Laparoscopic Adrenalectomy for Tumours | Pristyn Care

Risk Factors

Risk factors for adrenal tumours:

• Multiple endocrine neoplasia (MEN) syndromes
• Von Hippel-Lindau disease
• Neurofibromatosis type 1
• SDH gene mutations (hereditary phaeochromocytoma)
• Family history of adrenal neoplasia
• Previous malignancy with adrenal metastasis

Who Is at Risk

Individuals with hereditary syndromes (MEN2, VHL), family history of phaeochromocytoma, refractory hypertension, or incidentally found adrenal masses over 4 cm are at highest risk for adrenal tumours requiring surgery.

Diagnosis

Pre-operative evaluation includes:

• 24-hour urinary catecholamines and metanephrines
• Serum aldosterone-to-renin ratio (for Conn’s)
• Low-dose dexamethasone suppression test (for Cushing’s)
• CT adrenal protocol (Hounsfield units to characterise mass)
• Adrenal vein sampling for lateralisation of aldosterone excess
• MIBG scan or 68Ga-DOTATATE PET for phaeochromocytoma

Treatment: Laparoscopic Adrenalectomy

Pristyn Care performs laparoscopic transperitoneal or retroperitoneoscopic adrenalectomy. Phaeochromocytoma cases receive meticulous pre-operative alpha-blockade to prevent intraoperative hypertensive crisis.

Procedure

Surgical procedure involves:

• Pre-operative alpha-blockade for phaeochromocytoma (10-14 days of phenoxybenzamine or doxazosin)
• General anaesthesia with arterial line monitoring for phaeochromocytoma
• Laparoscopic transperitoneal or retroperitoneoscopic approach
• Early ligation of adrenal vein to prevent catecholamine surge
• Complete adrenal gland removal with intact capsule
• Haemostasis and drain placement if needed
• Specimen retrieval in endobag

After the Surgery

Post-operative care includes:

• Blood pressure monitoring and antihypertensive adjustment
• Hydrocortisone replacement if bilateral adrenalectomy or Cushing’s
• Serum electrolyte monitoring (potassium normalisation in Conn’s)
• Endocrinologist follow-up for hormonal reassessment
• Biochemical cure assessment at 3 months
• Annual surveillance imaging for adrenocortical carcinoma

Possible Complications of Adrenalectomy

Potential complications:

• Intraoperative hypertensive crisis (phaeochromocytoma)
• Adrenal insufficiency after bilateral adrenalectomy
• Bleeding from adrenal vein or adjacent vessels
• Injury to adjacent organs (kidney, spleen, liver)
• Wound infection or port-site hernia
• Recurrence if hereditary syndrome not addressed