Modern Surgical Management of Familial and Sporadic Parathyroid and Adrenal Disorders

摘要: Primary hyperparathyroidism (pHPT) is a common disease of the parathyroid glands. Multiple endocrine neoplasia (MEN) 1-related pHPT most often caused by multiglandular and can best be treated with subtotal parathyroidectomy (3-3½ glands) bilateral transcervical thymectomy to lower risk recurrent persistent disease. Also, permanent hypoparathyroidism (hypocalcaemia) significantly than after total autotransplantation.MEN2A-related sporadic are solitary effectively (low recurrence rate) safely nerve damage) minimally invasive parathyroidectomy. Laparoscopic adrenalectomy procedure choice for adrenal tumors. Tumor size significant predictor short-term outcome laparoscopic adrenalectomy. Patients tumors larger 3 cm have longer operation time, higher conversion rate, more estimated blood loss, intraoperative postoperative complications, hospital stay compared patients smaller cm. In addition, clinicopathological diagnosis has an effect on surgical outcome, however lesser degree tumor size. metastases, hypercortisolism, pheochromocytoma had loss aldosteronoma, while time was longer. Identification control vein critical steps in Variants venous anatomy, number veins draining gland or location relation hepatic inferior phrenic vein, occur percentage patients, particularly pheochromocytomas large The presence variant anatomy doesn’t, however, lead perioperative complications A rare (nor)epinephrine-secreting, neuro-endocrine gland. It cause severe hypertension, headache, palpitations, but also crisis, which shock multi-organ failure possibly death. Elective (laparoscopic) treatment choice. Preoperative alpha- (and beta-) blockers necessary hemodynamic instability, hypotension resection. Both presenting crisis as well MEN2 small tumors, who present less symptoms should not excluded from this (pre)treatment regime. Pheochromocytomas half frequently bilateral. unilateral feasible strategy patients. acceptable method, because malignant rarely generally slow progression MEN2, yearly screening timely surgery minimize hypertensive pheochromocytoma. Subtotal low rates great advantage preserving adrenocortical function, thereby preventing need chronic steroid replacement.