The patient remains alive with no evidence of disease 8 years after last surgery.

Adrenal Cortex Neoplasms↗
PubMed2005

Clinical outcomes of laparoscopic adrenalectomy according to tumor size.

OBJECTIVES: In order to evaluate the indication and usefulness of laparoscopic adrenalectomy, clinical outcomes of laparoscopic adrenalectomy for patients with adrenal tumors were examined. Whether tumor size affects surgical outcome was analysed, along with the long-term clinical outcome for these patients. PATIENTS AND METHODS: A total of 63 patients with adrenal tumor underwent laparoscopic adrenalectomy in our institute between 1999 and 2003. A laparoscopic transperitoneal approach was used in all cases. Underlying pathologies comprised Cushing syndrome (n = 12), pheochromocytoma (n = 13), primary aldosteronism (n = 21), non-functioning adenoma (n = 12) and others (n = 5). RESULTS: No open conversion was performed. Mean operative duration was 239 min, and mean estimated blood loss was 134 mL. Tumor diameter was significantly smaller for primary aldosteronism than for Cushing syndrome, which in turn was significantly smaller than for adrenocorticotropic hormone-independent macronodular hyperplasia (AIMAH). No significant differences in surgical outcome and postoperative recovery were noted between large (>or=5 cm) and small (<5 cm) tumors. Long-term clinical outcome was better for patients with pheochromocytoma or primary aldosteronism than for patients with Cushing syndrome. CONCLUSIONS: Laparoscopic adrenalectomy for benign tumor offers excellent surgical outcomes and convalescence. This is true for both small and large tumors.

Adrenal Gland Neoplasms↗
PubMed2005

Laparoscopic adrenalectomy for functioning and non-functioning adrenal tumors: analysis of surgical aspects based on histological types.

BACKGROUND: The aim of this study was to evaluate whether hormonal functions of the tumor influence the operative results of laparoscopic adrenalectomy, and to analyse the clinical outcomes in patients with various hormonally active adrenal tumors. METHODS: Clinical and pathological records of 68 patients were reviewed. The average age of patients was 40 years (range 20-75); 39 were women and 29 men. For the comparison, patients were divided into the non-functioning tumor group (n = 22) and the functioning tumor group (n = 46). RESULTS: All laparoscopic adrenalectomies were finished successfully, and no open surgery was necessary. The median operative time and blood loss in the two groups were similar; however, in subgroup analysis, operative time for pheochromocytoma was significantly longer than that for non-functioning tumor (P = 0.044). No difference was noted in intra- and postoperative data between the groups. Of the 22 patients with aldosteronoma, 18 (81.8%) became normotensive and no longer required postoperative blood pressure medications. Adrenalectomy led to an overall reduction in the median number of antihypertensive medications (P < 0.001). All patients with Cushing adenoma had resolution or improvement of the signs and symptoms during follow-up periods. There was no evidence of biochemical or clinical recurrence in any patient with pheochromocytoma. CONCLUSION: The results of this retrospective review document that laparoscopic adrenalectomy is a safe and effective treatment for functioning as well as non-functioning adrenal tumors, although endocrinologic features may play a significant role.

Adrenal Gland Neoplasms↗
PubMed1992

Adrenalectomy potentiates immediate early gene expression in rat brain.

Administration of kainate or pentylenetetrazole increased c-fos, c-jun, junB, and junD mRNA levels in rat brain in a dose-dependent manner. Kainate increased these mRNA levels predominantly in the hippocampus, and pentylenetetrazole was more effective in the cortex. Adrenalectomy (3 days) was used to eliminate endogenous glucocorticoid hormones. Adrenalectomy significantly potentiated kainate-induced increases, compared with increases caused by kainate (4 mg/kg) alone, in the hippocampal mRNA levels of c-fos and junB by 6.5-fold and of junD by twofold and tended to augment c-jun mRNA. Corticosterone administration blocked the potentiated stimulation of these mRNA levels caused by adrenalectomy. Adrenalectomy also significantly increased pentylenetetrazole-induced levels of c-fos mRNA in the cortex. These results demonstrate that glucocorticoids modulate immediate early gene expression in the brain, raising the possibility that this interaction contributes to interneuronal and interindividual differences in responses to stimuli and to the effects of stress- or disease-induced changes in glucocorticoid concentrations.

