Adrenal Glands Diagnostic Aspects and Surgical Therapy

359 Pages·2010·13.9 MB·English

by  Dimitrios A. Linos, Jon A. van Heerden

Dimitrios Linos (Editor)
Jon A. van Heerden (Editor)
Adrenal Glands
Dimitrios Linos (Editor)
Jon A. van Heerden (Editor)
Adrenal Glands
Diagnostic Aspects and Surgical Therapy
With 187 Figures
in 251 Separate Illustrations, Mostly in Color
and 52 Tables
Professor Dr. Dimitrios Linos
Director 1st Surgical Clinic, Hygeia Hospital
227 Kifissias Avenue, 14561 Kifissia, Greece
Professor Dr. Jon A. van Heerden
Department of Surgery, Mayo Clinic
First Street SW 200, Rochester, MN 55905, USA
ISBN 3-540-41099-6 Springer-Verlag Berlin Heidelberg New York
Library of Congress Control Number: 2004104845
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Preface
wV d’ eãei¢non men zwn, dia tou¢ ton de¢ ãalw¢ V zwn.
(Plou¢tarcoV 75 p. C)
Plutarch wrote that Alexander the Great once said that edge sharing, and technical pearls at meetings locally,
he owed his life to his father but he owed learning how nationally, and internationally.
to live well to his teacher,Aristotle. As impeccable as he was in his lectures,he was even
This book is a tribute to my teacher in surgery Jon more meticulous in the operating room.His operating
van Heerden. “Jon,” for his many friends, yet always rooms at Mayo were models of decorum, punctuality,
“Dr. van Heerden” for me (who never managed to expert teamwork, attention to minutiae, the abhor-
overcome the anxiety I felt, as a chief resident, when rence of blood loss, and ultimate respect not only for
interrupting a golf game to discuss patient problems) tissues, but most importantly for the patient. He truly
has inspired many surgeons worldwide. believed in the aphorism:“The most important person
It is not accidental that in this book most of the in the operating room is the patient – not the surgeon.”
renowned participants have been directly or indirectly Jon van Heerden was just and understanding but he
students, and/or friends, of Jon van Heerden. The was not lenient or flexible with members of the oper-
remaining contributors who are not surgeons have ating team and there was no margin for error.
known, respected and admired him for his contribu- In this book, integrity, skill, validity and reliability
tion to the field of adrenal surgery. are among the qualities the authors have aspired to as
The magic of JvH, as he is affectionately known in they tackle the captivating “mysteries”that shroud the
the surgical community, is his keen insight into a com- adrenal glands. Precision and concision were strived
plicated subject and his ability to transform complex- for in all chapters, which are both up to date and in-
ity into simplicity. And thus even the complexities of formative. With concrete data on the different aspects
some esoteric adrenal diseases are today readily un- of adrenal anatomy,physiology and pathology,and the
derstood by both generalists and specialists. One of practical and appropriate application of the surgical
his favorite quotes is in fact:“If it is not awfully simple, treatment, the reader can expect to be challenged and
it is usually simply awful.” enlightened, surprised as well as comforted, and fore-
Skills can be sharpened, knowledge acquired, most – educated.
but what is even more important is the fact that I cannot stress adequately how indebted I feel to
some people transfer their knowledge to others. the gracious contributions from the world-renowned
It could be argued that greatness in the intellect of a physicians and surgeons who rose to the challenge
person is only surpassed by the ability to inspire of producing this ambitious project with enthusiasm.
greatness in others; this then is the essence of JvH, Without their contribution this would have never been
who once stated “The greatest satisfaction in surgery a possibility, since neither the editors nor the publish-
lies in the achievements which others are inspired to ers would accept anything less than the very best avail-
perform.” able. A note of special thanks is due to Ms. Stephanie
JvH was a Consultant at the Mayo Clinic for 31 years Benko,from Springer-Verlag,and to my assistant Mary
and has influenced and stimulated innumerable Kostopoulou, who were both enthusiastic and tireless
trainees to perform the Art of Surgery with integrity in their organizational skills.
