| Laparoscopic adrenalectomy for phaeochromocytoma: endocrinological and surgical aspects of a new therapeutic approach. | |
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MedLine Citation:
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PMID: 10341865 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: To evaluate the results of laparoscopic resection of phaeochromocytoma with a focus on pre- and intra-operative endocrinological and pharmacological aspects. DESIGN: Retrospective study based on review of case notes and intraoperative anaesthetic records. PATIENTS: Eight patients (four men, four women) aged 13 to 70 (median: 45) years with symptomatic phaeochromocytoma (two patients with MEN IIa syndrome) diagnosed 6-36 months before adrenalectomy in four patients and just before operation in the four remaining patients. All patients presented with hypertension. MEASUREMENTS: Pre- and postoperative blood pressure (BP) was assessed using a sphygmomanometer, intraoperative measurements being obtained by intra-arterial line. Adrenaline (A), noradrenaline (NA), metadrenaline (metA), normetadrenaline (normetA) and vanillylmandelic acid (VMA) were measured in 24-h urine samples. Adrenal imagery consisted in all patients of abdominal computed tomography and [131I] metaiodobenzylguanidine (MIBG) scintigraphy, and in 2 patients, adrenal magnetic resonance imaging and octreotide scintigraphy. Determination of plasma volume was performed by isotopic method. RESULTS: Median (range) preoperative systolic and diastolic BP was 140 (130-240) and 90 (80-150) mm Hg, respectively. Predominant catecholamine secretion consisted of A in four patients (A pattern) and of NA (NA pattern) in the other four. Tumours smaller than 30 mm usually secreted A while larger ones secreted NA. Pre- and intra-operative BP control was straightforward in all but two patients with preferential NA secretion. The median number of systolic and diastolic BP peaks were higher in patients with NA pattern (n = 6, range: 3-9) than in those with A pattern (n = 1.5, range: 1-6). Total duration of pneumoperitoneum ranged from 120 to 240 (median: 195) min. Intra- and post-operative complications included intra-abdominal bleeding, laparoscopically controlled (in one case), and upper pole kidney ischaemia in another. Postoperative hospital stay ranged from 4 to 11 days. All patients were asymptomatic postoperatively and pharmacologically controlled hypertension persisted in two of them. CONCLUSIONS: Laparoscopic adrenalectomy is a safe and efficient technique to remove phaeochromocytoma in terms of intra- and postoperative morbidity, with a low complication rate. Pre- and intra-operative pharmacological blood pressure control is as effective as in conventional adrenalectomy, with greater instability in noradrenaline secreting tumours. |
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Authors:
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V Col; L de Cannière; E Collard; L Michel; J Donckier |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Clinical endocrinology Volume: 50 ISSN: 0300-0664 ISO Abbreviation: Clin. Endocrinol. (Oxf) Publication Date: 1999 Jan |
Date Detail:
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Created Date: 1999-06-09 Completed Date: 1999-06-09 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0346653 Medline TA: Clin Endocrinol (Oxf) Country: ENGLAND |
Other Details:
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Languages: eng Pagination: 121-5 Citation Subset: IM |
Affiliation:
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Department of General Internal Medicine, University Hospital UCL of Mont-Godinne, Yvoir, Belgium. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adrenal Gland Neoplasms / blood, physiopathology, surgery* Adrenalectomy / methods* Adult Aged Blood Pressure Epinephrine / blood Female Humans Laparoscopy* Male Middle Aged Norepinephrine / blood Pheochromocytoma / blood, physiopathology, surgery* Retrospective Studies Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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51-41-2/Norepinephrine; 51-43-4/Epinephrine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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