Two-stage bilateral laparoscopic adrenalectomy for large pheochromocytomas

Area of Science:

• Endocrinology
• Surgical Oncology
• Urology

Background:

• Bilateral adrenal tumors can cause severe, life-threatening hypertension due to excess catecholamine production.
• Pheochromocytomas, tumors of the adrenal medulla, require careful diagnosis and management.
• Hypertension exceeding 240/100 mm Hg with significant tachycardia necessitates prompt intervention.

Observation:

• A 66-year-old female presented with bilateral adrenal tumors, diagnosed as large pheochromocytomas (right: 130/116/93 mm, left: 85/61/53 mm).
• The patient exhibited severe hypertension and elevated blood adrenaline levels (10-fold increase).
• Imaging confirmed non-invasive tumors, precluding metastatic spread.

Findings:

• A two-stage laparoscopic transperitoneal adrenalectomy was performed, successfully removing both right (13x12x9.5 cm) and left (8.5x8x6 cm) pheochromocytomas.
• Histological examination confirmed radical extirpation with no signs of malignancy, though potential for malignant transformation was noted.
• Postoperative management led to stable remission of severe hypertension.

Implications:

• Laparoscopic transperitoneal adrenalectomy is a safe and effective treatment for large pheochromocytomas, including those with potential malignant characteristics.
• This minimally invasive approach offers a viable solution for managing complex adrenal tumors causing significant endocrine disruption.
• Successful surgical management can lead to long-term remission of severe hypertension associated with pheochromocytomas.