Don't Miss the Hormone-producing Tumor!:Endocrinological Assessment and Management of Functioning Tumors in the Adrenals, Retroperitoneum, and Mediastinum

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  • OKAMOTO Takahiro
    Department of Breast & Endocrine Surgery, Tokyo Women's Medical University
  • YOSHIDA Yusaku
    Department of Breast & Endocrine Surgery, Tokyo Women's Medical University

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  • ホルモン産生腫瘍を見逃すな！―副腎，後腹膜，縦隔腫瘍の内分泌学的管理―
  • ホルモン サンセイ シュヨウ オ ミノガス ナ! : フクジン,アトバラマク,ジュウカク シュヨウ ノ ナイブンピガクテキ カンリ

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<p>Tumors arising in the adrenal gland, retroperitoneum, or mediastinum may autonomically produce hormones. Missing the correct diagnosis may put the patient at risks of developing hemodynamic instability during the operation or postoperative adrenal insufficiency. Responsible surgeons need to be aware of such a rare disease and to prepare themselves for appropriate perioperative management.</p><p>Functioning tumors of the adrenal gland include pheochromocytoma, cortisol-producing neoplasm, and aldosterone-producing tumor. Neoplasms of paraganglia in the retroperitoneum or mediastinum producing noradrenaline are known as paragangliomas.</p><p>It is essential to give α-blockers preoperatively to control hypertension and restore circulatory volume in patients with pheochromocytoma/paraganglioma. Intra- and postoperative glucocorticoid administration for a long period of time is vital to prevent adrenal failure from various stresses in patients with Cushing's or subclinical Cushing's syndrome due to cortisone-producing tumors. The confirmatory tests to make the correct diagnosis and adrenal vein sampling to localize the lesion are keys to the successful management of patients with primary aldosteronism.</p><p>Surgeons who are unfamiliar with endocrinological care should consult with endocrine surgeons or endocrinologists.</p>

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