1. Surgical diseases of the adrenal gland

Question 1

Height of adrenals

Answer 1

T12

Question 2

Arterial supply

Answer 2

• Superior suprarenal a (← inferior phrenic a.)
• Middle suprarenal a. (← abdominal aorta)
• Inferior suprarenal a. (← renal a.)

Question 3

Adrenalectomy indications

Answer 3

Tumors less than 4 cm should be monitored clinically and radiologically.

Tumors greater than 6 cm should be surgically removed.

Question 4

Types of adrenalectomies

Answer 4

• Retroperitoneal: small tumors, patient face down
• Transabdominal: greater tumors and pediatrics
• Laparoscopic: small tumors

Question 5

Surgical treatment of Cushing syndrome

Answer 5

• Pituitary → transsphenoidal resection
• Ectopic ACTH → resection of the primary lesion, if possible (often not possible as it is SCLC)
• Primary adrenal causes → removal of the adrenal gland containing the tumor

Question 6

perioperative and postoperative considerations for primary Cushings patients

Answer 6

glucocorticoid replacement is given both pre- and post-op, as the pituitary-adrenal axis is suppressed

Question 7

Conn syndrome - primary hyperaldosteronism indication

Answer 7

Surgery only happen in case of an aldosterone-producing adrenal adenoma (APA), which account for 67% of cases

Question 8

Conn syndrome surgical approaches

Answer 8

Posterior or laprascopic approach

Question 9

Pharmacological conciderations for Conn syndrome patients that has undergone surgery

Answer 9

The patient should be treated with spironolactone preoperatively for 2 to 3 weeks to control blood pressure and to correct hypokalemia

Question 10

pheochromocytoma surgery

Answer 10

use “no touch” technique and early ligation of vein during operation

Question 11

Adrenocortical Carcinoma

Answer 11

Complete surgical removal = only cure