Book contents
- Frontmatter
- Contents
- Editor biographies
- List of contributors
- Preface
- Introduction
- Part I Medical management
- Part II Surgical procedures and their complications
- 42 Tracheostomy
- 43 Thyroidectomy
- 44 Parathyroidectomy
- 45 Lumpectomy and mastectomy
- 46 Gastric procedures (including laparoscopic antireflux, gastric bypass, and gastric banding)
- 47 Small bowel resection
- 48 Appendectomy
- 49 Colon resection
- 50 Abdominoperineal resection
- 51 Anal operations
- 52 Cholecystectomy
- 53 Common bile duct exploration
- 54 Major hepatic resection
- 55 Splenectomy
- 56 Pancreatoduodenal resection
- 57 Adrenal surgery
- 58 Lysis of adhesions
- 59 Ventral hernia repair
- 60 Inguinal hernia repair
- 61 Laparotomy in patients with human immunodeficiency virus infection
- 62 Abdominal trauma
- 63 Coronary artery bypass procedures
- 64 Cardiac rhythm management
- 65 Aortic valve surgery
- 66 Mitral valve surgery
- 67 Ventricular assist devices and cardiac transplantation
- 68 Pericardiectomy
- 69 Pulmonary lobectomy
- 70 Pneumonectomy
- 71 Hiatal hernia repair
- 72 Esophagogastrectomy
- 73 Colon interposition for esophageal bypass
- 74 Carotid endarterectomy
- 75 Abdominal aortic aneurysm repair
- 76 Aortobifemoral bypass grafting
- 77 Femoropopliteal bypass grafting
- 78 Lower extremity embolectomy
- 79 Treatment of chronic mesenteric ischemia
- 80 Inferior vena cava filters
- 81 Portal shunting procedures
- 82 Breast reconstruction after mastectomy
- 83 Facial rejuvenation
- 84 Liposuction
- 85 Repair of facial fractures
- 86 Flap coverage for pressure sores
- 87 Muscle flap coverage of sternal wound infections
- 88 Skin grafting for burns
- 89 Abdominal hysterectomy
- 90 Vaginal hysterectomy
- 91 Uterine curettage
- 92 Radical hysterectomy
- 93 Vulvectomy
- 94 Craniotomy for brain tumor
- 95 Intracranial aneurysm surgery
- 96 Evacuation of subdural hematomas
- 97 Stereotactic procedures
- 98 Transsphenoidal surgery
- 99 Treatment of herniated disk
- 100 General considerations in ophthalmic surgery
- 101 Cataract surgery
- 102 Corneal transplantation
- 103 Vitreoretinal surgery
- 104 Glaucoma surgery
- 105 Refractive surgery
- 106 Eye muscle surgery
- 107 Enucleation, evisceration and exenteration
- 108 Arthroscopic knee surgery
- 109 Total knee replacement
- 110 Total hip replacement
- 111 Fractures of the femoral shaft
- 112 Surgery for hip fractures
- 113 Lumbar spine surgery
- 114 Surgery for scoliosis or kyphosis in adults
- 115 Surgery of the foot and ankle
- 116 Lower extremity amputations
- 117 Surgical procedures for rheumatoid arthritis
- 118 Otologic surgery
- 119 Myringotomy and tubes
- 120 Tonsillectomy and adenoidectomy
- 121 Uvulopalatopharyngoplasty
- 122 Endoscopic sinus surgery
- 123 Cleft palate surgery
- 124 Facial surgery
- 125 Tracheotomy
- 126 Surgical management of head and neck cancer
- 127 Anterior cranial base surgery
- 128 Surgery for syndromic craniosynostosis
- 129 Nephrectomy
- 130 Cystectomy and urinary diversion
- 131 Radical prostatectomy
- 132 Transurethral resection of the prostate (TURP)
- 133 Interstitial laser thermal therapy for benign prostatic hyperplasia
- 134 Management of upper urinary tract calculi
- 135 Female urinary incontinence surgery
- Index
- References
57 - Adrenal surgery
Published online by Cambridge University Press: 12 January 2010
- Frontmatter
- Contents
- Editor biographies
- List of contributors
- Preface
- Introduction
- Part I Medical management
- Part II Surgical procedures and their complications
- 42 Tracheostomy
- 43 Thyroidectomy
- 44 Parathyroidectomy
- 45 Lumpectomy and mastectomy
- 46 Gastric procedures (including laparoscopic antireflux, gastric bypass, and gastric banding)
- 47 Small bowel resection
- 48 Appendectomy
- 49 Colon resection
- 50 Abdominoperineal resection
- 51 Anal operations
- 52 Cholecystectomy
- 53 Common bile duct exploration
- 54 Major hepatic resection
- 55 Splenectomy
- 56 Pancreatoduodenal resection
- 57 Adrenal surgery
- 58 Lysis of adhesions
- 59 Ventral hernia repair
- 60 Inguinal hernia repair
- 61 Laparotomy in patients with human immunodeficiency virus infection
- 62 Abdominal trauma
- 63 Coronary artery bypass procedures
- 64 Cardiac rhythm management
- 65 Aortic valve surgery
- 66 Mitral valve surgery
- 67 Ventricular assist devices and cardiac transplantation
