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The original article was updated to correct the listing of A. Hamy's name; it is correct as displayed above.
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BACKGROUND: Pheochromocytoma (PHEO) in pregnancy is a life-threatening condition. Its management is challenging with regards to the timing and type of surgery. METHODS: A retrospective review of the management of ten patients diagnosed with pheochromocytoma during pregnancy was performed. Data were collected on the initial diagnostic workup, symptoms, treatment, and follow-up. RESULTS: PHEO was diagnosed in ten patients who were between the 10th and the 29th weeks of pregnancy. Six patients had none to mild symptoms, while four had complications of paroxysmal hypertension. Imaging investigations consisted of MRI, CT scan and ultrasounds. All had urinary metanephrines, measured as part of their workup. Three patients had MEN 2A, one VHL syndrome, one suspected SDH mutation. All patients were treated either with α/ß blockers or calcium channel blockers to stabilize their clinical conditions. Seven patients underwent a laparoscopic adrenalectomy before delivery. Three out of these seven patients had a bilateral PHEO and underwent a unilateral adrenalectomy of the larger tumor during pregnancy, followed by a planned cesarean section and a subsequent contralateral adrenalectomy within a few months after delivery. Three patients had emergency surgery for maternal or fetal complications, with C-section followed by concomitant or delayed adrenalectomy. All newborns from the group of planned surgery were healthy, while two out three newborns within the emergency surgery group died shortly after delivery secondary to cardiac and pulmonary complications. CONCLUSIONS: PHEO in pregnancy is a rare condition. Maternal and fetal prognosis improved over the last decades, but still lethal consequences may be present if misdiagnosed or mistreated. A thorough multidisciplinary team approach should be tailored on an individual basis to better manage the pathology. Unilateral adrenalectomy in a pregnant patient with bilateral PHEO may be an option to avoid the risk of adrenal insufficiency after bilateral adrenalectomy.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/diagnóstico , Adrenalectomía/métodos , Feocromocitoma/diagnóstico , Complicaciones Neoplásicas del Embarazo , Neoplasias de las Glándulas Suprarrenales/cirugía , Adulto , Cesárea , Femenino , Humanos , Recién Nacido , Imagen por Resonancia Magnética , Masculino , Feocromocitoma/cirugía , Embarazo , Diagnóstico Prenatal , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
Abstract The necessity of performance of orthotopic fixing of spleen after main stage of a left-sided laparoscopic adrenalectomy was substantiated. The majority of patients, first of all ordinary or with a lean stature, are complaining on a temporary discomfort and pain in abdomen of various degree, what is connected with transition of a mobilized spleen in early postoperative period. A simple method of surgical fixation of spleen is putting of 2 or 3 sutures on dissected sheets of parietal peritoneum in region of mobilization of spleen and pancreatic tail, what is securely prevents such an unwanted signs and facilitate a postoperative period course.
Asunto(s)
Cavidad Abdominal/cirugía , Glándulas Suprarrenales/cirugía , Adrenalectomía/métodos , Bazo/cirugía , Técnicas de Sutura , Cavidad Abdominal/patología , Adolescente , Glándulas Suprarrenales/patología , Adrenalectomía/instrumentación , Adrenalectomía/psicología , Adulto , Anciano , Femenino , Humanos , Cinestesia , Laparoscopía , Masculino , Persona de Mediana Edad , Páncreas/cirugía , Estudios Prospectivos , Calidad de Vida , Encuestas y Cuestionarios , SuturasRESUMEN
The clinic experience for surgical treatment of patients, suffering cyst of suprarenal gland (SG), consisted of laparoscopic resection of SG together with a cyst and preserving a visually nonaffected parts of SG, due to what the risk reduction for chronic suprarenal insufficiency of various degree occurrence was achieved. The proposed method was applied in 49 (86.0%) patients of 57, who were operated on for the SG cysts. Intraoperative morbidity, complicated postoperative course and the recurrence occurrence after the SG resection were not observed. All the patients have had recovered, so application of restorational therapy was not needed. The proposed method of laparoscopic resection of SG together with a cyst, using modern instrumental methods of hemostasis (ultrasonic scissors), permits to avoid excessive resection of functioning parenchyma of SG, to reduce the risk for health and life of the patients, caused by chronic suprarenal insufficiency and intraoperative bleeding.