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International Journal of Medical Sciences And Clinical Research

Peer Reviewed | Open Access | E-ISSN: 2771-2265
Published Article

Application of A Novel Intraoperative Hemodynamic Stabilization Technique During One-Stage Bilateral Partial Adrenalectomy for Multiple Bilateral Pheochromocytomas: A Clinical Case Report

Application of A Novel Intraoperative Hemodynamic Stabilization Technique During One-Stage Bilateral Partial Adrenalectomy for Multiple Bilateral Pheochromocytomas: A Clinical Case Report

  • Khalimova Zamira Yusupovna
    Republican Specialized Scientific and Practical Medical Center of Endocrinology named after Academician Y.K. Turakulov, Tashkent, Uzbekistan
  • Omonov Oybek Avazkhanovich
    Republican Specialized Scientific and Practical Medical Center of Endocrinology named after Academician Y.K. Turakulov, Tashkent, Uzbekistan
  • Muzaffarov Farrukh Umarovich
    Republican Specialized Scientific and Practical Medical Center of Endocrinology named after Academician Y.K. Turakulov, Tashkent, Uzbekistan
  • Mirzakarimova Zukhra Sanzharovna
    Republican Specialized Scientific and Practical Medical Center of Endocrinology named after Academician Y.K. Turakulov, Tashkent, Uzbekistan
  • Mardonov Jamshid Normurotovich
    State Institution “Republican Specialized Scientific and Practical Medical Center of Surgery named after Academician V. Vakhidov”, Tashkent, Uzbekistan Tashkent State Medical University, Tashkent, Uzbekistan
Pheochromocytoma bilateral adrenal tumors laparoscopic adrenalectomy

Pheochromocytoma is a rare hormonally active tumor of the adrenal medulla characterized by catecholamine hypersecretion and a high risk of cardiovascular instability. Bilateral multiple forms of the disease represent a particular surgical challenge, requiring operative treatment with simultaneous preservation of cortical tissue to prevent chronic adrenal insufficiency. A critical stage of the procedure is venous outflow control, which is associated with the risk of pronounced arterial hypotension due to the abrupt cessation of catecholamine release into the systemic circulation. Objective. To present a clinical case of one-stage bilateral laparoscopic organ-sparing adrenalectomy for multiple bilateral pheochromocytomas using a developed intraoperative hemodynamic stabilization technique. Materials and Methods. A case of a female patient born in 1983 with clinical and laboratory signs of hormonally active tumors of both adrenal glands is described. Multislice computed tomography revealed bilateral lesions up to 4.7 cm in size. One-stage laparoscopic partial adrenalectomy was performed with maximal preservation of intact cortical tissue. At the stage of controlled venous outflow, rapid reinfusion of previously collected autologous blood (250 mL) synchronized with venous control was applied. Results. No critical intraoperative fluctuations in arterial blood pressure were recorded, and vasopressor support was not required. The postoperative period was uneventful. Plasma metanephrine and normetanephrine levels normalized. Histological examination confirmed the diagnosis of pheochromocytoma (ICD-O 8700/3). Conclusion. One-stage bilateral laparoscopic organ-sparing adrenalectomy is a feasible and safe treatment option in specialized centers. The use of synchronized autologous reinfusion may be considered a pathogenetically justified method for the prevention of post-clamping hypotension during surgical treatment of hormonally active adrenal tumors.

Lenders JWM, Duh QY, Eisenhofer G, Gimenez-Roqueplo AP, Grebe SKG, Murad MH, et al. Pheochromocytoma and paraganglioma: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2014;99(6):1915-1942.

Berends AMA, Buitenwerf E, de Krijger RR, Veeger NJGM, van der Horst-Schrivers ANA, Links TP, et al. Incidence of pheochromocytoma and paraganglioma: a population-based study in The Netherlands. Eur J Endocrinol. 2018;178(6):681-689.

Fassnacht M, Arlt W, Bancos I, Dralle H, Newell-Price J, Sahdev A, et al. Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline. Eur J Endocrinol. 2016;175(2):G1-G34

Fishbein L. Pheochromocytoma and paraganglioma: genetics, diagnosis, and treatment. N Engl J Med. 2019;381(6):552-565.

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