Spare Adrenal Gland Tissue During Pheochromocytoma Surgery: Study

By Gabriel Miller

May 12, 2014

NEW YORK (Reuters Health) - Surgery that spares as much of the adrenal gland as possible should be the treatment of choice for patients with pheochromocytoma, a new paper suggests.

"Adrenal-sparing surgery, a highly successful treatment option in experienced centers, should be the surgical approach of choice," according to Dr. Frederic Castinetti of Aix-Marseille University in Marseille, France and colleagues.

Pheochromocytoma originates in the inner section of the adrenal gland, known as the medulla. All of the tumors in the study were the result of multiple endocrine neoplasia type 2, an inherited autosomal dominant syndrome that can lead to a number of different tumors in the endocrine glands.

Pheochromocytoma may be symptomatic but is almost always benign. In about two-thirds of cases, both sides of the adrenal are involved.

When tissue is spared in order to maintain adrenal function, there is a possibility of recurrence. But after bilateral adrenalectomy, patients may suffer from Addison's disease-like symptoms.

There is controversy over which is best: a total, bilateral adrenalectomy for preventing recurrence in not yet affected glands, or an organ-sparing operation that leaves the risk of recurrence, said Dr. Reza Asari of the Medical University of Vienna, who has studied the issue.

Dr. Asari, who corresponded with Reuters Health by email, was not involved in the study.

The study included 563 patients with multiple endocrine neoplasia type 2 and pheochromocytoma. Patients were part of a database compiled by 30 academic medical centers in Europe, the Americas, and Asia from 1968 to 2013.

Overall, 79% had either unilateral or bilateral adrenalectomy. The remaining 21% underwent an organ-sparing operation.

In the patients who had tissue-sparing surgery, 4% had recurrence and 43% became steroid-dependent.

Dr. Douglas Evans, the chair of surgery at The Medical College of Wisconsin, said the high rate of adrenalectomies and low rate of organ-sparing procedures in the study does not reflect current practice patterns.

"It's probably the complete reverse now," said Dr. Evans, who wasn't involved in the study.

"Our approach now is to spare cortex on virtually every adrenal gland in every patient when we can, just because there really is no downside to it," he said. "Yes, they could develop a recurrent pheochromocytoma ...but you could still take it through a minimally invasive approach in most cases."

Full results were published April 16 online in Lancet Oncology.

SOURCE: http://bit.ly/1jIPs2O

Lancet Oncol 2014.

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