[Preoperative and postoperative management of adrenal masses]

Rosa Maria Paragliola, Alfredo Pontecorvi, Salvatore Maria Corsello, Maria Pia Ricciato, Francesca Gallo, Antonia De Rosa, Francesca Ianni, Pietro Locantore, Paola Senes

Risultato della ricerca: Contributo in rivistaArticolo in rivista

Abstract

The surgical approach of adrenal masses requires a careful preoperative and postoperative management. In order to avoid iatrogenic hypocortisolism, Cushing patients have to be treated, before adrenal surgery and then every eight hours, with hydrocortisone 100 mg iv. The therapy should be gradually reduced to 10-20 mg/die by mouth for six-twelve months. In primary hyperaldosteronism the target of medical treatment is to control blood pressure and serum potassium values as well as to normalize the circulating aldosterone levels or to obtain mineralocorticoid receptor blockade. Epleronone and spironolactone are the most common used drugs. Spironolactone has long been the drug of choice while epleronone represents a newer more expensive alternative with fewer side effects. Postoperative management generally does not require steroid replacement therapy. The management of pheochromocytoma requires a careful medical preparation for surgery: in fact, the surgical removal of a pheochromocytoma is a high-risk procedure and an experienced surgeon/anesthesiologist team is required. The preoperative medical therapy is aimed at controlling hypertension (including preventing a hypertensive crisis during surgery) and at avoiding cardiac arrhythmia. The most common used drugs are alpha-adrenergic blockade: phenoxybenzamine is an irreversible, long-acting, nonspecific alpha-adrenergic blocking agent. Doxazosine is a selective alpha1-adrenergic blocking agent with a more favorable side-effect profile, being less related to postoperative hypotension. Postsurgical management is aimed at expanding plasma volume: a copious hydration is required while the use of dopamine in hemodynamin support is not effective because of the preoperative use of alpha-blocking agents.
Titolo tradotto del contributo[Autom. eng. transl.] [Preoperative and postoperative management of adrenal masses]
Lingua originaleItalian
pagine (da-a)332-335
Numero di pagine4
RivistaIL GIORNALE DI CHIRURGIA
Volume31
Stato di pubblicazionePubblicato - 2010

Keywords

  • Adrenal Gland Neoplasms
  • Adrenergic alpha-Antagonists
  • Aldosterone Antagonists
  • Anti-Inflammatory Agents
  • Cushing Syndrome
  • Drug Therapy, Combination
  • Humans
  • Hydrocortisone
  • Hyperaldosteronism
  • Pheochromocytoma
  • Postoperative Care
  • Preoperative Care
  • Spironolactone
  • Treatment Outcome

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