title: The Use of Three-dimensional Printers for Partial Adrenalectomy: Estimating the Resection Limits.
abstract: OBJECTIVE
  To avoid hormonal replacement after partial adrenalectomy (PA), establishing the precise limit of an adrenal gland resection is essential. Herein, we evaluated the use of three-dimensional (3D) adrenal gland printing and volumetry measurement before PA to improve the determination of the remnant gland volume.
  
  
  METHODS
  Concomitant total adrenalectomy and a contralateral PA were performed in a patient with primary macronodular adrenal hyperplasia that exhibited mild hypercortisolism, arterial hypertension, and diabetes. Before surgery, a 3D replica of the adrenal gland to be partially resected was printed and given to the surgeon. The volumetry of the gland was measured by computed tomography 3D image reconstruction.
  
  
  RESULTS
  No postoperative complications were noted. Immediately after the surgery, the patient initiated corticosteroid replacement, which was interrupted 52 days later. At the 6-month follow-up, the patient stopped using medications for diabetes and reduced the number of antihypertensive medications from 5 to 1. The pre- and postoperative serum cortisol levels were, respectively, 28 and 8.7 mcg/dl (n 5-25 mcg/dl). The pre- and postoperative adrenocorticotropic hormone levels were, respectively, <5 and 88 pg/ml (n 7.2-63 pg/ml). The postoperative adrenal volume was 12% of the total preoperative adrenal volume.
  
  
  CONCLUSIONS
  The use of 3D printing associated with adrenal volumetry might be a useful tool for the surgeon when performing PA, enabling an estimation of the remnant gland volume.
authors.affiliation: Adrenal Disorders Group, Division of Urology, Hospital das Clínicas, University of São Paulo, School of Medicine, São Paulo, Brazil. Electronic address: vsrougi@gmail.com.
authors.forename: Victor
authors.initials: V
authors.lastname: Srougi
authors.affiliation: Radiology Department, Hospital das Clínicas, University of São Paulo, School of Medicine, São Paulo, Brazil.
authors.forename: Bruno A
authors.initials: BA
authors.lastname: Rocha
authors.affiliation: Adrenal Disorders Group, Division of Urology, Hospital das Clínicas, University of São Paulo, School of Medicine, São Paulo, Brazil.
authors.forename: Fabio Y
authors.initials: FY
authors.lastname: Tanno
authors.affiliation: Adrenal Disorders Group, Division of Endocrinology, Hospital das Clínicas, University of São Paulo, School of Medicine, São Paulo, Brazil.
authors.forename: Madson Q
authors.initials: MQ
authors.lastname: Almeida
authors.affiliation: Radiology Department, Hospital das Clínicas, University of São Paulo, School of Medicine, São Paulo, Brazil.
authors.forename: Ronaldo H
authors.initials: RH
authors.lastname: Baroni
authors.affiliation: Adrenal Disorders Group, Division of Endocrinology, Hospital das Clínicas, University of São Paulo, School of Medicine, São Paulo, Brazil.
authors.forename: Berenice B
authors.initials: BB
authors.lastname: Mendonça
authors.affiliation: Adrenal Disorders Group, Division of Urology, Hospital das Clínicas, University of São Paulo, School of Medicine, São Paulo, Brazil.
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
authors.affiliation: Adrenal Disorders Group, Division of Endocrinology, Hospital das Clínicas, University of São Paulo, School of Medicine, São Paulo, Brazil.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Fragoso
authors.affiliation: Adrenal Disorders Group, Division of Urology, Hospital das Clínicas, University of São Paulo, School of Medicine, São Paulo, Brazil.
authors.forename: Jose L
authors.initials: JL
authors.lastname: Chambô
mesh_terms: D000307:Adrenal Gland Diseases / Q000601:surgery*; D000311:Adrenal Glands / Q000473:pathology*; D000315:Adrenalectomy / Q000379:methods*; D000368:Aged; D006801:Humans; D006965:Hyperplasia / Q000601:surgery; D008297:Male; D009929:Organ Size; D066330:Printing, Three-Dimensional