Skip to main content
SpringerLink
Log in

Nebennierenresektion zum Erhalt der adrenokortikalen Funktion

Indikationen und Ergebnisse

Adrenalectomy for preservation of adrenocortical function

Indication and results

  • Leitthema
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Der Standardeingriff bei Nebennierentumoren ist nach wie vor die Adrenalektomie. Die Nebennierenresektion zum adrenokortikalen Funktionserhalt hat im Zeitalter der minimal-invasiven Chirurgie eine allgemein akzeptierte und bewährte Indikation bei hereditären bilateralen Phäochromozytomen. Dazu sollte wenigstens ein Drittel einer Nebenniere in situ verbleiben. Bei unilateralen Nebennierentumoren bestehen die meisten Erfahrungen mit der Nebennierenresektion beim Conn-Syndrom. Die Ergebnisse entsprechen hier denjenigen der (radikalen) Adrenalektomie. Alle anderen Tumorentitäten stellen derzeit Ausnahmeindikationen für eine Nebennierenresektion dar.

Abstract

The standard procedure for adrenal tumors is total adrenalectomy. In order to preserve adrenocortical function, partial adrenalectomy has become an accepted and proven option in bilateral hereditary pheochromocytomas. For this at least one third of one gland has to be maintained. In unilateral adrenal tumors, partial adrenalectomy has mainly been used in Conn’s syndrome. Studies demonstrate results identical to those of total adrenalectomy. All other adrenal tumors are exceptional indications for partial adrenalectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Al-Sobhi S, Peschel R, Bartsch G et al (2000) Partial laparoscopic adrenalectomy for aldosterone-producing adenoma: short-and long-term results. J Endourol 14:497–499

    PubMed  CAS  Google Scholar 

  2. Albanese CT, Wiener ES (1993) Routine total bilateral adrenalectomy is not warranted in childhood familial pheochromocytoma. J Pediatr Surg 28:1248–1251

    Article  PubMed  CAS  Google Scholar 

  3. Asari R, Scheuba C, Kaczirek K et al (2006) Estimated risk of pheochromocytoma recurrence after adrenal-sparing surgery in patients with multiple endocrine neoplasia type 2A. Arch Surg 141:1199–1205

    Article  PubMed  CAS  Google Scholar 

  4. Bao ZM (1987) Removal of pheochromocytoma by enucleation. Urology 29:211–212

    Article  PubMed  CAS  Google Scholar 

  5. Barczynski M, Konturek A, Golkowski F et al (2007) Posterior retroperitoneoscopic adrenalectomy: a comparison between the initial experience in the invention phase and introductory phase of the new surgical technique. World J Surg 31:65–71

    Article  PubMed  Google Scholar 

  6. Bausch B, Borozdin W, Neumann HP (2006) Clinical and genetic characteristics of patients with neurofibromatosis type 1 and pheochromocytoma. N Engl J Med 354:2729–2731

    Article  PubMed  CAS  Google Scholar 

  7. Bel’tsevich DG, Kuznetsov NS (2002) Causes of recurrence of patients with chromaffin tumors. Khirurgiia (Mosk):19–23

  8. Birnbaum J, Giuliano A, Herle AJ Van (1989) Partial adrenalectomy for pheochromocytoma with maintenance of adrenocortical function. J Clin Endocrinol Metab 69:1078–1081

    PubMed  CAS  Google Scholar 

  9. Brauckhoff M, Gimm O, Brauckhoff K et al (2004) Repeat adrenocortical-sparing adrenalectomy for recurrent hereditary pheochromocytoma. Surg Today 34:251–255

    Article  PubMed  Google Scholar 

  10. Brauckhoff M, Gimm O, Thanh PN et al (2003) Critical size of residual adrenal tissue and recovery from impaired early postoperative adrenocortical function after subtotal bilateral adrenalectomy. Surgery 134:1020–1028)

    Article  PubMed  Google Scholar 

  11. Brauckhoff M, Kaczirek K, Thanh PN et al (2003) Technical aspects of subtotal endoscopic adrenalectomy. Eur Surg 35:84–88

