Subject(s)
Abdomen, Acute/etiology , Abdomen, Acute/diagnosis , Abdomen, Acute/surgery , Angiography , Diagnosis, Differential , Gangrene , Humans , Ileus/diagnosis , Ileus/surgery , Intestinal Perforation/diagnosis , Intestinal Perforation/surgery , Intestine, Small/blood supply , Intestine, Small/pathology , Ischemia/diagnosis , Ischemia/surgery , Medical History Taking , Mesenteric Vascular Occlusion/diagnosis , Mesenteric Vascular Occlusion/surgery , Necrosis , Physical Examination/methods , Pneumoperitoneum/diagnosis , Pneumoperitoneum/etiology , Prognosis , Tomography, X-Ray ComputedABSTRACT
Microadenomectomy via a transsphenoidal approach is today's treatment of choice to achieve normal cortisol blood levels in patients with ACTH-secreting pituitary tumors. Should neurosurgery fail, bilateral adrenalectomy is recommended. Today the endoscopic, transabdominal or retroperitoneal adrenalectomy is regarded as the gold standard for the operation of endocrine-active adrenal tumors. Therefore, in principle, the question of the indication for the endoscopic operation no longer arises but only the question of the technical feasibility in individual cases. We report on a patient with a pituitary-dependent Cushing's syndrome after a twice-repeated unsuccessful transsphenoidal adenomectomy and with additional polycystic kidney and liver disease, who underwent bilateral retroperitoneoscopic adrenalectomy. Despite the massive enlargement of both kidneys, it was possible to safely perform a bilateral retroperitoneoscopic adrenalectomy. In the case of marked bilateral cystic kidneys, a bilateral retroperitoneoscopic adrenalectomy in Cushing's syndrome is technical possible and a safe and effective method of treatment.
Subject(s)
Adenoma/surgery , Adrenalectomy/methods , Cushing Syndrome/surgery , Pituitary Neoplasms/surgery , Adenoma/complications , Adult , Cushing Syndrome/etiology , Cysts/complications , Female , Humans , Laparoscopy/methods , Liver Diseases/complications , Pituitary Neoplasms/complications , Polycystic Kidney Diseases/complications , Treatment OutcomeABSTRACT
OBJECTIVE: To assess the outcome of the surgical treatment of patients who had adrenalectomy for phaeochromocytoma. DESIGN: Retrospective clinical study. SETTINGS: University hospital, Germany. SUBJECTS: 87 consecutive patients with phaeochromocytoma who were operated on. INTERVENTIONS: 29 flank and 58 transabdominal adrenalectomies between 1974 and 2000. RESULTS: The mean tumour diameter was 5 cm (range 2-13), and the mean weight 91 g (range 7-550). The postoperative hospital stay was 11 days. The flank incision entailed the shortest operating time (95 minutes). Two of the phaeochromocytomas were malignant. There were two wound infections but no deaths. With a correct selection of patients, a flank incision is safe. Endoscopic retroperitoneal adrenalectomies should be preferred.
