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Complications after bilateral adrenalectomy for phaeochromocytoma in multiple endocrine neoplasia type 2--a plea to
J S de Graaf1, R P Dullaart, R P Zwierstra
1Department of Surgery, University Hospital, Groningen, The Netherlands.
Objective:
To evaluate the complications of the adrenocortical supplementation that is needed after bilateral adrenalectomy for phaeochromocytoma in patients with multiple endocrine neoplasia (MEN) type 2 syndrome.
Design:
Retrospective study.
Setting:
University hospital, The Netherlands.
Materials:
28 patients with MEN 2 who underwent total adrenalectomy for phaeochromocytoma between 1972 and 1996.
Main Outcome Measures:
Perioperative morbidity and mortality, histopathological findings, complications of adrenocortical supplementation therapy.
Results:
22 patients had bilateral phaeochromocytomas on histopathological examination (79%) and 6 patients had initially unilateral phaeochromocytomas There was no operative mortality or substantial morbidity except for one splenic injury that necessitated splenectomy. During a mean follow-up period of 14 years (range 1-26) nine patients (32%) had a total of 19 Addisonian crises that necessitated admission to hospital. One patient died of an unrecognised Addisonian crisis.
Conclusion:
Complications of adrenocortical supplementation therapy are considerable, but they can be reduced when unilateral adrenalectomy is done for a unilateral phaeochromocytoma in patients with MEN 2 syndrome, provided that they are carefully followed up.