    Google Scholar 

  12. Brauckhoff M, Nguyen Thanh P, Bar A et al (2003) Subtotal bilateral adrenalectomy preserving adrenocortical function. Chirurg 74:646–651

    Article  PubMed  CAS  Google Scholar 

  13. Brauckhoff M, Stock K, Stock S et al (2008) Limitations of intraoperative adrenal remnant volume measurement in patients undergoing subtotal adrenalectomy. World J Surg 32:863–872

    Article  PubMed  Google Scholar 

  14. Brauckhoff M, Thanh PN, Gimm O et al (2003) Functional results after endoscopic subtotal cortical-sparing adrenalectomy. Surg Today 33:342–348

    Article  PubMed  Google Scholar 

  15. Bravo EL, Gifford RW Jr (1984) Current concepts. Pheochromocytoma: diagnosis, localization and management. N Engl J Med 311:1298–1303

    PubMed  CAS  Google Scholar 

  16. Brennan MF, Keiser HR (1982) Persistent and recurrent pheochromocytoma: the role of surgery. World J Surg 6:397–402

    Article  PubMed  CAS  Google Scholar 

  17. Cheng SP, Saunders BD, Gauger PG et al (2008) Laparoscopic partial adrenalectomy for bilateral pheochromocytomas. Ann Surg Oncol 15:2506–2508

    Article  PubMed  Google Scholar 

  18. Chin EH, Baril DT, Weber KJ et al (2008) Laparoscopic cortical-sparing adrenalectomy for bilateral pheochromocytoma. Surg Endosc 22:2075

    Article  PubMed  Google Scholar 

  19. Graaf JS de, Lips CJ, Rutter JE et al (1999) Subtotal adrenalectomy for phaeochromocytoma in multiple endocrine neoplasia type 2A. Eur J Surg 165:535–538

    Article  PubMed  Google Scholar 

  20. Decourcy JL (1934) Subtotal bilateral adrenalectomy for hyperadrenalism (essential hypertension). Ann Surg 100:310–318

    Article  PubMed  CAS  Google Scholar 

  21. Diner EK, Franks ME, Behari A et al (2005) Partial adrenalectomy: the National cancer institute experience. Urology 66:19–23

    Article  PubMed  Google Scholar 

  22. Dluhy RG (2002) Pheochromocytoma – death of an axiom. N Engl J Med 346:1486–1488

    Article  PubMed  Google Scholar 

  23. Dralle H, Scheumann GF, Nashan B et al (1994) Review: recent developments in adrenal surgery. Acta Chir Belg 94:137–140

    PubMed  CAS  Google Scholar 

  24. Edstrom E, Grondal S, Norstrom F et al (1999) Long term experience after subtotal adrenalectomy for multiple endocrine neoplasia type IIa. Eur J Surg 165:431–435

    Article  PubMed  CAS  Google Scholar 

  25. Fendrich V, Ramaswamy A, Nies C (2003) Hyperaldosteronism persisting after subtotal adrenalectomy. Chirurg 74:473–477

    Article  PubMed  CAS  Google Scholar 

  26. Grabner P, Hauer-Jensen M, Jervell J et al (1991) Long-term results of treatment of cushing’s disease by adrenalectomy. Eur J Surg 157:461–464

    PubMed  CAS  Google Scholar 

  27. Hamberger B, Telenius-Berg M, Cedermark B et al (1987) Subtotal adrenalectomy in multiple endocrine neoplasia type 2. Henry Ford Hosp Med J 35:127–128

    PubMed  CAS  Google Scholar 

  28. Heniford BT, Iannitti DA, Hale J et al (1997) The role of intraoperative ultrasonography during laparoscopic adrenalectomy. Surgery 122:1068–1073

    Article  PubMed  CAS  Google Scholar 

  29. Ikeda Y, Takami H, Sasaki Y et al (2003) Is laparoscopic parial or cortical-sparing adrenalectomy worthwile? Eur Surg 35:89–92

