Adrenal Glands Diagnostic Aspects and Surgical Therapy PDF
Preview Adrenal Glands Diagnostic Aspects and Surgical Therapy
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 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. 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Editor: Gabriele Schröder, Heidelberg, Germany Desk editor: Stephanie Benko, Heidelberg, Germany Production editor: Ingrid Haas, Heidelberg, Germany Cover-Design: Frido Steinen-Broo, Pau, Spain Illustrations: Rüdiger Himmelhan, Heidelberg, Germany Typesetting: Fotosatz-Service Köhler GmbH, Würzburg, Germany Printing and bookbinding: Stürtz AG, Würzburg, Germany Printed on acid-free paper. 24/3150 ih - 5 4 3 2 1 0 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:
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