Adrenalectomy↗
PubMed1987

Studies on the maturation of the small intestine of the fetal sheep. I. The effects of bilateral adrenalectomy.

The effect of bilateral adrenalectomy at 120 d gestation on subsequent maturation of proximal and distal small intestine was investigated in chronically catheterized fetal sheep. Ten adrenalectomized and fourteen controls were examined at 136 d; some following infusion of [3H]thymidine at 3-6 d or 4 h before termination of pregnancy. Mean plasma cortisol levels were 5.3 +/- 0.7 ng/ml in the adrenalectomized group; control values ranged from 14 to 39 ng/ml level during the 2-week experimental period. Fetal body growth was significantly increased following adrenalectomy. In the small intestine, growth of mucosal structures was reduced, especially in distal regions. Villus height was significantly reduced in both regions. External muscle thickness was significantly increased in both regions. Despite these changes there was no alteration in villus enterocyte morphology, nor were there any significant changes in villus or crypt densities. The proportion of crypt cells labelled with [3H]thymidine was unaffected by adrenalectomy. In proximal regions, migration rate of labelled enterocytes declined from 12.0 to 5.83% villus height/d (P less than 0.025) after adrenalectomy; there was no change in migration rate in distal regions. The estimated renewal time was greater in both proximal and distal regions in adrenalectomized compared with control fetuses.

Adrenalectomy↗
PubMed1983

Aldosterone on sodium transport of rat distal colon in long-term adrenalectomy during acute and chronic substitution.

1. The influence of aldosterone upon water and sodium transport properties of the distal colon was studied in long-term adrenalectomy (11-29 days).2. Six groups of rats were used: I, normal (control); II, adrenalectomized; III, adrenalectomized, acutely substituted with aldosterone (200 mug/kg 4 h); IV, adrenalectomized rats receiving aldosterone simultaneously with the specific inhibitor spironolactone (40 mg/kg within 4 h); V, adrenalectomized, substituted chronically with aldosterone (2 x 75 mug/kg day); VI, adrenalectomized, substituted chronically with dexamethasone (120 mug/kg day).3. Distal colon segments were perfused in vivo with isotonic Ringer solution. In addition, a hypotonic electrolyte solution (Na(+) 111 mM) was used in groups I and II.4. In adrenalectomy (group II), net water absorption (J(v)) was significantly decreased from (normal) 54.4 mul/h cm(2)+/-10.5 (n = 9) to 41.2 mul/h cm(2)+/-7.3 (n = 4), and net Na(+) absorption (J(Na)) was decreased from 13.6 mumol/h cm(2)+3.5 to 8.5 mumol/h cm(2)+/-0.9 (isotonic perfusate). Similarly, J(v) was decreased from 54.0 mul/h cm(2)+/-8.3 (n = 4) to 37.3 mul/h cm(2)+/-4.2 (n = 7), and J(Na) from 8.6 mumol/h cm(2)+/-2.1 to 4.2 mumol/h cm(2)+/-2.1 (hypotonic perfusate).5. Acute aldosterone substitution in adrenalectomy (III) had no effect upon J(v) (37.1 mul/h cm(2)+/-10.3; n = 5) but increased J(Na) to 10.3 mumol/h cm(2)+/-0.3.6. The luminal Na(+) steady-state concentration was higher in group II (11.2 mmol l(-1)+/-3.6; n = 6) than in group I (3.3 mmol l(-1)+/-1.4; n = 29). Acute aldosterone substitution restored this value to normal (3.0 mmol l(-1)+/-1.2; n = 4). The aldosterone effect was partly blocked by spironolactone: the Na(+) steady-state concentration was 6.4 mmol/l+/-0.6 (n = 3) in group IV.7. At the steady-state luminal Na(+) concentration, the osmotically driven net water fluxes were not different in groups I and II, indicating that the hydraulic permeability coefficient is not altered in adrenalectomy.8. In group V, J(v) (54.9 mul/h cm(2)+/-10.9; n = 7) and J(Na) (11.9 mumol/h cm(2)+/-1.7; n = 6) were not significantly different from normal.9. In group VI, J(v) (37.3 mul/h cm(2)+/-6.0; n = 5) and J(Na) (8.0 mumol/h cm(2)+/-1.4) were not significantly different from group II.10. The mineralocorticoid effects of aldosterone in long-term adrenalectomy appear to represent the principal determining factors of colonic J(v) and J(Na).

