eMedicine Specialties > Urology > Surgery

Adrenal Surgery: Follow-up

Author: Brian J Miles, MD, Medical Director, Chief of Urology Service, Director of Education, Associate Professor, Department of Urology, St Luke's Episcopal Hospital; Program Director, Baylor College of Medicine
Coauthor(s): Mohit Khera, MD, MBA, MPH, Assistant Professor of Urology, Scott Department of Urology, Baylor College of Medicine; Edward C Schatte, MD, Urologist, Adult and Pediatric Urology of Houston; John S Colen, MD, Resident Physician, Department of Urology, Baylor College of Medicine
Contributor Information and Disclosures

Updated: Aug 20, 2009

Outcome and Prognosis

  • Primary hyperaldosteronism: The surgical removal of the adrenal gland and adenoma provides excellent results, with most patients being cured.
  • Pheochromocytoma: Long-term cures are rare in cases of malignant pheochromocytomas. In cases of metastatic disease, 5-year survival rates as high as 36% have been reported.
  • Neuroblastoma: Surgery of neuroblastoma is an important element in diagnosis, staging, and treatment of children with neuroblastoma. Surgery is curative therapy for people with stage I and early stage II disease, with a reported 2-year survival rate of 89%. Reviews regarding safety reveal a low complication rate, most commonly less than 10%. Advanced-stage tumors usually require a combination of surgery, chemotherapy, and/or radiation therapy to provide a complete response.
  • Adrenocortical carcinoma: At presentation, 19% of patients had IVC involvement and 32% had metastases. The median time of survival was 17 months, and evaluation of factors affecting survival reveal benefit to the following characteristics: age younger than 54 years, absence of metastasis, and nonfunctional tumors.11 Another study at Memorial Sloan-Kettering reviewed 115 patients and revealed overall median survival to be 38 months, with a 5-year survival rate of 37%. Patients with stage I or II disease fared better, with a 5-year survival rate of 60%, while patients with stage III and IV disease had a 5-year survival rate of 10%.

Future and Controversies

Laparoscopic approach

Little debate exists in the literature that laparoscopic approaches decrease operative morbidity. The laparoscopic approach typically is used for smaller adrenal tumors. At many laparoscopic centers, the laparoscopic adrenalectomy has become the criterion standard. Multiple centers have attempted to emphasize a particular approach or laparoscopic method, and regardless of which approach is advocated, one point remains applicable across the board: cure rate and operative morbidity are similar for laparoscopic and open adrenalectomy (in small tumors). No method is for all patients, and, in general, selecting the approach based on patient and tumor characteristics and with consideration of surgeon approach familiarity yields the best results.

 


More on Adrenal Surgery

Overview: Adrenal Surgery
Workup: Adrenal Surgery
Treatment: Adrenal Surgery
Follow-up: Adrenal Surgery
References
[ CLOSE WINDOW ]

References

  1. Mayo CH. Paroxysmal hypertension with tumor of the retroperitoneal nerve. JAMA. 1927;89:1047.

  2. Crout JR, Pisano JJ, Sjoerdsma A. Urinary excretion of catecholamines and their metabolites in pheochromocytoma. Am Heart J. Mar 1961;61:375-81. [Medline].

  3. Nitschke R, Smith EI, Shochat S, et al. Localized neuroblastoma treated by surgery: a Pediatric Oncology Group Study. J Clin Oncol. Aug 1988;6(8):1271-9. [Medline].

  4. [Guideline] Grumbach MM, Biller BM, Braunstein GD, Campbell KK, Carney JA, Godley PA, et al. Management of the clinically inapparent adrenal mass ("incidentaloma"). Ann Intern Med. Mar 4 2003;138(5):424-9. [Medline].

  5. Wooten MD, King DK. Adrenal cortical carcinoma. Epidemiology and treatment with mitotane and a review of the literature. Cancer. Dec 1 1993;72(11):3145-55. [Medline].

  6. Walz MK, Peitgen K, Diesing D, et al. Partial versus total adrenalectomy by the posterior retroperitoneoscopic approach: early and long-term results of 325 consecutive procedures in primary adrenal neoplasias. World J Surg. Dec 2004;28(12):1323-9. [Medline].

