Manejo quirúrgico del incidentaloma suprarrenal / Surgical management of adrenal incidentaloma

Background: The adrenal incidentaloma is a lesion found on imaging studies for diagnosis of non-adrenal disorders. Most of these patients are not of surgical treatment. Our objective was to describe the clinical features and results of surgical management of adrenal incidentalomas in the Hospital de la Universidad de Chile. Material and Methods: Retrospective descriptive study. Period 2000 to 2009. Information was gathered from medical records and biopsies registers of patients with operated adrenal incidentaloma. Results: We evaluated 24 patients undergoing surgery, 66.7 percent female, 58.3 percent between 41 and 70 years. 58.3 percent were found in the study of abdominal pain. Surgical indications were: size ≥ 4 cm, enlarged in controls, atypical features in the abdominal and pelvic CT and/or functionality. 54.2 percent were ≥ 4 cm, 16.7 percent increase in size in controls, 45.8 percent had atypical features in the abdominal and pelvic CT and 33.3 percent were functioning, being the most frequent hypercortisolism. In 87.5 percent of patients the approach was laparoscopically. The morbidity was 12.6 percent (pneumonia, wound infection and stroke) and perioperative mortality was 0 percent. Discussion: The adrenal incidentaloma is a rare indication for surgery of adrenal tumors. Before the intervention should be studies in order to evaluate functionality and suspicion of malignancy. Functionating tumors and suspicious of malignancy should be resected, being the laparoscopic approach the election, likely in most cases.

Introducción: El incidentaloma suprarrenal es aquella lesión encontrada como hallazgo en estudios imagenológicos para el diagnóstico de desórdenes no suprarrenales. La gran mayoría de esos pacientes no son de resorte quirúrgico. Nuestro objetivo es describir las características clínicas y resultados del manejo quirúrgico de los incidentalomas suprarrenales operados en el Hospital Clínico de la Universidad de Chile. Material y Método: Estudio descriptivo-retrospectivo. Período 2000-2009. Se obtuvo información de fichas clínicas y registro de biopsias de los pacientes operados por incidentaloma suprarrenal. Resultados: Se evaluaron 24 pacientes intervenidos quirúrgicamente, el 66,7 por ciento sexo femenino, el 58,3 por ciento entre los 41 y los 70 años. El 58,3 por ciento se pesquisaron durante el estudio de dolor abdominal. Las indicaciones quirúrgicas fueron: tamaño ≥ 4 cm, aumento de tamaño en controles, características atípicas en la TC abdomino-pelviana y/o la funcionalidad. El 54,2 por ciento fueron ≥ de 4 cm, 16,7 por ciento aumento de tamaño en controles, 45,8 por ciento tenía características atípicas en la TC abdomino-pelviana y 33,3 por ciento fueron funcionantes, siendo lo más frecuente el hipercortisolismo. El 87,5 por ciento de los pacientes se abordaron por vía laparoscópica. La morbilidad fue de 12,6 por ciento (neumonía, infección de herida operatoria y AVE) y la mortalidad peri operatoria fue de 0 por ciento. Discusión: El incidentaloma suprarrenal es una indicación infrecuente de cirugía de tumores suprarrenales. Antes de la intervención deben estudiarse con el propósito de evaluar funcionalidad y sospecha de malignidad. Los tumores funcionantes y sospechosos de malignidad deben ser resecados, siendo la vía laparoscópica la de elección, factible en la gran mayoría de los casos.

Disfunción eréctil y estudio vascular de arterias cavernosas como factor predictor de cardiopatía coronaria / Erectile dysfunction and vascular study of cavernous arteries like predicting factor of coronary cardiopathy

During the last 15 years there has been increasing evidence demonstrating that erectile dysfunction (ED) due to vascular etiology is a primary manifestation of endothelial damage and that in a high percentage of the affected men it precedes coronary artery disease (CAD). These findings have positionated ED as a significant risk factor for CAD. The association between these pathological entities relies mainly in anatomical factor since the diameter of the cavernosal arteries is 1 to 2 mm and of the coronary arteries 3 to 4 mm. Considering that the physiopathology of the endothelial dysfunction is the same in both diseases, the clinical manifestations (DE) become apparent first in the organ with the smaller arteries. Classically the vascular study of the penis has been done with the color doppler ultrasound of the cavernosal arteries associated with an injection of prostaglandin E2; in the clinical setting this study represents a penile stress test (functional study). A pathological result in the color doppler ultrasound of the cavernosal arteries in patients with DE predicts the presence of CAD with high accuracy. Taking this information in account the specific study of these blood vessels may allow the detection of patients in risk of having CAD, positionating this study as a screnning method for patients in cardiovascular risk.