Yeap Boon Tat, Teah Kai Ming, Tan Janes Belinda GeilNii, Azizan Nornazirah
Department of Anaesthesiology and Intensive Care, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, 88400, Kota Kinabalu, Sabah, Malaysia.
Department of Anaesthesiology and Intensive Care, Hospital Sultanah Aminah, 81000, Johor Bahru, Malaysia.
Ann Med Surg (Lond). 2021 Oct 30;71:102996. doi: 10.1016/j.amsu.2021.102996. eCollection 2021 Nov.
Adrenocortical carcinoma (ACC) is a rare aggressive tumor that can be hormone or non-hormone secreting. It is usually associated with fatal outcomes due to its physiological hormonal interaction. We report a successful anaesthetic and surgical management for a patient who presented to us with a huge hemorrhagic ACC which was complicated with acute respiratory failure.
A 56-year-old lady presented to us with progressive abdominal distension and right hypochondriac pain for two months. She was anemic with elevated liver enzymes. Urgent computed tomography (CT) of the abdomen and pelvis showed a huge right supra renal mass. She subsequently developed respiratory failure due to splinting of diaphragm, of which successfully underwent an emergency exploratory laparotomy. Subsequent endocrine and histopathological work up showed an adrenocortical carcinoma (ACC).
Suprarenal masses usually originate from the adrenal glands. They should be investigated to rule out phaeochromocytoma, which originate from the inner adrenal medulla or outer cortex to form ACC. The latter usually occur in women and of poor prognosis. Huge ACC may cause acute respiratory failure by way of splinting of diaphragm. Both anaesthetic and surgical teams should be well trained in handling patients who undergo adrenal surgeries.
A giant hemorrhagic functional ACC is extremely uncommon with very poor prognosis. Such conditions should be investigated to rule out phaeochromocytoma. Its potential neuro-hormonal interactions and anatomical correlations can cause fatal perioperative cardio-respiratory embarrassment. The anaesthetic and surgical teams should be capable in managing the hemodynamic instabilities that may present during surgical manipulation and resection of a large ACC.
肾上腺皮质癌（ACC）是一种罕见的侵袭性肿瘤，可分泌激素或不分泌激素。由于其生理激素相互作用，通常与致命后果相关。我们报告了一例巨大出血性肾上腺皮质癌并伴有急性呼吸衰竭患者的成功麻醉和手术治疗。
一名56岁女性因进行性腹胀和右季肋部疼痛两个月前来就诊。她贫血且肝酶升高。腹部和盆腔紧急计算机断层扫描（CT）显示右侧肾上腺有一个巨大肿块。随后，由于膈肌受抑制，她出现了呼吸衰竭，并成功接受了急诊剖腹探查术。随后的内分泌和组织病理学检查显示为肾上腺皮质癌（ACC）。
肾上腺肿块通常起源于肾上腺。应进行检查以排除起源于肾上腺髓质内部或皮质外部形成ACC的嗜铬细胞瘤。后者通常发生在女性中，预后较差。巨大的肾上腺皮质癌可能通过膈肌受抑制导致急性呼吸衰竭。麻醉和手术团队都应在处理接受肾上腺手术的患者方面接受良好培训。
巨大出血性功能性肾上腺皮质癌极为罕见，预后极差。应进行此类情况的检查以排除嗜铬细胞瘤。其潜在的神经激素相互作用和解剖学关联可导致围手术期致命的心肺窘迫。麻醉和手术团队应能够处理在大型肾上腺皮质癌手术操作和切除过程中可能出现的血流动力学不稳定情况。