  7. Janetschek G, Lhotta K, Gasser R, et al. Adrenal-sparing laparoscopic surgery for aldosterone-producing adenoma. J Endourol. Apr 1997;11(2):145-8. [Medline].

  8. Munver R, Del Pizzo JJ, Sosa RE. Adrenal-preserving minimally invasive surgery: the role of laparoscopic partial adrenalectomy, cryosurgery, and radiofrequency ablation of the adrenal gland. Curr Urol Rep. Feb 2003;4(1):87-92. [Medline].

  9. Schulsinger DA, Sosa RE, Perlmutter AP, Vaughan ED Jr. Acute and chronic interstitial cryotherapy of the adrenal as a treatment modality. World J Urol. Feb 1999;17(1):59-64. [Medline].

  10. Nakajo M, Hokotate H, Tsuchimochi S, et al. Non-surgical therapy of primary aldosteronism: transcatheter arterial infusion of ethanol into an aldosteronoma. Biomed Pharmacother. Jun 2000;54 Suppl 1:119s-132s. [Medline].

  11. Tritos NA, Cushing GW, Heatley G, Libertino JA. Clinical features and prognostic factors associated with adrenocortical carcinoma: Lahey Clinic Medical Center experience. Am Surg. Jan 2000;66(1):73-9. [Medline].

  12. Acosta E, Pantoja JP, Gamino R, Rull JA, Herrera MF. Laparoscopic versus open adrenalectomy in Cushing's syndrome and disease. Surgery. Dec 1999;126(6):1111-6. [Medline].

  13. Albala DM. Laparoscopic adrenalectomy. In: Marshall FF, ed. Textbook of Operative Urology. Philadelphia, Pa: WB Saunders Co; 1996:193.

  14. Bloom LS, Libertino JA. Surgical management of Cushing's syndrome. Urol Clin North Am. Aug 1989;16(3):547-65. [Medline].

  15. Blumenfeld JD, Sealey JE, Schlussel Y, et al. Diagnosis and treatment of primary hyperaldosteronism. Ann Intern Med. Dec 1 1994;121(11):877-85. [Medline].

  16. Brennan MF. Adrenocortical carcinoma. CA Cancer J Clin. Nov-Dec 1987;37(6):348-65. [Medline].

  17. Bukowski RM, Klein EA. Management of adrenal neoplasms. In: Vogelzang NJ, Scardino PT, Shipley WU, et al, eds. Comprehensive Textbook of Genitourinary Oncology. Baltimore, Md: Williams & Wilkins; 1996:125.

  18. Caplan RH, Strutt PJ, Wickus GG. Subclinical hormone secretion by incidentally discovered adrenal masses. Arch Surg. Mar 1994;129(3):291-6. [Medline].

  19. Cassady JR, Hutter JJ, Whitesell LJ. Neuroblastoma: Natural history and current therapy and approaches. In: Vogelzang NJ, Scardino PT, Shipley WU, et al, eds. Comprehensive Textbook of Genitourinary Oncology. Baltimore, Md: Williams & Wilkins; 1996:98.

  20. Cañete A, Jovani C, Lopez A, Costa E, Segarra V, Fernández JM, et al. Surgical treatment for neuroblastoma: complications during 15 years' experience. J Pediatr Surg. Oct 1998;33(10):1526-30. [Medline].

  21. Cerfolio RJ, Vaughan ED, Brennan TG, Hirvela ER. Accuracy of computed tomography in predicting adrenal tumor size. Surg Gynecol Obstet. Apr 1993;176(4):307-9. [Medline].

  22. Chan JE, Meneghetti AT, Meloche RM, Panton ON. Prospective comparison of early and late experience with laparoscopic adrenalectomy. Am J Surg. May 2006;191(5):682-6. [Medline].

