Περίληψη:
Adrenal insufficiency represents a debilitating condition which mandates lifelong steroid replacement and which is associated with significant long-term morbidity, due to either inadequate or excessive replacement. The concept of preserving healthy cortical tissue by means of partial adrenalectomy has evolved as a means of avoiding the detrimental consequences of adrenal insufficiency. The advent of advanced technology in adrenal surgery has greatly facilitated the performance of partial adrenalectomy, enabling utilization of this method in an increasing number of endocrine diseases. Hereditary pheochromocytoma, Conn’s syndrome, Cushing’s syndrome, and non-functional adrenal masses represent the current indications for partial adrenalectomy, although the specific circumstances under which adrenal-sparing surgery should be proposed are still debatable. Partial adrenalectomy can be achieved by all types of minimally invasive surgery. In the absence of randomized, prospective, controlled studies designed to compare laparoscopic, retroperitoneoscopic, and robot-assisted partial adrenalectomy, none of these techniques has as yet been proven to be the gold standard for adrenal-sparing surgery. Apart from indications for surgery, results of surgery, and different types of partial adrenalectomy, controversial topics addressed in this review article include technical aspects such as the volume of residual adrenal tissue needed, ligation of adrenal vein, and means of tumor identification. Discussion of these controversial topics represents an attempt to define the role of partial adrenalectomy in modern adrenal surgery. © 2020, Hellenic Endocrine Society.
Συγγραφείς:
Perysinakis, I.
Aggeli, C.
Kaltsas, G.
Zografos, G.N.
Λέξεις-κλειδιά:
corticosteroid, adrenal insufficiency; adrenal tumor; adrenalectomy; computer assisted tomography; Cushing syndrome; human; laparoscopic surgery; medical society; minimally invasive surgery; morbidity; neurofibromatosis type 1; nuclear magnetic resonance imaging; organ size; pheochromocytoma; practice guideline; primary hyperaldosteronism; Review; robot assisted surgery; suprarenal vein; surgical approach; surgical technique; systematic review; technology; treatment duration; treatment indication; tumor localization; vein ligation; von Hippel Lindau disease; adrenal insufficiency; adrenal tumor; adrenalectomy; adverse event; pathology, Adrenal Gland Neoplasms; Adrenal Insufficiency; Adrenalectomy; Humans
