CHAPTER 19 Adrenalectomy


I. Aldosteronoma
A. Aldosteronomas are the most common functional adrenal tumor and the most common cause of primary hyperaldosteronism (see Table 19-1). Patients classically present with hypertension refractory to multiple medications and hypokalemia. Other symptoms include headaches, polyuria, nocturia, muscle weakness, and cramping.

B. The presence of a unilateral adrenal lesion with biochemical evidence of primary hyperaldosteronism (see Table 19-1) is an indication for adrenalectomy. When imaging shows either bilateral normal glands or bilateral adrenal nodules, adrenal vein sampling may be used to establish the laterality of the lesion. Patients with lateralizing venous sampling benefit from adrenalectomy. Laparoscopic adrenalectomy is the procedure of choice because these lesions are generally small and benign. In contrast, bilateral aldosterone hypersecretion is managed medically (typically with spironolactone).

III. Pheochromocytoma

C. The presence of an adrenal tumor with biochemical evidence of a pheochromocytoma (see Table 19-1) is an indication for adrenalectomy. Manipulation of a pheochromocytoma during surgery can result in the release of large amounts of catecholamines and hemodynamic instability. All patients should receive α- and β-antagonists and volume replacement before surgery. α-Blockade must be initiated before β-blockade because hypertensive crises can result from unopposed alpha stimulation.

May 26, 2018 | Posted by in GENERAL SURGERY | Comments Off on Adrenalectomy

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