and humility. Many, many more surgeons have bene-
fited from his devotion to teaching, educating, knowl- Dimitrios A. Linos, MD, FACS
Preface
You, our readers, are justified to ask “Why is there a The medical/surgical world is shrinking due to im-
need for yet another textbook on a rare aspect of en- proved and rapid communications and ease of travel.
docrine surgery?” We, your editors, albeit biased, feel The contributors to this volume represent many dif-
that the answer is an affirmative one and is based on ferent countries, which is most gratifying. We believe
a number of closely interrelated factors. that this international flavor will only increase in the
Much has changed in the understanding, elucida- future and that this increase is good for all concerned,
tion, and identification and management of almost all patients in particular.
aspects of diseases that affect the adrenal glands. We We are deeply indebted to all of the contributors
have, indeed, come a long way since Thomas Addison to this publication, be they physicians, surgeons, ra-
in 1855 succinctly stated “It will hardly be disputed diologists,anesthesiologists,artists,or publishers.They
that at the present moment, the function of the supra- have unselfishly given us and you not only their ex-
renal capsules, and the influence they exercise in the pertise but their most precious possession – their time.
general economy are almost or altogether unknown.” Lastly, both of us stand on the shoulders of our
Similarly, the surgical approach to these retroperi- teachers and our role models, who have enabled us to
toneal glands has undergone an amazing revolution in see a little further than perhaps they did. Humbly, we
the most recent decade.We wonder if Hugh-Young, fa- thus thank Jim Priestley,Bill Remine,Dick Welbourne,
mous for developing and popularizing the posterior Sheldon Sheps, and Bill Young.You, our revered teach-
open approach to the adrenal glands,could have,in his ers, collectively exemplify to us the thoughts elo-
wildest dreams, ever imagined outpatient laparoscop- quently expressed by Halsted.
ic adrenalectomy.We think not! It is our sincere wish that you,who have honored us
Today,and in the future, the emphasis is going to be by reading this introduction and what follows,will de-
on teamwork with close cooperation and communica- rive a modicum of pleasure as you peruse Adrenal
tion between many disciplines when caring for pa- Glands: Diagnostic Aspects and Surgical Therapy. If
tients with adrenal pathology. Surgeons, in particular, you per chance read something that may benefit pa-
will need to change their daily vocabulary from I to we. tient care, this educational endeavor will have been
This is an essential factor which this textbook hope- well worth the effort and our wishes shall have been
fully clearly emphasizes and exemplifies, and the var- granted and fulfilled.
ious disciplines are indeed well represented by our
contributors. Jon van Heerden
Table of Contents
1 History of Adrenal Surgery . . . . . . . . . . 1 11 Overview of Mineralocorticoid
Dean A. Harris, Malcolm H. Wheeler Excess Syndromes . . . . . . . . . . . . . . . 115
Richard D. Gordon, Michael Stowasser
2 Surgical Anatomy . . . . . . . . . . . . . . . 7
Nancy Dugal Perrier, Michael Sean Boger 12 Primary Aldosteronism:
The Surgical Perspective . . . . . . . . . . . . 127
3 Hypothalamic-Pituitary-Adrenal Axis . . . . 19 Bertil Hamberger
Ioannis Kyrou, Constantine Tsigos
13 Primary Adrenocortical Carcinoma . . . . . 131
4 The Sympathoadrenal System: Integrative Charles A.G. Proye, François N. Pattou,
Regulation of the Cortical and the Medullary Jonathan Armstrong
Adrenal Functions . . . . . . . . . . . . . . . 33
A. Souvatzoglou 14 Recurrent Adrenocortical Carcinoma . . . . 143
Paolo Miccoli, Pietro Iacconi
5 The Value of Adrenal Imaging
in Adrenal Surgery . . . . . . . . . . . . . . . 41 15 Metastatic Adrenocortical Carcinoma . . . . 151
Bruno Niederle, Gertraud Heinz-Peer, D.E. Tsakayannis, Dimitrios A. Linos
Klaus Kaczirek, Amir Kurtaran
16 Virilizing and Feminizing Adrenal Tumors . . 159
6 Cushing’s Syndrome . . . . . . . . . . . . . . 57 Michael Brauckhoff, Oliver Gimm,
Alejandro Ayala, George Chrousos Henning Dralle
7 Subclinical Cushing’s Syndrome . . . . . . . 67 17 Pheochromocytoma . . . . . . . . . . . . . . 177
Felix Beuschlein, Martin Reincke Cord Sturgeon, Quan-Yang Duh
8 Ectopic Cushing’s Syndrome . . . . . . . . . 75 18 Extra-adrenal and Malignant
D. Vassiliadi, S. Tsagarakis, N. Thalassinos Pheochromocytoma . . . . . . . . . . . . . . 189
Gerard M. Doherty
9 Cushing’s Syndrome in Children
and Adolescents . . . . . . . . . . . . . . . . 87 19 Pheochromocytoma in MEN-2A, MEN-2B,
George Mastorakos, and von Hippel-Lindau Disease . . . . . . . . 195
Christina Kanaka-Gantenbein Geoffrey B. Thompson
10 Classic Congenital Adrenal Hyperplasia . . . 101 20 Benign Paragangliomas . . . . . . . . . . . . 201
Evangelia Charmandari, George Chrousos, Abbie L. Young, William F. Young, Jr.
