Adrenalectomy for non-neuroblastic pathology in children

Michael D. Traynor, Alaa Sada, Geoffrey B. Thompson, Christopher R. Moir, Irina Bancos, David R. Farley, Benzon M. Dy, Melanie L. Lyden, Elizabeth B. Habermann, Travis J. McKenzie

Research output: Contribution to journalArticle

Abstract

Background: Adrenalectomy for non-neuroblastic pathologies in children is rare with limited data on outcomes. We reviewed our experience of adrenalectomy in this unique population. Methods: Retrospective study of children (age ≤ 18) who underwent adrenalectomy with non-neuroblastic pathology from 1988 to 2018. Clinical and operative details of patients were abstracted. Outcomes included length of stay and 30-day postoperative morbidity. Results: Forty children underwent 50 adrenalectomies (12 right-sided, 18 left-sided, 10 bilateral). Six patients (15%) presented with an incidental adrenal mass while 4 (10%) had masses found on screening for genetic mutations or prior malignancy. The remaining 30 (75%) presented with symptoms of hormonal excess. Nineteen patients (48%) underwent genetic evaluation and 15 (38%) had genetic predispositions. Diagnoses included 9 patients (23%) with pheochromocytoma, 8 (20%) with adrenocortical adenoma, 8 (20%) with adrenocortical carcinoma, 7 (18%) with adrenal hyperplasia, 2 (5%) with metastasis, and 6 (14%) with additional benign pathologies. Of 50 adrenalectomies, twenty-five (50%) were laparoscopic. Median hospital length of stay was 3 days (range 0–11). Post-operative morbidity rate was 17% with the most severe complication being Clavien–Dindo grade II. Conclusion: Adrenalectomy for non-neuroblastic pathology can be done with low morbidity. Its frequent association with genetic mutations and syndromes requires surgeons to have knowledge of appropriate pre-operative testing and post-operative surveillance.

Original languageEnglish (US)
JournalPediatric Surgery International
DOIs
StateAccepted/In press - Jan 1 2019

Keywords

  • Adrenocortical carcinoma
  • Endocrine
  • Laparoscopic adrenalectomy
  • Pediatric adrenalectomy
  • Pheochromocytoma
  • Primary pigmented nodular adrenocortical disease (PPNAD)

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

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    Traynor, M. D., Sada, A., Thompson, G. B., Moir, C. R., Bancos, I., Farley, D. R., Dy, B. M., Lyden, M. L., Habermann, E. B., & McKenzie, T. J. (Accepted/In press). Adrenalectomy for non-neuroblastic pathology in children. Pediatric Surgery International. https://doi.org/10.1007/s00383-019-04589-9