appropriate management of adrenal Cancer Adrenocortical carcinoma (ACC) is a rare (1–2 per million) and aggressive cancer with a poor prognosis. At the time of diagnosis, approximately 25% of patients have nodal involvement, and 20% have distant metastases. Roughly 60% of ACCs are functioning tumors, and the mean size of tumors at the time of …
Long term success of adrenalectomy for functional tumors Patients with an APA can expect a ≈ 100% cure of hypokalemia, and > 90% will show significant improvement in hypertension after adrenalectomy. Approximately 30% to 60% can completely stop antihypertensive therapy. Factors that predict a favorable outcome include young age (< 40 years), shorter duration of …
Appropriate perioperative management of a cortisol producing adrenal adenoma Diabetes and hypertension should be adequately treated prior to surgery. Patients with Cushing’s syndrome have an increased relative risk for thromboembolic complications; therefore, measures to prevent venous thromboembolism (VTE) should be implemented. Intraoperative replacement of glucocorticoids is controversial for patients with Cushing’s syndrome. However, patients with …
Perioperative management of a cortisol producing adrenal adenoma Read More »
Cortical sparing adrenalectomy, and when is it indicated? Patients with pheochromocytomas associated with a familial syndrome are at increased risk of developing bilateral and/or recurrent pheochromocytomas. These patients may be treated with cortical-sparing (partial) adrenalectomy in an effort to prevent adrenal insufficiency should another pheochromocytoma arise requiring additional adrenalectomy. This approach balances the benefit of …
appropriate perioperative management of pheochromocytomas Surgical resection is the only chance for cure for patients with pheochromocytomas. All patients with the biochemical diagnosis of a pheochromocytoma should undergo preoperative alpha-adrenergic blockade for 7 to 14 days to prevent unstable intraoperative blood pressure. Phenoxybenzamine is a nonselective long-acting alpha-adrenergic blocker; the starting dose is 10 mg …
Aldosterone resolution score (ARS) The ARS accurately identifies individuals at low (ARS ≦ 1) or high (ARS ≦ 4) likelihood of complete resolution of hypertension without further need for lifelong antihypertensive medications after adrenalectomy for aldosteronoma. Points Predictor Present Absent No. of antihypertensive medications ≦ 2 2 0 Body mass index ≦ 25 1 0 …
Adrenal vein sampling ratios for localization Both aldosterone and cortisol are measured in all AVS samples to determine the cortisol-corrected aldosterone values. The criteria used to determine lateralization of aldosterone hypersecretion depend on whether the AVS is done under cosyntropin administration. With cosyntropin administration, a cortisol-corrected aldosterone ratio from high-side to low-side of > 4:1 …