Year 2013 Vol. 21 No 5

GENERAL AND SPECIAL SURGERY

U.A. PRIVALOV1, L.K. KULIKOV1, N.M. BYKOVA2, V.F. SOBOTOVICH1

DIAGNOSTICS AND SURGICAL TREATMENT FOR PHEOCHROMOCYTOMAS IN PATIENTS WITH ADRENAL INCIDENTALOMAS

SBEE APE "Irkutsk State Medical Academy of Post-Graduate Education"1
MAME "Municipal Clinical Hopital 10"2, Irkutsk,
The Russian Federation

Objectives. To evaluate efficacy of diagnostics and surgical treatment of pheochromocytomas among patients with incidental adrenal mass.
Methods. Within the prospective cohort study 322 patients with incidental adrenal mass have been investigated. Indications for surgery were defined to 169 patients. Pheochromocytoma (adrenal paraganglioma) was hystlogically verified in 15 patients. The effectiveness of clinical, laboratory and radiological methods of diagnosis of pheochromocytomas, intraoperative complications, the results of surgical treatment have been analyzed.
Results. Combination of arterial hypertension, tachycardia, hyperhidrosis and pallor among clinical signs of hypercatecholamine was considered as the highest diagnostics value (sensitivity 84%, specificity 86%). Multispiral computer tomography (MCT) with contrast is highly sensitive (96%) but low specific (56%) method in the differential diagnostics of pheochromocyte. Diagnostic value of determination of the catecholamine excretion with the urine turned out to be low (sensitivity 66% and specificity 96%). The test for dayly metanephrine urine had a great diagnostic significance (sensitivity 96% and specificity 100%). Despite on all pheochromocytomas were initially detected as incidentalomas, only 4 (26,6%) cases were referred as silent pheochromocytomas. Intraoperative catecholamine crisis developed in 3 (20%) patients undergoing open surgery and in 1 patient during laparoscopy. There were no postoperative complications and lethal outcomes. Residual arterial hypertension in long-term period after surgery was detected in 6 (40%) patients.
Conclusion. Clinical patterns of hypercatecholaminemia were observed in the majority of patients with adrenal pheochromocytoma previously verified as incidental adrenal mass. The main cause of delay diagnostics of pheochromacytomas was considered as noncompliance by general practitioners of the investigation algorithm of patients observation with arterial hypertension. Silent pheochromocytoma is the most dangerous one which can result as life threaten complication both during examination and surgery. Laparoscopic adrenalectomy is the operation of choice in the case when tumor size > 6 cm.

Keywords: incidental adrenal mass, silent pheochromacytoma, differential diagnostics, adrenalectomy
p. 24 30 of the original issue
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Address for correspondence:
664079, Rossiiskaia Federatsiia, g. Irkutsk, m-n. Iubileinyi, d. 100, GBOU DPO Irkutskaia gosudarstvennaia meditsinskaia akademiia poslediplomnogo obrazovaniia, kafedra khirurgii,
e-mail: privalov@smtp.ru,
Privalov Yurii Anatol'evich
Information about the authors:
Privalov Yu.A. PhD, an associate professor of the chair of surgery of SEI DPO "Irkutsk State Medical Academy for Postgraduate Education".
Kulikov L.K. MD, professor, a head of the chair of surgery of SEI DPO "Irkutsk State Medical Academy for Postgraduate Education".
Bykova N.M. PhD, a head of the endocrinology department of Irkutsk MAEH "Municipal clinical hospital 10".
Sobotovich V.F. PhD, an associate professor of the chair of surgery of SEI DPO "Irkutsk State Medical Academy for Postgraduate Education".
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