  23. Conn JW. Primary aldosteronism. J Lab Clin Med. Apr 1955;45(4):661-4. [Medline].

  24. Conn JW, Cohen EL, Rovner DR. Landmark article Oct 19, 1964: Suppression of plasma renin activity in primary aldosteronism. Distinguishing primary from secondary aldosteronism in hypertensive disease. By Jerome W. Conn, Edwin L. Cohen and David R. Rovner. JAMA. Jan 25 1985;253(4):558-66. [Medline].

  25. Fassnacht M, Kenn W, Allolio B. Adrenal tumors: how to establish malignancy?. J Endocrinol Invest. Apr 2004;27(4):387-99. [Medline].

  26. Ganguly A. Primary aldosteronism. N Engl J Med. Dec 17 1998;339(25):1828-34. [Medline].

  27. Gockel I, Heintz A, Roth W, Junginger T. Adrenalectomy for bilateral and recurrent pheochromocytoma: increased intraoperative risk?. Am Surg. Mar 2006;72(3):232-7. [Medline].

  28. Godellas CV, Prinz RA. Surgical approach to adrenal neoplasms: laparoscopic versus open adrenalectomy. Surg Oncol Clin N Am. Oct 1998;7(4):807-17. [Medline].

  29. Hanssen WE, Kuhry E, Casseres YA, de Herder WW, Steyerberg EW, Bonjer HJ. Safety and efficacy of endoscopic retroperitoneal adrenalectomy. Br J Surg. Jun 2006;93(6):715-9. [Medline].

  30. Hough AJ, Hollifield JW, Page DL, Hartmann WH. Prognostic factors in adrenal cortical tumors. A mathematical analysis of clinical and morphologic data. Am J Clin Pathol. Sep 1979;72(3):390-9. [Medline].

  31. Imai T, Kikumori T, Ohiwa M, et al. A case-controlled study of laparoscopic compared with open lateral adrenalectomy. Am J Surg. Jul 1999;178(1):50-3; discussion 54. [Medline].

  32. Imperato-McGinley J, Gautier T, Ehlers K, et al. Reversibility of catecholamine-induced dilated cardiomyopathy in a child with a pheochromocytoma. N Engl J Med. Mar 26 1987;316(13):793-7. [Medline].

  33. Jossart GH, Burpee SE, Gagner M. Surgery of the adrenal glands. Endocrinol Metab Clin North Am. Mar 2000;29(1):57-68, viii. [Medline].

  34. Jovenich JJ. Anesthesia in adrenal surgery. Urol Clin North Am. Aug 1989;16(3):583-7. [Medline].

  35. Lumachi F, Ermani M, Basso SM, Armanini D, Iacobone M, Favia G. Long-term results of adrenalectomy in patients with aldosterone-producing adenomas: multivariate analysis of factors affecting unresolved hypertension and review of the literature. Am Surg. Oct 2005;71(10):864-9. [Medline].

  36. Luton JP, Cerdas S, Billaud L, et al. Clinical features of adrenocortical carcinoma, prognostic factors, and the effect of mitotane therapy. N Engl J Med. Apr 26 1990;322(17):1195-201. [Medline].

  37. Malone MJ, Libertino JA, Tsapatsaris NP, Woods BO. Preoperative and surgical management of pheochromocytoma. Urol Clin North Am. Aug 1989;16(3):567-82. [Medline].

  38. Manger WM, Gifford RW. Chap 102. In: Pheochromocytoma. Hypertension Pathophysiology Diagnosis and Management. 1990.

  39. Nakada T, Kubota Y, Sasagawa I, et al. Therapeutic outcome of primary aldosteronism: adrenalectomy versus enucleation of aldosterone-producing adenoma. J Urol. Jun 1995;153(6):1775-80. [Medline].

  40. Neri LM, Nance FC. Management of adrenal cysts. Am Surg. Feb 1999;65(2):151-63. [Medline].

  41. Newell-Price J, Grossman A. Diagnosis and management of Cushing's syndrome. Lancet. Jun 19 1999;353(9170):2087-8. [Medline].

  42. Novick AC, Straffon RA, Kaylor W, Bravo EL. Posterior transthoracic approach for adrenal surgery. J Urol. Feb 1989;141(2):254-6. [Medline].