Adrenalectomy↗
PubMed2002

Adiponectin is stimulated by adrenalectomy in ob/ob mice and is highly correlated with resistin mRNA.

Plasma levels of the adipocyte product adiponectin, a putative insulin-sensitizing agent, are reduced in obesity, whereas plasma levels of resistin, an agent that some believe to confer insulin resistance, are thought to increase with obesity. Because adrenalectomy can increase insulin sensitivity, we hypothesized that adrenalectomy would increase expression of adiponectin and decrease expression of resistin. Therefore, we measured adiponectin mRNA, adiponectin peptide, and resistin mRNA in adrenalectomized ob/ob mice. Adrenalectomy restored adiponectin expression in ob/ob mice to wild-type levels and stimulated adiponectin peptide to above wild-type levels. Surprisingly, expression of adiponectin and resistin was highly positively correlated even after statistical removal of effects of insulin, glucose, and adiposity. In addition, adiponectin and resistin expression were also highly correlated in diet-induced obese mice. The data support a role for adiponectin in mediating some effects of adrenalectomy on insulin sensitivity.

Adiponectin↗
PubMed1984

Adrenalectomy reverses insulin resistance in muscle from obese (ob/ob) mice.

Glucose transport and insulin resistance in the skeletal muscle of the genetically obese (ob/ob) mouse has been studied in animals at 6-7 wk of age using an in situ perfused hindquarter preparation. Rates of glucose uptake and the uptake of radioactively labeled 2-deoxy-D-glucose were lower in muscles from intact ob/ob mice than in those from their lean littermates. Following adrenalectomy the basal rate of glucose or 2-deoxy-D-glucose uptake in the ob/ob mice was restored to normal. The uptake of 2-deoxyglucose was tested at two insulin concentrations. In lean mice, adrenalectomy had no effect on 2-deoxyglucose uptake. Adrenalectomy, however, restored the responsiveness to insulin in the ob/ob mouse to normal. The activity ratio of muscle glycogen synthase was elevated by insulin but the effect was greater in the lean animals with or without adrenal glands than in the obese mouse. Adrenalectomy in the obese mouse did not correct this defect.

Adrenal Glands↗
PubMed1984

Effects of adrenalectomy on activation of glycogen phosphorylase in rat myocardium.

