Bilateral Laparoscopic Partial Adrenalectomy: A Case Presentation and Review of the Literature

Abstract

Laparoscopic adrenalectomy is the standard of care for benign adrenal diseases. Partial adrenalectomy has been performed for various tumors to preserve adrenal function while avoiding steroid supplements postoperatively. This article discusses a patient that underwent bilateral laparoscopic partial adrenalectomies for bilateral pheochromocytomas and reviews the literature on partial adrenalectomy. A 40-year-old woman with a recent diagnosis of hypertension and an emergent Caesarian section for pre-eclampsia presented to an outside clinic with labile blood pressure, diaphoresis, palpitations, and headache. Physical examination was unremarkable with no bruits appreciated in the neck or abdomen. Medical management of her hypertension was initiated with minimal response. Ultimately, a 24-h urine demonstrated elevated urinary metanephrine and normetanephrine levels consistent with a pheochromocytoma. An abdomen and pelvis computed tomogram revealed bilateral, discrete, solid adrenal masses measuring 3.9 3.3 cm and 2.3 2.7 cm on the left and right, respectively. Selective adrenal venous sampling confirmed bilateral biochemically active pheochromocytomas. Bilateral laparoscopic partial adrenalectomies were performed using laparoscopic staplers to divide the tumor from the normal gland. Both adrenal veins were preserved. Glucocorticoid function was monitored by serial cortisol measurements and glucocorticoid supplementation was initiated on postoperative day one with a 4-week taper. At 1-year follow-up, she remains asymptomatic with a normal blood pressure, cortisol levels, and urine catecholamines. Laparoscopic partial adrenalectomies for bilateral pheochromocytomas are safe and effective. Partial resections preserve adrenal function while eradicating long-term steroid requirements.




J Med Cases. 2014;5(4):212-216
doi: https://doi.org/10.14740/jmc1708w