Diagnosis: how to diagnose adrenal disease?
The diagnosis is based on clinical findings, on laboratory tests and imaging studies (MRI, CT scan, nuclear medicine investigations such as scintigraphy or PET). It is essential to establish cooperation between various specialists, including endocrinologists, radiologists, nuclear physicians, geneticists, and surgeons.
How we treat adrenal disease?
The nodular adrenal disease with surgical indication can be treated in most cases with an intervention of laparoscopic adrenalectomy: unilateral (adenomas, incidentalomas functioning adrenal lesions, pheochromocytoma) or bilateral (nodular adrenal hyperplasia, Cushing's disease relapsed after pituitary surgery). The traditional open surgery or, in very selected cases, freezing (cryoablation) of adrenal lesions are less frequent therapeutic strategies.
During the intervention of laparoscopic adrenalectomy the patient is subjected to general anesthesia and positioned on their side after appropriate pharmacological preparation. In case of pheochromocytoma, the patient is prepared for intervention with α-blockers (doxazosin, phenoxybenzamine) to get a close hand pressure. Other medications may be needed in particular conditions (e.g. Β-blockers, calcium channel blockers).
In case of primary aldosteronism, the pressure control is achieved with the administration of an aldosterone antagonist, possibly associated with potassium integration in the event of hypokalemia.
Prior to surgery a bladder catheter is placed when the patient is asleep. Typically, 4 to 5 small incisions are used to introduce laparoscopic instruments. The surgery can be performed with a transperitoneal or retroperitoneal access based on a careful preoperative evaluation. In selected cases, one may resort to partial removal of the adrenal gland. The average duration of adrenalectomy surgery is approximately 2 hours.
At the end of the surgery, a drain is placed and left to be removed 2-3 days after surgery. The postoperative average hospital stay is 3-4 days. The patient is able to walk, feed on the first postoperative day and eventual replacement therapy may be administered.
After the removal of an adenoma secreting cortisol, the patient develops a hypoadrenalism consequent to temporary failure of the adrenal gland, which may also require months to reactivate. During this period the patient should take cortisone therapy.
How will I be followed after laparoscopic adrenalectomy?
The follow-up care after surgery of nodular adrenocortical disease is divided basically into two categories, based on histological examination.
In case of benign disease (e.g. Adrenal adenoma), based on the performance of laboratory tests and abdominal ultrasound, follow up is to be performed usually at one and three months after surgery. Followed by outpatient visits, endocrinological control, in the absence of particular problems, can continue deferred over time.
Our facility has laparoscopic adrenalectomy as an established technique since 1992 (first in Europe) with about 400 cases treated. This series has often been the subject of numerous publications and presentations at major national and international urological conferences.