Our Summary

This research paper looks back at the results of surgeries (specifically adrenalectomies, or removal of the adrenal glands) performed on children with non-neuroblastic diseases (those not involving the nerve tissues) between 1988 and 2018. The researchers gathered information about the patients and their surgeries, and then studied things like how long they stayed in the hospital and any complications within the first 30 days after surgery.

They found that 40 children had a total of 50 adrenalectomies. Some of these children had tumors in their adrenal glands discovered by chance, while others were screened because of genetic mutations or previous cancer. The majority of children, however, had symptoms related to excess hormone production.

Almost half of the patients were tested for genetic conditions and more than a third had genetic predispositions. The diagnoses varied, including different types of tumors and adrenal gland overgrowth.

Half of the surgeries were performed using a minimally invasive technique called laparoscopy. On average, the children stayed in the hospital for 3 days after surgery. The rate of complications after surgery was 17%, with the most serious being a type known as Clavien-Dindo grade II.

The researchers concluded that this type of surgery can be performed with a low risk of complications. However, because it is often linked with genetic mutations and syndromes, surgeons need to be aware of the necessary tests before surgery and monitoring after surgery.

FAQs

  1. What is the most common reason children undergo adrenalectomy for non-neuroblastic pathology, according to the study?
  2. What is the association between adrenalectomy for non-neuroblastic pathology and genetic mutations?
  3. What was the post-operative morbidity rate for children who underwent adrenalectomy for non-neuroblastic pathology from 1988 to 2018 in the study?

Doctor’s Tip

A helpful tip a doctor might tell a patient about adrenalectomy is to make sure to follow up with regular post-operative surveillance, especially if there is a genetic predisposition or syndrome associated with the adrenal pathology. This can help monitor for any potential complications or recurrence of the condition. It is also important to discuss any concerns or symptoms with your healthcare provider to ensure proper management and care.

Suitable For

Patients who are typically recommended adrenalectomy include those with adrenal masses causing hormonal excess symptoms, such as pheochromocytoma, adrenocortical adenoma, adrenocortical carcinoma, adrenal hyperplasia, and metastasis. Adrenalectomy may also be recommended for patients with genetic predispositions or syndromes that increase their risk of developing adrenal tumors. In some cases, adrenalectomy may be performed for incidental adrenal masses found during imaging studies or genetic screening. The procedure is often performed laparoscopically in children with low morbidity rates and short hospital stays. Surgeons should be aware of appropriate pre-operative testing and post-operative surveillance for patients undergoing adrenalectomy for non-neuroblastic pathologies.

Timeline

Before adrenalectomy:

  • Patients may present with symptoms of hormonal excess, incidental adrenal mass, or adrenal mass found on genetic mutation screening or prior malignancy screening.
  • Patients may undergo genetic evaluation to determine any predispositions.
  • Diagnoses may include pheochromocytoma, adrenocortical adenoma, adrenocortical carcinoma, adrenal hyperplasia, metastasis, or other benign pathologies.

After adrenalectomy:

  • Patients may undergo laparoscopic adrenalectomy, with a median hospital length of stay of 3 days.
  • Post-operative morbidity rate is 17%, with the most severe complication being Clavien-Dindo grade II.
  • Surgeons must have knowledge of appropriate pre-operative testing and post-operative surveillance, especially due to the frequent association of adrenalectomy for non-neuroblastic pathologies with genetic mutations and syndromes.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with adrenalectomy?
  2. How will my adrenal function be affected after the surgery?
  3. Will I need any additional testing or surveillance after the procedure?
  4. What is the recovery process like after adrenalectomy?
  5. How long will I need to stay in the hospital after the surgery?
  6. Will I need any medications or hormone replacement therapy after the procedure?
  7. Are there any dietary or lifestyle changes I should make post-surgery?
  8. What is the success rate of adrenalectomy for my specific condition?
  9. Are there any long-term effects or implications of having one or both adrenal glands removed?
  10. Are there any alternative treatment options available for my condition?

Reference

Authors: Traynor MD Jr, Sada A, Thompson GB, Moir CR, Bancos I, Farley DR, Dy BM, Lyden ML, Habermann EB, McKenzie TJ. Journal: Pediatr Surg Int. 2020 Feb;36(2):129-135. doi: 10.1007/s00383-019-04589-9. Epub 2019 Nov 5. PMID: 31691026