Department of Urology, Toho University Sakura Medical Center, Chiba, Japan.
Int J Urol. 2023 Oct;30(10):818-826. doi: 10.1111/iju.15218. Epub 2023 Jun 27.
The major adrenal tumors with endocrine activity are primary aldosteronism, Cushing's syndrome/mild autonomous cortisol secretion, and pheochromocytoma/paraganglioma. Excessive aldosterone secretion in primary aldosteronism causes cardiovascular, renal, and other organ damage in addition to hypertension and hypokalemia. Cortisol hypersecretion in Cushing's syndrome/mild autonomous cortisol secretion causes obesity, hypertension, impaired glucose tolerance, and cardiometabolic syndrome. Massive secretion of catecholamines in pheochromocytoma/paraganglioma causes hypertension and cerebrocardiovascular disease due to rapid blood pressure fluctuation. Moreover, pheochromocytoma multi-system crisis is a feared and possibly fatal presentation of pheochromocytoma/paraganglioma. Thus, adrenal tumors with endocrine activity are considered an indication for adrenalectomy, and perioperative management is very important. They have a risk of perioperative complications, either due to direct hemodynamic effects of the hormone hypersecretion or due to hormone-related comorbidities. In the last decades, deliberate preoperative evaluation and advanced perioperative management have significantly reduced complications and improved outcomes. Furthermore, improvements in anesthesia and surgical techniques with the feasibility of laparoscopic adrenalectomy have contributed to reduced morbidity and mortality. However, there are still several challenges to be considered in the perioperative care of these patients. There are very few data available prospectively to guide clinical management, due to the rarity of adrenal tumors with endocrine activity. Therefore, most guidelines are based on retrospective data analyses or small case series. In this review, the latest knowledge is summarized, and practical pathways to reduce perioperative complications and improve outcomes in adrenal tumors with endocrine activity are presented.
具有内分泌活性的主要肾上腺肿瘤包括原发性醛固酮增多症、库欣综合征/轻度自主皮质醇分泌和嗜铬细胞瘤/副神经节瘤。原发性醛固酮增多症中醛固酮的过度分泌除了高血压和低钾血症外，还会导致心血管、肾脏和其他器官损伤。库欣综合征/轻度自主皮质醇分泌中皮质醇的过度分泌会导致肥胖、高血压、葡萄糖耐量受损和心血管代谢综合征。嗜铬细胞瘤/副神经节瘤中儿茶酚胺的大量分泌会因血压的快速波动而导致高血压和心脑血管疾病。此外，嗜铬细胞瘤多系统危象是嗜铬细胞瘤/副神经节瘤的一种可怕且可能致命的表现。因此，具有内分泌活性的肾上腺肿瘤被认为是肾上腺切除术的指征，围手术期管理非常重要。它们有发生围手术期并发症的风险，这可能是由于激素过度分泌的直接血液动力学效应，也可能是由于与激素相关的合并症。在过去的几十年中，术前精心评估和先进的围手术期管理显著降低了并发症的发生率并改善了结局。此外，麻醉和手术技术的改进以及腹腔镜肾上腺切除术的可行性也有助于降低发病率和死亡率。然而，在这些患者的围手术期护理中仍有几个挑战需要考虑。由于具有内分泌活性的肾上腺肿瘤罕见，因此可用于指导临床管理的前瞻性数据非常有限。因此，大多数指南都是基于回顾性数据分析或小病例系列得出的。在这篇综述中，总结了最新的知识，并提出了降低具有内分泌活性的肾上腺肿瘤围手术期并发症发生率和改善结局的实用方法。
