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Bilateral Adrenalectomy

Total Adrenalectomy


Presentation

  • We present the anesthetic management of a patient who was diagnosed with bilateral neuroendocrine tumors soon after heart-lung transplantation and underwent successful staged bilateral adrenalectomy.[ncbi.nlm.nih.gov]
  • Presenting M scores and source of adrenocorticotropic hormone excess (ectopic versus pituitary) were similar. Both groups improved metabolically after treatment. Over one-third of AEs in the SI BA group occurred within 12 months of presentation.[ncbi.nlm.nih.gov]
  • The first patient, a ten-year-old with XX genotype, reared as a male, presented with resistant hypokalaemia and hypertension. The second patient, a 23-year-old with XY genotype, presented with bilateral adrenal masses and resistant hypertension.[ncbi.nlm.nih.gov]
  • Abstract We present a 7-year-old girl with a 2-year history of decelerated growth rate and cushingoidal obesity, upon admission presenting with fixed hypertension.[ncbi.nlm.nih.gov]
  • Elevated serum ACTH ( 200 ng/mL) was present during followup in 33% (13 of 40). A QOL survey demonstrated 86% of patients felt good to excellent compared with 1 year pre-BA.[ncbi.nlm.nih.gov]
Ankle Edema
  • Improvements of hypertension, body weight, Cushingoid appearance, impaired muscle strength, and ankle edema were achieved in 87, 90, 65, 61, and 78% of the patients, respectively.[ncbi.nlm.nih.gov]
Galactorrhea
  • When she was 23, symptoms and signs of acromegaly and subsequently galactorrhea-amenorrhea had developed. Plasma GH and PRL were increased and she was followed up by the administration of bromocriptine (2.5 mg-12.5 mg/day, p.o.).[ncbi.nlm.nih.gov]
Hypotension
  • After hypotensive pretreatment, a left adrenalectomy was performed, resulting in normalization of corticoadrenal function, blood pressure, Cushing features and growth rate. Histopathology confirmed PPNAD.[ncbi.nlm.nih.gov]
  • Post-operative concerns included acute adrenal insufficiency, hypoglycaemia, hypotension and hyperkalemia, which were successfully managed in ICU. Patient was then given oral corticosteroids.[ijaweb.org]
Neck Swelling
  • RESULTS: A 59-year-old man presented with nasal congestion and neck swelling and was noted to have hypokalemia, hypertension, and hyperglycemia. A nasal biopsy demonstrated a poorly differentiated carcinoma with neuroendocrine features.[ncbi.nlm.nih.gov]
Cranial Neuropathy
  • Two patients developed new pituitary dysfunction and no patient developed cranial neuropathy or visual deficit after GK SRS.[ncbi.nlm.nih.gov]
Secondary Amenorrhea
  • A 21-year-old woman was referred to Hamamatsu University School of Medicine University Hospital complaining of a deepening voice, hirsutism and secondary amenorrhea.[ncbi.nlm.nih.gov]

Workup

  • Tumor marker CA-125 was elevated and additional ovarian cancer staging workup confirmed stage IIIC due to one lymph node positive for carcinoma.[ncbi.nlm.nih.gov]
  • Preoperative workup revealed hypokalemia, anaemia, hypertension and hyperglycemia. She was posted for laparoscopic bilateral adrenalectomy.[ijaweb.org]
  • The aim of the present study is to present the case of an asymptomatic epidermoid splenic cyst associated with a continuous increase of CA 19-9 and to describe the applied clinical workup and surgical management by laparoscopic total splenectomy.[ncbi.nlm.nih.gov]
Liver Biopsy
  • One patient underwent a simultaneous wedge liver biopsy for a right lobar lesion. There were no complications. Each patient resumed a regular diet on the first postoperative day.[ncbi.nlm.nih.gov]

Treatment

  • Abstract Up to one-third of subjects who have had bilateral adrenalectomy for treatment of Cushing's disease will develop Nelson's syndrome.[ncbi.nlm.nih.gov]
  • Treatment with dexamethasone 0.5 mg nocte resulted in suppression of androgens in the daytime, but not in the evening, particularly androstenedione.[ncbi.nlm.nih.gov]
  • Selected patients with solitary metastases from non-small cell lung cancer can benefit from an aggressive treatment approach that includes resection of the metastases.[ncbi.nlm.nih.gov]
  • In this article, the authors review the role of BLA in the treatment of refractory CD.[ncbi.nlm.nih.gov]
  • CONTEXT: Bilateral adrenalectomy has been recently proposed as a surgical treatment option for patients with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency.[ncbi.nlm.nih.gov]

Prognosis

  • Metastatic non-small-cell lung cancer is a common condition with a dismal prognosis. Although palliative chemotherapy improves survival and quality of life, nearly all patients die of progressive disease.[ncbi.nlm.nih.gov]
  • In ectopic Cushing's syndrome, long-term mortality is high but is mostly dependent on the prognosis of the underlying malignant neuroendocrine tumour.[ncbi.nlm.nih.gov]
  • Prognosis after Bilateral Adrenalectomy: The prognosis for a positive end result following bilateral adrenalectomy is good. Recovery from Bilateral Adrenalectomy: The total recovery time for bilateral adrenalectomy is three to six weeks.[orangecountysurgeons.org]
  • Prognosis Prognosis after treatment is good but quality of life may be affected due to the long-term effects of hypercortisolemia. Without treatment the disease is life-threatening as in the case of manifest hypercortisolism.[orpha.net]
  • Because long-term prognosis associated with this surgical technique remains controversial, strategies for treating AIMAH must be carefully considered on a case-by-case basis.[jmedicalcasereports.biomedcentral.com]

Etiology

  • The patient records were analyzed to obtain patient demographics, disease etiology, surgical approach, operating room information, postoperative complications (30 days), hospital length of stay (LOS), and follow-up information.[ncbi.nlm.nih.gov]
  • Etiology The exact etiology is unknown but the adrenal overgrowth seen in AIMAH may be due to the expression of aberrant membrane receptors found in the adrenal cortex that regulate cortisol secretion and which are stimulated by gastric inhibitory polypeptide[orpha.net]
  • Some authors suggested that CS should be included in the differential diagnoses of certain high-risk patient populations, including patients who present with diabetes mellitus, hypertension, and early-onset osteoporosis. 85 Quality of Life CS of any etiology[endocrinefacts.org]

Epidemiology

  • Summary Epidemiology Prevalence of endogenous CS is estimated at 1/26,000 and AIMAH represents less than 1% of the cases.[orpha.net]
  • In patients with a benign adrenal adenoma, SMR 1.90. * Graversen et al. 2012 64 Spain, N 49, 1975-1992 Epidemiological study Overall, SMR 3.8.[endocrinefacts.org]
Sex distribution
Age distribution

Prevention

  • Laparoscopic bilateral adrenalectomy was offered to both patients to prevent accumulation of adrenal steroid precursors; this would likely restore regular 4-week menstrual cycles, decrease virilization, and decrease dosage of replacement therapy.[pediatrics.aappublications.org]
  • The exclusion of a pheochromocytoma is crucial, since this tumor must be treated with alpha blockers before surgery to prevent a hypertensive crisis.[urology-textbook.com]
  • Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest. 2008; 133 (6 Suppl):381S–453S. [ PubMed ] [ Google Scholar ] 38.[ncbi.nlm.nih.gov]
  • Laparoscopic adrenalectomy is less invasive than open surgery for treating AIMAH and may prevent a number of post-operative complications due to impaired glucose tolerance and immunodeficiency.[jmedicalcasereports.biomedcentral.com]

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