  43. Orth DN. Cushing's syndrome. N Engl J Med. Mar 23 1995;332(12):791-803. [Medline].

  44. Perry RR, Keiser HR, Norton JA, et al. Surgical management of pheochromocytoma with the use of metyrosine. Ann Surg. Nov 1990;212(5):621-8. [Medline].

  45. Schulick RD, Brennan MF. Long-term survival after complete resection and repeat resection in patients with adrenocortical carcinoma. Ann Surg Oncol. Dec 1999;6(8):719-26. [Medline].

  46. Smith CD, Weber CJ, Amerson JR. Laparoscopic adrenalectomy: new gold standard. World J Surg. Apr 1999;23(4):389-96. [Medline].

  47. Steinsapir J, Carr AA, Prisant LM, Bransome ED Jr. Metyrosine and pheochromocytoma. Arch Intern Med. Apr 28 1997;157(8):901-6. [Medline].

  48. Tada K, Okuda Y, Yamashita K. Three cases of malignant pheochromocytoma treated with cyclophosphamide, vincristine, and dacarbazine combination chemotherapy and alpha-methyl-p-tyrosine to control hypercatecholaminemia. Horm Res. 1998;49(6):295-7. [Medline].

  49. Ulchaker JC, Goldfarb DA, Bravo EL, Novick AC. Successful outcomes in pheochromocytoma surgery in the modern era. J Urol. Mar 1999;161(3):764-7. [Medline].

  50. van Heerden JA, Sheps SG, Hamberger B, et al. Pheochromocytoma: current status and changing trends. Surgery. Apr 1982;91(4):367-73. [Medline].

  51. Vaughan ED Jr, Phillips H. Modified posterior approach for right adrenalectomy. Surg Gynecol Obstet. Nov 1987;165(5):453-5. [Medline].

  52. Walther MM, Keiser HR, Linehan WM. Pheochromocytoma: evaluation, diagnosis, and treatment. World J Urol. Feb 1999;17(1):35-9. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

adrenal surgery, adrenal gland surgery, suprarenal surgery, Conn syndrome, Conn's syndrome, hyperaldosteronism, Cushing syndrome, Cushing's syndrome, pheochromocytoma, neuroblastoma, adrenocortical carcinoma, benign adenoma, primary hyperaldosteronism, partial adrenalectomy, bilateral adrenal hyperplasia, tumors of the adrenal cortex, multiple endocrine neoplasia, von Hippel-Lindau disease, von Recklinghausen disease, von Recklinghausen's disease, adrenal carcinoma, adrenal gland lesions, laparoscopic adrenalectomy, total adrenalectomy, radical adrenalectomy, laparoscopic partial adrenal resection, laparoscopic partial adrenalectomy, bilateral adrenal hyperplasia, ablation of adrenal masses, metastatic adrenocortical carcinoma

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Brian J Miles, MD, Medical Director, Chief of Urology Service, Director of Education, Associate Professor, Department of Urology, St Luke's Episcopal Hospital; Program Director, Baylor College of Medicine
Brian J Miles, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Association of Military Surgeons of the US, Society of Urologic Oncology, and Texas Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Mohit Khera, MD, MBA, MPH, Assistant Professor of Urology, Scott Department of Urology, Baylor College of Medicine
Mohit Khera, MD, MBA, MPH is a member of the following medical societies: American Medical Association, American Urological Association, and Texas Medical Association
Disclosure: Auxilium Honoraria Speaking and teaching; Coloplast Honoraria Speaking and teaching; American Medical Systems Honoraria Speaking and teaching

Edward C Schatte, MD, Urologist, Adult and Pediatric Urology of Houston
Edward C Schatte, MD is a member of the following medical societies: American Urological Association
Disclosure: Pfizer Consulting fee Speaking and teaching; Astellas Consulting fee Speaking and teaching; Glaxo Smith Kline Consulting fee Speaking and teaching; novartis Consulting fee Speaking and teaching

John S Colen, MD, Resident Physician, Department of Urology, Baylor College of Medicine
John S Colen, MD is a member of the following medical societies: American Medical Association, American Medical Student Association/Foundation, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Bradley Fields Schwartz, DO, FACS, Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine
Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.