ADRENAL SURGERY
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1
What is a phaeochromocytoma?
A rare tumor of the adrenal medulla that overproduces catecholamines (like epinephrine and norepinephrine).
2
What is the classic triad of symptoms for a phaeochromocytoma?
Episodic headache, tachycardia (fast heart rate), and diaphoresis (excessive sweating).
3
What is the most common clinical sign of a phaeochromocytoma?
Hypertension (high blood pressure), which can be sustained or occur in attacks.
4
What is the surgical procedure typically used to remove a phaeochromocytoma?
Adrenalectomy (removal of the adrenal gland).
5
What pre-operative medication is essential for a patient undergoing surgery for phaeochromocytoma?
Alpha-blockers (and sometimes beta-blockers) to control blood pressure and heart rate and prevent a hypertensive crisis.
6
Why is the size of an adrenal tumor important in determining treatment?
Adrenal masses larger than 4-6 cm are considered high risk for cancer and should be surgically removed.
7
What is an Adrenal Incidentaloma?
An adrenal mass that is discovered incidentally during an imaging scan (CT or MRI) performed for another reason.
8
What condition is caused by an adrenal tumor that secretes excess cortisol?
Cushing's Syndrome.
9
What is the benefit of the Mini Back Scope Adrenalectomy (MBSA)?
It is considered a minimally invasive and safe operation for adrenal glands.
10
What specialized imaging test can help confirm a phaeochromocytoma and identify multiple or extra-adrenal tumors?
MIBG (meta-iodobenzylguanidine) or Ga-68 Dotatate PET/CT scan.
11
What are the two main surgical approaches for adrenalectomy?
Laparoscopic (minimally invasive) and open.
12
What is the primary indication for adrenal surgery?
A hormonally active adrenal mass or a mass suspicious for malignancy.
13
What is the most common functional tumor of the adrenal cortex?
Aldosteronoma (causing primary hyperaldosteronism, or Conn's syndrome).
14
What pre-operative management is necessary for a patient with an aldosteronoma?
Mineralocorticoid receptor antagonists (like spironolactone) and blood pressure control.
15
What is the risk associated with a large, non-functional adrenal mass (>6 cm)?
Increased risk of being an adrenocortical carcinoma (ACC) and usually warrants resection.
16
What hormone replacement therapy is often required after bilateral adrenalectomy?
Both glucocorticoid and mineralocorticoid replacement.
17
What specific risk is associated with removing a cortisol-secreting tumor?
Post-operative adrenal insufficiency requiring temporary steroid replacement.
18
What position is often used for the laparoscopic posterior retroperitoneal approach to the adrenal gland?
Prone (face down) position.
19
What is another name for Conn's Syndrome?
Primary Hyperaldosteronism
20
What is the primary cause of Conn's Syndrome (Primary Hyperaldosteronism)?
Overproduction of aldosterone from one or both adrenal glands.
21
What are the two main causes of primary hyperaldosteronism?
An aldosterone-producing adenoma (APA) on one gland (Conn's tumor) or Bilateral Idiopathic Adrenal Hyperplasia (BAH).
22
What is the effect of excess aldosterone on the kidneys?
It promotes sodium reabsorption (leading to water retention and hypertension) and potassium excretion (leading to hypokalemia).
23
What is the classic electrolyte abnormality often seen in Conn's Syndrome?
Hypokalemia (low potassium), though many patients present with normal potassium levels.
24
What is the recommended screening test for Conn's Syndrome?
The Aldosterone-to-Renin Ratio (ARR), which will be elevated due to high aldosterone and suppressed renin.
25
What is the key physiological finding related to Renin in this syndrome?
Suppressed Plasma Renin Activity (PRA), as the kidneys sense the high blood pressure and volume expansion.
26
What is the definitive, localizing diagnostic procedure to distinguish unilateral from bilateral disease?
Adrenal Vein Sampling (AVS) .
27
What is the definitive treatment for an Aldosterone-Producing Adenoma (APA)?
Unilateral Adrenalectomy (surgical removal of the affected gland).
28
What is the primary medical treatment for Bilateral Adrenal Hyperplasia (BAH)?
Mineralocorticoid Receptor Antagonists (MRAs), such as Spironolactone or Eplerenone.
29
What is the most common presenting sign/symptom of Conn's Syndrome?
Resistant Hypertension (high blood pressure that is difficult to control with multiple medications)
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