Adrenalectomy causes a depressed glycogenolytic response to catecholamines in myocardium. Total phosphorylase activity (a + b) is 20% lower in isolated, perfused hearts from adrenalectomized (ADX) rats compared with hearts from sham-operated (sham) rats even though the basal activity ratios (-AMP/+AMP) do not differ. In response to epinephrine (50 nM), the sham group has a higher activity ratio than the ADX group (0.23 vs. 0.16); the difference in specific activities of phosphorylase a in the two groups is even greater, 87 versus 49 U/mg protein. The glycogen content of the heart is 30% lower in the ADX group. Adrenalectomy does not alter the accumulation of cAMP and activation of cAMP-dependent protein kinase caused by epinephrine. Although rat heart contains a heat-stable phosphatase inhibitor, the activity of this inhibitor, as judged by phosphorylase phosphatase activity, is not altered by epinephrine stimulation or by adrenalectomy. Epinephrine perfusion increases the activity ratios (pH 6.8:8.2) of phosphorylase kinase equally in sham and ADX hearts; however, the specific activities of phosphorylase kinase (basal and hormone-stimulated) at either pH are lower after adrenalectomy. The sensitivity of phosphorylase kinase activity to stimulation by calcium is the same in the sham and ADX groups. A radioimmunoassay for phosphorylase kinase detects 10% less of this enzyme in hearts from adrenalectomized animals. Specific activities at pH 6.8 and 8.2 based on the quantity of phosphorylase kinase detected by radioimmunoassay suggest a lower phosphorylation state in the ADX group. Decreases in quantities of phosphorylase and phosphorylase kinase and enzyme dissociation due to glycogen depletion could all contribute to a depressed glycogenolytic response in the ADX group.

Adrenal Glands↗
PubMed1987

Brown adipose tissue metabolism in ob/ob mice: effects of a high-fat diet and adrenalectomy.

Adrenalectomy prevents development of obesity in ob/ob mice fed high-carbohydrate stock diets partly by stimulating the low thermogenic capacity of their brown adipose tissue (BAT). Adrenalectomy, however, fails to prevent development of obesity in ob/ob mice fed a high-fat diet. Effects of adrenalectomy on BAT metabolism in ob/ob mice fed a high-fat diet were thus examined. ob/ob mice fed the high-fat diet developed gross obesity despite normal BAT metabolism, as assessed by rates of norepinephrine turnover in BAT, GDP binding to BAT mitochondria, and GDP-inhibitable, chloride-induced mitochondrial swelling. Adrenalectomy failed to arrest the development of obesity or to influence BAT metabolism in ob/ob mice fed the high-fat diet. Development of obesity in ob/ob mice fed a high-fat diet is not associated with low thermogenic capacity of BAT or with adrenal secretions, as it is in ob/ob mice fed high-carbohydrate stock diets.

Adipose Tissue, Brown↗
PubMed1988

Delayed extra-adrenal epinephrine secretion after bilateral adrenalectomy in rats.

Regulated systemic extra-adrenal epinephrine secretion has been demonstrated in long-term bilaterally adrenalectomized humans. To determine whether this is demonstrable immediately after adrenalectomy and therefore presumably ongoing when the adrenal medullas are intact or if it develops over time after the adrenal medullas are removed, we measured plasma catecholamine concentrations before and serially after bilateral adrenalectomy with cortical reimplantation in rats. We found plasma epinephrine concentrations to decrease from 244 +/- 41 pg/ml to levels that were not convincingly detectable, using a single-isotope derivative assay with a detection limit of 10 pg/ml, for up to 1 wk after bilateral adrenalectomy with cortical reimplantation. Plasma epinephrine concentrations increased thereafter, becoming detectable in all animals and averaging 31 +/- 6 pg/ml 4 wk after adrenalectomy. Thus extra-adrenal epinephrine secretion appears to be a delayed response to removal of the adrenal medullas and cannot be assumed to be ongoing when the adrenal medullas are intact.

Adrenal Cortex↗
PubMed1988

Adrenalectomy fails to stimulate brown adipose tissue metabolism in ob/ob mice fed glucose.

