Endocrine Abstracts

Objective: We reviewed perioperative management of patients undergoing adrenal surgery at UHS between 1/12/2020 to 1/6/2022 (19-month period) since formalisation of its regional adrenal MDT.

Results: 45 adrenalectomies were performed during this period with all cases being discussed at the adrenal MDT, of which 24 (53%) were referred from peripheral hospitals. Laparoscopic surgery was performed in 35/45 (78%) (median length of stay (LOS): 3d), open in 10/45 (22%) (median LOS: 6d). 100 % of eligible patients had metanephrines checked and 96% had 1 mg overnight dexamethasone test. 36/45 (80%) were symptomatic lesions or adrenal metastases. 9/45 (20%) were incidentally discovered: 5xPheochromocytoma, 1xadrenocortical carcinoma (ACC), 1xMild Autonomous Cortisol Excess (MACE) 1xConn’s, 1xNon-functioning. 21/45 (47%) had malignant histology (3xACC, 3xSarcoma, 4xRCC, 11xAdrenal metastases). Lesions > 6 cm (13/45) were malignant in 77%. Full staging imaging in 12/13, FDG PET in 4/13, open surgery in 9/13. 24/45 (53%) were benign (1xPeriadrenal paraganglioma, 15xAdrenal adenoma, 8xPheochromocytoma). 22/45 (49%) were functioning lesions (1xAndrogens secreting adenoma, 5xConn’s, 8xPheochromocytoma, 3xACC, 1xAdrenal Cushing’s, 4xMACE adenoma). All pheochromocytomas received pre-operative preparation and MIBG. 3/5 patients with Conn’s adenoma underwent lateralisation with AVS, 2/5 opted for surgery without AVS (1xco-secretory, 1xyoung patient). All achieved BP/potassium normalisation off medications. 19/45 were identified at risk for post-operative adrenal insufficiency of whom 89% had perioperative steroid plan documented in notes.

Conclusion: 49% adrenalectomies for functioning and 47% for malignant disease (including rising numbers of tumours such as ACC and sarcomas), emphasise the role of the adrenal MDT and the importance of concentrating expertise of adrenal surgeons experienced in laparoscopic, open and oncological surgery, as well as adrenal oncologist with ACC and mitotane experience. MDT continues to ensure, that those at risk of post-surgical hypoadrenalism, suspected ACC and with functioning adrenal disease undergo full endocrine work-up and have a documented perioperative plan.