    Article  Google Scholar 

  30. Imai T, Tanaka Y, Kikumori T et al (1999) Laparoscopic partial adrenalectomy. Surg Endosc 13:343–345

    Article  PubMed  CAS  Google Scholar 

  31. Inabnet WB, Caragliano P, Pertsemlidis D (2000) Pheochromocytoma: inherited associations, bilaterality and cortex preservation. Surgery 128:1007–1011

    Article  PubMed  CAS  Google Scholar 

  32. Irvin GL 3rd, Fishman LM, Sher JA (1983) Familial pheochromocytoma. Surgery 94:938–940

    PubMed  Google Scholar 

  33. Ishidoya S, Ito A, Sakai K et al (2005) Laparoscopic partial versus total adrenalectomy for aldosterone producing adenoma. J Urol 174:40–43

    Article  PubMed  Google Scholar 

  34. Janetschek G, Finkenstedt G, Gasser R et al (1998) Laparoscopic surgery for pheochromocytoma: adrenalectomy, partial resection, excision of paragangliomas. J Urol 160:330–334

    Article  PubMed  CAS  Google Scholar 

  35. Jansson S, Khorram-Manesh A, Nilsson O et al (2006) Treatment of bilateral pheochromocytoma and adrenal medullary hyperplasia. Ann N Y Acad Sci 1073:429–435

    Article  PubMed  Google Scholar 

  36. Jeschke K, Janetschek G, Peschel R et al (2003) Laparoscopic partial adrenalectomy in patients with aldosterone-producing adenomas: indications, technique and results. Urology 61:69–72

    Article  PubMed  CAS  Google Scholar 

  37. Julien JS, Ball D, Schulick R (2006) Robot-assisted cortical-sparing adrenalectomy in a patient with von hippel-lindau disease and bilateral pheochromocytomas separated by 9 years. J Laparoendosc Adv Surg Tech A 16:473–477

    Article  PubMed  Google Scholar 

  38. Kaouk JH, Matin S, Bravo EL et al (2002) Laparoscopic bilateral partial adrenalectomy for pheochromocytoma. Urology 60:1100–1103

    Article  PubMed  Google Scholar 

  39. Klempa I, Menzel J, Baca I (1989) Subtotal adrenalectomy versus autotransplantation of the adrenal cortex – an alternative procedure in bilateral adrenalectomy in MEN II? Chirurg 60:266–271

    PubMed  CAS  Google Scholar 

  40. Kok KY, Yapp SK (2002) Laparoscopic adrenal-sparing surgery for primary hyperaldosteronism due to aldosterone-producing adenoma. Surg Endosc 16:108–111

    Article  PubMed  CAS  Google Scholar 

  41. Konig KB, Krarup T, Lund JO (2002) Adrenal insufficiency after unilateral adrenalectomy for primary hyperaldosteronism. Ugeskr Laeger 164:340–342

    PubMed  Google Scholar 

  42. Lairmore TC, Ball DW, Baylin SB et al (1993) Management of pheochromocytomas in patients with multiple endocrine neoplasia type 2 syndromes. Ann Surg 217:595–601

    Article  PubMed  CAS  Google Scholar 

  43. Lee JE, Curley SA, Gagel RF et al (1996) Cortical-sparing adrenalectomy for patients with bilateral pheochromocytoma. Surgery 120:1064–1070

    Article  PubMed  CAS  Google Scholar 

  44. Liu DY (1993) Diagnosis and treatment of recurrent pheochromocytoma. Zhonghua Wai Ke Za Zhi 31:622–624

    PubMed  CAS  Google Scholar 

  45. Machens A, Brauckhoff M, Gimm O et al (2006) Risk-oriented approach to hereditary adrenal pheochromocytoma. Ann N Y Acad Sci 1073:417–428

    Article  PubMed  Google Scholar 

  46. Meria P, Kempf BF, Hermieu JF et al (2003) Laparoscopic management of primary hyperaldosteronism: clinical experience with 212 cases. J Urol 169:32–35