Adrenalectomy arrests the development of obesity in ob/ob mice fed nonpurified high-starch diets partly by stimulating the low thermogenic activity of brown adipose tissue (BAT). However, adrenalectomy fails to suppress the development of obesity in ob/ob mice fed a purified high-glucose diet. Effects of adrenalectomy on BAT metabolism in ob/ob mice fed purified high-starch or high-glucose diets were therefore examined. Adrenalectomy markedly decreased the efficiency of energy retention and increased BAT metabolism (as assessed by GDP binding to BAT mitochondria, GDP-inhibitable acetate- or chloride-induced mitochondrial swelling, and by rates of norepinephrine turnover in BAT) in ob/ob mice fed a high-starch purified diet but had only minimal effects on energy efficiency or BAT metabolism in ob/ob mice fed a high-glucose purified diet. Plasma insulin concentrations decreased and thyroxine concentrations increased in adrenalectomized ob/ob mice fed the high-starch diet; changes in these hormones were less pronounced in adrenalectomized ob/ob mice fed the high-glucose diet. Consumption of glucose mimics effects of adrenal secretions on BAT metabolism in ob/ob mice.

Adipose Tissue, Brown↗
PubMed1983

Kinetics of zinc absorption by the rat jejunum: effects of adrenalectomy and dexamethasone.

Effects of dexamethasone and adrenalectomy on the kinetics of jejunal 65Zn uptake and absorption were studied in the anesthetized adult rat. The jejunal lumen was perfused in situ with 5 mM glucose in 150 mM saline containing 65Zn and [14C]polyethylene glycol as volume marker. Over the 30-min perfusion period, the rate of net 65Zn removal from the perfusate was biexponential due to the establishment of a return flux to the lumen. An open two-compartment model satisfactorily describes these observations: (formula; see text) Dexamethasone (2 mg/kg ip 7 h before perfusion) increased k12 by 75% (P less than 0.0002) and decreased k20 by 45% (P less than 0.04). Both effects were independent of adrenalectomy. Mathematical simulations using the compartmental model and experimentally determined kinetic constants predicted that transfer of 65Zn into the body should be enhanced by adrenalectomy and retarded by dexamethasone administered to adrenalectomized rats. Dexamethasone and adrenalectomy thus differentially affect Zn uptake and absorption in this system, suggesting a possible adrenocortical hormone involvement in the regulation of Zn absorption. These changes are apparently not mediated via metallothionein.

Adrenalectomy↗
PubMed1999

Real indications for adrenalectomy in renal cell carcinoma.

OBJECTIVES: Adrenalectomy is a part of radical nephrectomy because of the surgical oncology principle of a 'wide margin beyond the malignancy' and due to concern over possible metastases to the ipsilateral adrenal gland, especially in upper pole tumors. But, neither the frequency, predisposing factors of the renal cell carcinoma nor mechanisms of involvement of the adrenal gland are well defined. We assessed the ipsilateral adrenal involvement in renal cell carcinoma to determine whether ipsilateral adrenalectomy during radical nephrectomy is essential. MATERIAL AND METHOD: In a series of 15,347 autopsies in Jena from 1985 through 1996, 272 renal cell carcinoma with 24 adrenal metastases were found. In the same period 9 adrenal metastases were found in 639 radical nephrectomies. Contralateral and bilateral metastases were seen in 15 cases of the autopsy series and in 2 cases of the operative series. RESULTS: The risk of adrenal metastases correlated with multifocal tumors, pleomorphic cell type, anaplastic growth pattern and tumors that were larger than 2.5 cm. Of the 24 renal cell carcinomas with adrenal metastases in the autopsy series, 23 had evidence of widespread disease and 22 had lymph node metastases. A preoperative abdominal computerized tomography was performed in all 9 patients of the operative series with renal cell carcinoma and adrenal involvement. The adrenal gland was considered abnormal in 8 of the 9 cases (88.9%). Only in 1 patient was the computerized tomography incorrectly interpreted as negative. CONCLUSION: We think adrenalectomy should only be performed if there is radiographic evidence of metastases in the adrenal gland or adrenal infiltration by a large upper-pole tumor is possible. Macroscopically normal adrenal glands should not be removed during tumor nephrectomy because the need and benefit of routine adrenalectomy are extremely limited.

Adrenal Gland Neoplasms↗