Synchronized Laparoscopic Bilateral Adrenalectomy for Pheochromocytoma in Multiple Endocrine Neoplasia Syndrome: A Case Report
Main Article Content
Keywords
adrenalectomy, case report, laparoscopic, pheochromocytoma
Abstract
Pheochromocytomas are tumors producing catecholamines that arise from chromaffin cells in the adrenal medulla. They are usually benign in multiple endocrine neoplasia type 2 (MEN2) syndrome, but they tend to present bilaterally in 50–80% of the patients. Few researchers have reported success with simultaneous laparoscopic bilateral adrenalectomy. Hence, we report a 48-year-old woman who presented with a panic attack, headache, and abdominal discomfort that had started 10 years ago. The computed tomography (CT) scan showed a large bilateral cystic lesion in both adrenal glands in favor of pheochromocytomas (30 × 22 mm and 18 × 15 mm on the right side and 40 × 33 mm and 35 × 28 mm on the left side). The patient underwent bilateral laparoscopic adrenalectomy without intraoperative or postoperative complications. The total blood loss was 50 cc, and the operative time was 4 h. The histopathology of the specimen revealed pheochromocytomas of adrenal masses. In conclusion, our case demonstrates that synchronized laparoscopic bilateral adrenalectomy can be a safe and feasible treatment option for pheochromocytomas in MEN2 patients.
References
2. Machens A, Brauckhoff M, Holzhausen HJ, Thanh PN, Lehnert H, Dralle H. Codon-specific development of pheochromocytoma in multiple endocrine neoplasia type 2. J Clin Endocrinol Metab. 2005;90(7):3999–4003. 10.1210/jc.2005-0064
3. Yadav K, Bakshi G, Prakash G, Tamhankar A, Verma K. Simultaneous bilateral laparoscopic adrenalectomy for pheochromocytoma in multiple endocrine neoplasia (MEN) syndrome: Case report with review literature. Int J Surg Case Rep. 2014;5(8):487–90. 10.1016/j.ijscr.2014.03.007
4. Shen WT, Grogan R, Vriens M, Clark OH, Duh QY. One hundred two patients with pheochromocytoma treated at a single institution since the introduction of laparoscopic adrenalectomy. Arch Surg. 2010;145(9):893–7. 10.1001/archsurg.2010.159
5. Iusco D, Sarli L, Di Mauro D, Violi V, Roncoroni L. Endoscopic treatment of bilateral pheochromocytoma in MEN 2A syndrome: Case report and review of the literature. G Chir. 2007;28(10):363–6.
6. Martins D, Rodrigues D, Melo M, Carrilho F. Laparoscopic adrenalectomy as an effective approach to massive bilateral pheochromocytomas. BMJ Case Rep. 2017;2017:bcr2017221009. 10.1136/bcr-2017-221009
7. Ilias I, Pacak K. Current approaches and recommended algorithm for the diagnostic localization of pheochromocytoma. J Clin Endocrinol Metab. 2004;89(2):479–91. 10.1210/jc.2003-031091
8. Čtvrtlík F, Koranda P, Schovánek J, Škarda J, Hartmann I, Tüdös Z. Current diagnostic imaging of pheochromocytomas and implications for therapeutic strategy. Exp Ther Med. 2018;15(4):3151–60. 10.3892/etm.2018.5871
9. Ungureanu S, Şipitco N, Alexa Z, Gonţa V, Bujac M, Parnov M, et al. MEN 2A syndrome–Multiple endocrine neoplasia with autosomal dominant transmission. Int J Surg Case Rep. 2020;73:141–5. 10.1016/j.ijscr.2020.07.015
10. Rodriguez JM, Balsalobre M, Ponce JL, Ríos A, Torregrosa NM, Tebar J, et al. Pheochromocytoma in MEN 2A syndrome. Study of 54 patients. World J Surg. 2008;32(11):2520–6. 10.1007/s00268-008-9734-2
11. Kozłowski T, Choromanska B, Wojskowicz P, Astapczyk K, Łukaszewicz J, Rutkowski D, et al. Laparoscopic adrenalectomy: Lateral transperitoneal versus posterior retroperitoneal approach–Prospective randomized trial. Wideochir Inne Tech Maloinwazyjne. 2019;14(2):160–9. 10.5114/wiitm.2019.84694
12. Liao CH, Chung SD, Lai MK, Yu HJ, Chueh SC. Laparoscopic simultaneous bilateral partial and total adrenalectomy: A longer follow-up. BJU Int. 2009;104(9):1269–73. 10.1111/j.1464-410X.2009.08523.x
13. Meng C, Du C, Peng L, Li J, Li J, Li Y, et al. Comparison of posterior retroperitoneoscopic adrenalectomy versus lateral transperitoneal laparoscopic adrenalectomy for adrenal tumors: A systematic review and meta-analysis. Front Oncol. 2021;11:667985. 10.3389/fonc.2021.667985
14. Chai YJ, Yu HW, Song RY, Kim SJ, Choi JY, Lee KE. Lateral transperitoneal adrenalectomy versus posterior retroperitoneoscopic adrenalectomy for benign adrenal gland disease: Randomized controlled trial at a single tertiary medical center. Ann Surg. 2019;269(5):842–8. 10.1097/sla.0000000000002603
15. Conzo G, Tartaglia E, Gambardella C, Esposito D, Sciascia V, Mauriello C, et al. Minimally invasive approach for adrenal lesions: Systematic review of laparoscopic versus retroperitoneoscopic adrenalectomy and assessment of risk factors for complications. Int J Surg. 2016;28(Suppl 1):S118–23. 10.1016/j.ijsu.2015.12.042