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RETROPERITONEAL LAPAROSCOPIC ADRENALECTOMY IN A PREGNANT WOMAN WITH CUSHING’S SYNDROME
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- MANAMI AISHIMA
- From the Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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- MASATOSHI TANAKA
- From the Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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- MASASHI HARAOKA
- From the Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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- SEIJI NAITO
- From the Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Description
A 31-year-old woman presented at gestational week 26 with facial edema and hypertension. On physical examination she had features typical of Cushing’s syndrome and blood pressure of 184/104 mm. Hg. Laboratory examination demonstrated hypokalemia (potassium 2.9 mEq./l., normal 3.6 to 4.9) and mild anemia (hemoglobin 9.5 gm./dl., normal 12.0 to16.0). Plasma cortisol was 58.6 mg./dl (normal 5.5 to17.0), adrenocorticotropic hormone 5.5 pg./ml. (normal 8.2 to 54.8) and urinary cortisol excretion 1,860 mg./24 hours (normal 30 to 100). Furthermore, plasma cortisol was not suppressed with high dose (8 mg.) dexamethasone. Ultrasonography and magnetic resonance image showed a 3 cm. mass in the left adrenal gland. However, the sella turcica was normal size on magnetic resonance imaging. These findings prompted the diagnosis of Cushing’s syndrome due to left adrenal adenoma. Although hypertension was treated with methyldopa, blood pressure had not decreased by gestational week 31. Retroperitoneoscopic adrenalectomy was successfully performed with the patient in the right full lateral position, and under general and epidural anesthesia (figs. 1 and 2). Pneumoperitoneum was created with carbon dioxide insufflation at 10 mm. Hg. Operating time was 125 minutes and estimated blood loss was 250 ml. Convalescence was uneventful. Pathological examination confirmed the diagnosis of Cushing’s syndrome due to an adrenocortical adenoma. Postoperatively, temporary pulmonary edema developed but the remainder of the pregnancy was uneventful. At gestational week 40 a healthy 2,470 gm. male neonate was delivered via a normal vaginal delivery without any complications.
Journal
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- Journal of Urology
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Journal of Urology 164 (3 Part 1), 770-771, 2000-09
Ovid Technologies (Wolters Kluwer Health)