- 68 Pericardiectomy
- 69 Pulmonary lobectomy
- 70 Pneumonectomy
- 71 Hiatal hernia repair
- 72 Esophagogastrectomy
- 73 Colon interposition for esophageal bypass
- 74 Carotid endarterectomy
- 75 Abdominal aortic aneurysm repair
- 76 Aortobifemoral bypass grafting
- 77 Femoropopliteal bypass grafting
- 78 Lower extremity embolectomy
- 79 Treatment of chronic mesenteric ischemia
- 80 Inferior vena cava filters
- 81 Portal shunting procedures
- 82 Breast reconstruction after mastectomy
- 83 Facial rejuvenation
- 84 Liposuction
- 85 Repair of facial fractures
- 86 Flap coverage for pressure sores
- 87 Muscle flap coverage of sternal wound infections
- 88 Skin grafting for burns
- 89 Abdominal hysterectomy
- 90 Vaginal hysterectomy
- 91 Uterine curettage
- 92 Radical hysterectomy
- 93 Vulvectomy
- 94 Craniotomy for brain tumor
- 95 Intracranial aneurysm surgery
- 96 Evacuation of subdural hematomas
- 97 Stereotactic procedures
- 98 Transsphenoidal surgery
- 99 Treatment of herniated disk
- 100 General considerations in ophthalmic surgery
- 101 Cataract surgery
- 102 Corneal transplantation
- 103 Vitreoretinal surgery
- 104 Glaucoma surgery
- 105 Refractive surgery
- 106 Eye muscle surgery
- 107 Enucleation, evisceration and exenteration
- 108 Arthroscopic knee surgery
- 109 Total knee replacement
- 110 Total hip replacement
- 111 Fractures of the femoral shaft
- 112 Surgery for hip fractures
- 113 Lumbar spine surgery
- 114 Surgery for scoliosis or kyphosis in adults
- 115 Surgery of the foot and ankle
- 116 Lower extremity amputations
- 117 Surgical procedures for rheumatoid arthritis
- 118 Otologic surgery
- 119 Myringotomy and tubes
- 120 Tonsillectomy and adenoidectomy
- 121 Uvulopalatopharyngoplasty
- 122 Endoscopic sinus surgery
- 123 Cleft palate surgery
- 124 Facial surgery
- 125 Tracheotomy
- 126 Surgical management of head and neck cancer
- 127 Anterior cranial base surgery
- 128 Surgery for syndromic craniosynostosis
- 129 Nephrectomy
- 130 Cystectomy and urinary diversion
- 131 Radical prostatectomy
- 132 Transurethral resection of the prostate (TURP)
- 133 Interstitial laser thermal therapy for benign prostatic hyperplasia
- 134 Management of upper urinary tract calculi
- 135 Female urinary incontinence surgery
- Index
- References
Summary
Adrenalectomy is performed to remove functional masses such as adrenocortical hyperplasia (Cushing's disease), cortisol-secreting adenoma or adenocarcinoma (Cushing's syndrome), aldosterone-secreting adenoma (Conn's syndrome), pheochromocytoma, and adrenal causes of feminizing or virilizing syndromes. Non-functional masses that are also treated with adrenalectomy include adrenal adenocarcinoma, symptomatic adrenal cysts or angiomyolipomas, adrenal incidentalomas >4 cm discovered on imaging studies, and isolated adrenal metastases.
With functioning tumors confirmed biochemically, a CT or MRI is performed to determine the side of the neoplasm as well as its size, local invasion, and hepatic metastases. A 131I-MIBG scan is also performed in patients with a diagnosis of pheochromocytoma to localize occult second tumors or metastatic disease to the liver, lung, or bone. Selective venous sampling from the adrenal veins and inferior vena cava is useful to confirm the diagnosis of an aldosterone-secreting adenoma verses bilateral adrenal micronodular hyperplasia of the zona glomerulosa.
Preoperative alpha and, occasionally, beta blockade is necessary before all adrenalectomies performed for pheochromocytomas. Preoperative administration of spironolactone may help reverse persistent hypokalemia in patients with aldosterone-secreting adenomas. Perioperative glucocorticoid supplementation is used in patients undergoing adrenalectomies for Cushing's disease or syndrome.
A laparoscopic approach with or without hand-assist under general anesthesia is used when non-malignant adrenal lesions under 10–12 cm are to be excised. An open anterior transabdominal, flank extraperitoneal, or posterior (with resection of the 12th rib) retroperitoneal approach under general anesthesia is used when adrenal adenocarcinoma, a mass >10–12 cm, extensive adhesions, or portal hypertension is present.
- Type
- Chapter
- Information
- Medical Management of the Surgical PatientA Textbook of Perioperative Medicine, pp. 555 - 556Publisher: Cambridge University PressPrint publication year: 2006