Perioperative Management of Endocrine Active Adrenal Tumors

Florentine Schreiner; Gurpreet Anand; Felix Beuschlein

doi:10.1055/a-0654-5251

Experimental and Clinical Endocrinology & Diabetes, Table of Contents

Exp Clin Endocrinol Diabetes 2019; 127(02/03): 137-146
DOI: 10.1055/a-0654-5251

Review

Perioperative Management of Endocrine Active Adrenal Tumors

Florentine Schreiner^*

¹Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitätsspital Zürich, Zürich, Switzerland

,

Gurpreet Anand^*

¹Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitätsspital Zürich, Zürich, Switzerland

,

Felix Beuschlein

¹Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitätsspital Zürich, Zürich, Switzerland

²Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany

› Author Affiliations

Abstract

Endocrine active adrenal tumors are associated with a relevant risk of complications during surgery, either due to direct hemodynamic effects of the hormone excess or due to hormone related comorbidities. Over the last decades, careful preoperative evaluation and improved peri-interventional medical management of affected patients has resulted in a significant reduction of perioperative complications. In addition, improvement in anesthesia and surgical techniques with the feasibility of laparoscopic adrenalectomy have contributed to reduce morbidity. Nevertheless, there are still several challenges to be considered in the perioperative care of these patients. Due to the rarity of functionally active adrenal tumors, there are no prospective data available to guide clinical management. Accordingly, most recommendations are based on retrospective data analysis, expert opinion or carry weak evidence based on small series or case reports. The aim of this review is to summarize the current knowledge and to suggest practical approaches to reduce perioperative complications in endocrine active adrenal tumors. This review exclusively deals with data from adult patients with functionally active adrenal tumors.

Key words

pheochromocytoma - paraganglioma - primary aldosteronism - Cushing’s syndrome - surgery - laparoscopy - perioperative management

Full Text

References

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