SURGICAL MANAGEMENT OF BILATERAL PHEOCHROMOCYTOMA.

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Vol. 87 No. 1 (2009): Issue Jan 2009

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Hadj Omar El Malki
Clinique chirurgicale ''A'' de l'hôpital Ibn Sina Rabat-Maroc.
Amine Benkabbou
Clinique chirurgicale ''A'' de l'hôpital Ibn Sina Rabat-Maroc.
Saâd Lahmidani
Clinique chirurgicale ''A'' de l'hôpital Ibn Sina Rabat-Maroc.
Raouf Mohsine
Clinique chirurgicale ''A'' de l'hôpital Ibn Sina Rabat-Maroc.
Lahcen Ifrine
Clinique chirurgicale ''A'' de l'hôpital Ibn Sina Rabat-Maroc.
Abdelkader Belkouchi
Clinique chirurgicale ''A'' de l'hôpital Ibn Sina Rabat-Maroc.

Abstract

Aim : the aim of this retrospective study was to assess our experience in surgical management of bilateral pheochromocytoma (BP) and to report diagnosis  methods and therapeutic results of a series of 10 patients treated in “surgical clinique A” department.
Methods: from 1986 to 2005, we studied all cases of histological confirmed BP in their clinical, biochemical and radiological aspects. We analyzed all of therapeutic attitudes suggested and their results.
Results: Ten patients underwent adrenalectomy for BP: 6 men and 4 women with age average of 37,1 (13-60). Eight of them were synchronous BP versus two metachronous ones. Eight patients were symptomatic. One of them had a Von Hippel Lindeau syndrome and 2 others had a familial form of BP. For the two asymptomatic cases: the first one was an incidentaloma and the second one was discovered in a MEN IIb screening. As a primary biochemical diagnostic measure, the determination of the excretion rate of cathecholamine in the 24h urine was high among 6 patients. The ultrasonic imaging and CT scaning were done to localize the tumor site. The surgical treatment consisted in a bilateral adrenalectomy in one phase for 5 patients and in two phases for the 5 others (one
double laparoscopy). An enucleating of a pancreatic nodule was an associated act practiced on a patient. Perioperative incidents were related in heart rythme dysfonctions, crises of hypertension among 6 patients and a cardiac arrest rehabilitated. In postoperative phase we assess a death case of sepsis chock, an  acute adrenal insufficiency, an acute pancreatitis and a liver metastasis one year after the adrenalectomy. All patients were under hydrocortisone (30mg) for
life.
Conclusion: Bilateral adrenalectomy is the basic treatment of a BP. A familial screening must be systematically carried out. Laparoscopic adrenalectomy has good results.

Keywords:

Pheochromocytoma, familial, multiple endocrine neoplasias, laparoscopy

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References

  1. Mirallie E., Cariou B., Kraeber-Bodere F. Phéochromocytomes bilatéraux. Génétique et traitement. Ann Chir. 2005; 130:273-6.
  2. Amar L., Bertherat J., Baudin E., Ajzenberg C., Bressac-de Paillerets B., Chabre O., et al.: Genetic testing in pheochromocytoma or functional paraganglioma. J Clin Oncol. 2005; 23: 8812-8.
  3. Yip L., Lee JE., Shapiro SE., Waguespack SG., Sherman SI., Hoff AO., et al. Surgical management of hereditary pheochromocytoma. J Am Coll Surg. 2004; 198: 525-35.
  4. Elder EE., Elder G., Larsson C. Pheochromocytoma and functional paraganglioma syndrome: no longer the 10% tumor. J Surg Oncol. 2005; 89: 193-201.
  5. Proye C. Phéochromocytome. In : Chirurgie des glandes surrénales. Rapport présenté au 96ème Congrès Français de Chirurgie. Paris : Arnette 1994 : 89-114.
  6. Peix JL. Glandes surrénales. In: Endocrinologie Chirurgicale . Proye C.; Dubost C.;. McGraw-hill publishing company 1991, 157-191.
  7. Kimura N., Watanabe T., Noshiro T., Shizawa S., Miura Y. Histological grading of adrenal and extra-adrenal pheochromocytomas and relationship to prognosis: a clinicopathological analysis of 116 adrenal pheochromocytomas and 30 extra-adrenal sympathetic
  8. Peix JL. Incidentalomes. In : Chirurgie des glandes surrénales. Rapport présenté au 96ème Congrès Français de Chirurgie Paris: Arnette 1994: 115-129.
  9. Cook D.M., Loriaux D.L. The incidental adrenal mass. Am J Med. 1996, 101: 88-94.
  10. Proye C. Perspectives actuelles dans la chirurgie des polyendocrinopathies. Rev Franç Endocrinol Clin. 1998, 39: 5-22.
  11. Lee J.E., Curley S.A., Gagel R.F., Evans DB., Hickey RC. Corticalsparing adrenalectomy for patients with bilateral pheochromocytoma. Surgery 1996; 120: 1064-71.
  12. Neumann HP., Bender BU., Reincke M., Eggstein S., Laubenberger J., Kirste G. Adrenal-sparing surgery for phaeochromocytoma. Br J Surg 1999; 86: 94-7
  13. Guerrieri M., Baldarelli M., Scarpelli M., Santini S., Lezoche G.,Lezoche E. Laparoscopic adrenalectomy in pheochromocytomas. J Endocrinol Invest. 2005; 28: 523-7.
  14. Poulin EC, Schlachta CM, Burpee SE, Pace KT, Mamazza J. Laparoscopic adrenalectomy: pathologic features determine outcome. Can J Surg. 2003; 46: 340-4.