Adrenalectomy




Indications



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General Indications




  • Clinically or biochemically apparent adrenal hormonal hyperfunction.
  • Possible or certain malignant adrenal mass.
  • Adrenal mass of uncertain significance.




Specific Conditions and Disease States




  • Primary hyperaldosteronism.

    • Unilateral cortical adenoma causing Conn’s syndrome.
    • Bilateral hyperplasia with unilateral dominance (established by adrenal vein sampling).

  • Hypercortisolism.

    • Unilateral cortical adenoma.
    • Refractory Cushing’s syndrome (from Cushing’s disease, primary adrenal hyperplasia, or ectopic adrenocorticotropic hormone [ACTH] syndrome).

  • Pheochromocytoma.
  • Unilateral cortical adenoma causing virilization.
  • Myelolipoma (in selected situations).
  • Adrenal cyst (if refractory or symptomatic).
  • Adrenocortical carcinoma.
  • Incidentaloma with indeterminate or concerning imaging characteristics.
  • Adrenal metastases of other primary cancers (in selected situations).




Contraindications



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Laparoscopic Adrenalectomy



Absolute




  • Adrenocortical carcinoma (certain or likely).
  • Refractory coagulopathy.
  • Comorbidities precluding safe general anesthesia.



Relative




  • Previous ipsilateral partial adrenal resection.
  • Previous extensive upper abdominal or retroperitoneal surgery.
  • Very large adrenal tumors (> 6–8 cm).
  • Suboptimal medical preparation for pheochromocytoma resection.


Jan 8, 2019 | Posted by in UROLOGY | Comments Off on Adrenalectomy
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