    Article  PubMed  Google Scholar 

  47. Mugiya S, Suzuki K, Saisu K et al (1999) Unilateral laparoscopic adrenalectomy followed by contralateral retroperitoneoscopic partial adrenalectomy in a patient with multiple endocrine neoplasia type 2a syndrome. J Endourol 13:99–104

    Article  PubMed  CAS  Google Scholar 

  48. Nakada T, Kubota Y, Sasagawa I et al (1995) Therapeutic outcome of primary aldosteronism: adrenalectomy versus enucleation of aldosterone-producing adenoma. J Urol 153:1775–1780

    Article  PubMed  CAS  Google Scholar 

  49. Nambirajan T, Leeb K, Neumann HP et al (2005) Laparoscopic adrenal surgery for recurrent tumours in patients with hereditary phaeochromocytoma. Eur Urol 47:622–626

    Article  PubMed  Google Scholar 

  50. Neumann HP, Bausch B, McWhinney SR et al (2002) Germ-line mutations in nonsyndromic pheochromocytoma. N Engl J Med 346:1459–1466

    Article  PubMed  CAS  Google Scholar 

  51. Neumann HP, Bender BU, Reincke M et al (1999) Adrenal-sparing surgery for phaeochromocytoma. Br J Surg 86:94–97

    Article  PubMed  CAS  Google Scholar 

  52. O’Riordain DS, Farley DR, Young W Jr et al (1994) Long-term outcome of bilateral adrenalectomy in patients with cushing’s syndrome. Surgery 116:1088–1093

    Google Scholar 

  53. Pautler SE, Choyke PL, Pavlovich CP et al (2002) Intraoperative ultrasound aids in dissection during laparoscopic partial adrenalectomy. J Urol 168:1352–1355

    Article  PubMed  Google Scholar 

  54. Porpiglia F, Destefanis P, Bovio S et al (2002) Cortical-sparing laparoscopic adrenalectomy in a patient with multiple endocrine neoplasia type IIA. Horm Res 57:197–199

    Article  PubMed  CAS  Google Scholar 

  55. Priestley JT, Sprague RG, Walters W et al (1951) Subtotal adrenalectomy for cushing’s syndrome: a preliminary report of 29 cases. Ann Surg 134:464–475

    Article  PubMed  CAS  Google Scholar 

  56. Radmayr C, Neumann H, Bartsch G et al (2000) Laparoscopic partial adrenalectomy for bilateral pheochromocytomas in a boy with von Hippel-Lindau disease. Eur Urol 38:344–348

    Article  PubMed  CAS  Google Scholar 

  57. Rutherford JC, Stowasser M, Tunny TJ et al (1996) Laparoscopic adrenalectomy. World J Surg 20:758–760

    Article  PubMed  CAS  Google Scholar 

  58. Sasagawa I, Suzuki H, Izumi T et al (2000) Posterior retroperitoneoscopic partial adrenalectomy using ultrasonic scalpel for aldosterone-producing adenoma. J Endourol 14:573–576

    Article  PubMed  CAS  Google Scholar 

  59. Sasagawa I, Suzuki H, Tateno T et al (1998) Retroperitoneoscopic partial adrenalectomy using an endoscopic stapling device in patients with adrenal tumor. Urol Int 61:101–103

    Article  PubMed  CAS  Google Scholar 

  60. Sasagawa I, Suzuki Y, Itoh K et al (2003) Posterior retroperitoneoscopic partial adrenalectomy: clinical experience in 47 procedures. Eur Urol 43:381–385

    Article  PubMed  Google Scholar 

  61. Shen WT, Lim RC, Siperstein AE et al (1999) Laparoscopic vs open adrenalectomy for the treatment of primary hyperaldosteronism. Arch Surg 134:628–631

    Article  PubMed  CAS  Google Scholar 

  62. Sparagana M (1988) Late recurrence of benign pheochromocytomas: the necessity for long-term follow-up. J Surg Oncol 37:140–146

    Article  PubMed  CAS  Google Scholar 

  63. Telenius-Berg M, Ponder MA, Berg B et al (1989) Quality of life after bilateral adrenalectomy in MEN 2. Henry Ford Hosp Med J 37:160–163

