The Role of Adrenal Cortex-Sparing Surgery for Bilateral Masses in Three Cases

Abstract

Pheochromocytoma are the functional adrenal lesions originating from the chromaffin cells. For the cases of pheochromocytoma observed in multiple endocrine neoplasia Type 2 and Von Hippel syndrome, the bilateral adrenal glands are involved. In classical approach, total adrenalectomy is applicable on such masses while adrenal failure is almost inevitable. Lifelong cortisol and fludrocortisones replacement are necessary for the patients with adrenal failure while the rate of morbidity and mortality has significantly increased. With the introduction of the minimal invasive surgical approach, cortex sparing adrenalectomy has been brought forward for the adrenal tumors. The primary objective of the cortex sparing surgery is to prevent the lifelong replacement and the permanent adrenal failure after adrenalectomy. Therefore, it is particularly preferred in the case of genetic pheochromocytoma with bilateral adrenal involvement. However, in the case of the selected cases, it can also be applicable for adenoma producing aldostrerone and Cushing syndrome. The adrenal tumor will be completely removed and if sufficient tissue is reserved in the manner to preserve the cortex function, no long-term recurrence and adrenal failure is to be developed. Therefore, cortex-sparing surgery may be a good alternative to total adrenalectomy for the patients with small benign functional adrenal tumors or bilateral genetic pheochromocytoma.