Adrenal disorders, surgical approaches and postoperative complications

Adrenal disorders in surgical practice are. presented either as hyperfunctional disorders or non functional disorders [incidentalomas]. Functionally, medullary tumors [pheochromocytoma] result in excess secretion of catecholamines[l], on the other hand, functioning adrenocortical tumors could secrete excess of cortisol [Cushing syndrome], aldosterone [Conn's syndrome] or sex hormones [virilizing syndromes]. [2 The aim of our study is to identify and to show our experience in the surgical approach and postoperative complications of adrenal disorders. This is a prospective study of 20 cases diagnosed as having adrenal disorders, admitted and evaluated in Baghdad Teaching Hospital-Medical City from January 2002 to December 2004. The data collected including age, gender, types of clinical adrenal disorders, surgical approaches and postoperative complications. Surgical excision was performed in 19 cases, eleven through anterior transabdominal approach [11/20, 55%], and eight through thoracoabdominal approach [8/20, 40%]. A better outcome was recorded in the thoracoabdominal approach. The most common encountered surgical morbidity was hypertension [3/19, 15.8%] and hypocalcemia [3/19, 15.8%]. Thoracoabdominal approach has better outcome especially in excising right adrenal tumor but transabdominal approach is preferable in excising a bilateral adrenal gland

Adrenal disorders, presentations and ways of investigations

Adrenal disorders in surgical practice are presented either as hyperfunctional disorders or non functional disorders [incidentalomas]. Functionally, medullary tumors [pheochromocytoma] result in excess secretion of catecholamines[1] on the other hand, functioning adrenocortical tumors could secrete excess of cortisol [Gushing syndrome], aldosterone [Conn's syndrome] or sex hormones [virilizing syndromes][2]. Aim of our study was to identify the most common types of adrenal tumors, its presentation and outlining the best diagnostic work up and to show our experiences in dealing with adrenal disorders in Iraq. This is a prospective study of 20 cases diagnosed as having adrenal disorders, admitted and evaluated in Baghdad Teaching Hospital-Medical City from January 2002 to December 2004. The collected data including; age, gender, presentations, methods of investigations and histopathological records. Their assessment revealed that adrenal disorders were most commonly encountered in the [30-39] years age group [9/20, 45%]. The mean age was 40 years with a female preponderance and female: male ratio of 2: 1. Obesity was noted in [7/20, 35%]. Headache was manifested in [5/20, 25%], palpitation in [4/20, 20%] and uncontrolled hypertension in [4/20, 20%]. Plasma cortisol was elevated and its diurnal rhythm was lost in [8/20, 40%], 24-urinary VMA was elevated in [6/20, 30%]. 24-urniary 17-ketosteroid was elevated in [1/20, 5%]. The most commonly encountered clinical type of adrenal disorders was hypercortisonism in the form of Gushing disease and syndrome[8/20, 40%]. Adrenal disorders mostly affect young age group patients with a female preponderance. Functioning adrenal disorders have presented earlier than non functioning ones owing to the symptoms they had caused. U/S, CT scan, MRI and IVP are very important in visualization, localization, assessment of distant metastases and finally discrimination of benign from malignant disorders