    PubMed  CAS  Google Scholar 

  64. Heerden JA van, Roland CF, Carney JA et al (1990) Long-term evaluation following resection of apparently benign pheochromocytoma(s)/paraganglioma(s). World J Surg 14:325–329

    Article  PubMed  Google Scholar 

  65. Heerden JA van, Sizemore GW, Carney JA et al (1985) Bilateral subtotal adrenal resection for bilateral pheochromocytomas in multiple endocrine neoplasia, type IIa: a case report. Surgery 98:363–366

    PubMed  Google Scholar 

  66. Heerden JA van, Sizemore GW, Carney JA et al (1984) Surgical management of the adrenal glands in the multiple endocrine neoplasia type II syndrome. World J Surg 8:612–621

    Article  PubMed  Google Scholar 

  67. Walther MM, Herring J, Choyke PL et al (2000) Laparoscopic partial adrenalectomy in patients with hereditary forms of pheochromocytoma. J Urol 164:14–17

    Article  PubMed  CAS  Google Scholar 

  68. Walz MK, Alesina PF, Wenger FA et al (2006) Laparoscopic and retroperitoneoscopic treatment of pheochromocytomas and retroperitoneal paragangliomas: results of 161 tumors in 126 patients. World J Surg 30:899–908

    Article  PubMed  Google Scholar 

  69. Walz MK, Gwosdz R, Levin SL et al (2008) Retroperitoneoscopic adrenalectomy in Conn’s syndrome caused by adrenal adenomas or nodular hyperplasia. World J Surg 32:847–853

    Article  PubMed  Google Scholar 

  70. Walz MK, Neumann HPH, Peitgen K et al (2003) Endoscopic treatment of recurrent and extraadrenal pheochromocytomas. Eur Surg 35:93–96

    Google Scholar 

  71. Walz MK, Peitgen K, Diesing D et al (2004) Partial versus total adrenalectomy by the posterior retroperitoneoscopic approach: early and long-term results of 325 consecutive procedures in primary adrenal neoplasias. World J Surg 28:1323–1329

    Article  PubMed  Google Scholar 

  72. Walz MK, Peitgen K, Hoermann R et al (1996) Posterior retroperitoneoscopy as a new minimally invasive approach for adrenalectomy: results of 30 adrenalectomies in 27 patients. World J Surg 20:769–774

    Article  PubMed  CAS  Google Scholar 

  73. Walz MK, Peitgen K, Saller B et al (1998) Subtotal adrenalectomy by the posterior retroperitoneoscopic approach. World J Surg 22:621–626

    Article  PubMed  CAS  Google Scholar 

  74. Weigel RJ, Wells SA, Gunnells JC et al (1994) Surgical treatment of primary hyperaldosteronism. Ann Surg 219:347–352

    Article  PubMed  CAS  Google Scholar 

  75. Yip L, Lee JE, Shapiro SE et al (2004) Surgical management of hereditary pheochromocytoma. J Am Coll Surg 198:525–534

    Article  PubMed  Google Scholar 

  76. Zhang X, He H, Chen Z et al (2004) Retroperitoneal laparoscopic management of primary aldosteronism with report of 130 cases. Zhonghua Wai Ke Za Zhi 42:1093–1095

    PubMed  Google Scholar 

  77. Zintel HA, Wolferth CC, Jeffers WA et al (1951) Subtotal adrenalectomy in the treatment of patients with severe essential hypertension. Ann Surg 134:351–360

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Chirurgie und Zentrum Minimal Invasive Chirurgie, Kliniken Essen-Mitte, Henricistraße 92, 45136, Essen, Deutschland

    M.K. Walz

Authors
  1. M.K. Walz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M.K. Walz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Walz, M. Nebennierenresektion zum Erhalt der adrenokortikalen Funktion. Chirurg 80, 99–104 (2009). https://doi.org/10.1007/s00104-008-1612-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-008-1612-9

Schlüsselwörter

Keywords

Search

Navigation