Endocrine Abstracts

Historically, bilateral subtotal adrenalectomy was first attempted in patients with failed pituitary surgery for Cushing syndrome. Currently the operation is discussed predominantly in the context of familial phaeochromocytomas in an attempt to preserve sufficient cortical function and avoid life-long steroid dependence. The patients have to be informed of the significance of their particular genetic mutation, the impact of the size of tumours on the intraoperative feasibility of cortex-sparring, the risk of ipsilateral recurrence and the (limited) ability to ensure adequate stress-related steroid response. Technically the operation is made possible by the extensive venous drainage of the gland, such that dividing the main adrenal vein does not preclude preservation of viable and functional adrenal remnant. The advantages of the retroperitoneoscopic versus the laparoscopic approach will be discussed. Such patients should be referred to units/surgeons with established experience with adrenal surgery and this can only be achieved through centralization of these rare cases in dedicated medical institutions. Current issues regarding training and delivery of adrenal surgery will be mentioned.