Deborah P. Merke
X Table of Contents
21 Neuroblastoma . . . . . . . . . . . . . . . . . 211 30 Open Right Anterior Adrenalectomy . . . . . 303
Jed G. Nuchtern, Heidi V. Russell, Dimitrios A. Linos
Jason M. Shohet
31 Open Posterior Adrenalectomy . . . . . . . . 309
22 Miscellaneous Adrenal Neoplasms Dimitrios A. Linos
(Cysts, Myelolipoma, Hemangioma,
Lymphangioma) . . . . . . . . . . . . . . . . 223 32 Right Anterior Laparoscopic Adrenalectomy 313
Melanie L. Richards Dimitrios A. Linos
23 Adrenal Incidentalomas . . . . . . . . . . . . 231 33 Left Anterior Laparoscopic Adrenalectomy . . 321
Miguel F. Herrera, Juan Pablo Pantoja, Dimitrios A. Linos
Nayví España
34 Laparoscopic Lateral Transabdominal
24 Clinically Inapparent Adrenal Mass Adrenalectomy . . . . . . . . . . . . . . . . . 325
(Incidentaloma or Adrenaloma) . . . . . . . 241 Sanziana Roman, Robert Udelsman
Dimitrios A. Linos
35 Posterior Retroperitoneoscopic
25 Genetic Syndromes Associated Adrenalectomy . . . . . . . . . . . . . . . . . 333
with Adrenal Tumors . . . . . . . . . . . . . 251 Martin K. Walz
Göran Åkerström, Per Hellman
36 Laparoscopic Partial Adrenalectomy . . . . . 341
26 Adrenal Tumors and Pregnancy . . . . . . . 265 Geoffrey B. Thompson
M. Nicole Lamb, David R. Farley
37 Virtual Reality and Robotic Technologies
27 Adrenal-Sparing Surgery . . . . . . . . . . . 275 in Adrenal Surgery . . . . . . . . . . . . . . . 345
Richard A. Hodin, Antonia E. Stephen Jacques Marescaux, Francesco Rubino,
Luc Soler
28 Anesthesia for Adrenal Surgery . . . . . . . . 287
Stavros G. Memtsoudis, Cephas Swamidoss, Subject Index . . . . . . . . . . . . . . . . . . 355
Maria Psoma
29 Open Left Anterior Adrenalectomy . . . . . . 299
Dimitrios A. Linos
List of Contributors
Åkerström, Göran, MD Brauckhoff, Michael, MD
Professor, Department of Surgery Klinik für Allgemein-, Viszeral- und Gefäßchirurgie
Akademiska Sjukhuset, Uppsala Universitet Martin Luther Universität Halle/Wittenberg
75185 Uppsala, Sweden Ernst-Grube-Strasse 40
Email:
XII List of Contributors
Duh, Quan-Yang, MD Heinz-Peer, Gertraud, MD
Professor of Surgery, Surgical Service Assistant Professor of Radiology
Veterans Affairs Medical Center Department of Radiology
University of California Division of Surgical Radiology
4150 Clement Street Medical University of Vienna
San Francisco, CA 94121, USA Währinger Gürtel 18-20
Email: