title: Laparoscopic Unilateral Total and Contralateral Subtotal Adrenalectomy for Bilateral Adrenocorticotropic Hormone-Secreting Pheochromocytoma: Report of a Rare Case.
abstract: Background:Bilateral adrenal tumors are not common in clinical practice, but are an important source of ectopic adrenocorticotropic hormone (ACTH) secretion. Standard operative management for bilateral pheochromocytomas might dictate the removal of the involved adrenal gland and the removal of the contralateral adrenal gland. We present a case of bilateral ACTH-secreting pheochromocytoma treated with staged laparoscopic unilateral total and contralateral subtotal adrenalectomy.Case Presentation:A 58-year-old male with elevated hyperglycemia and general fatigue was hospitalized for pneumonia. CT incidentally revealed bilateral adrenal tumor. Biochemical examination was significant for elevated urinary metanephrine and normetanephrines, and plasma catecholamine level. CT scan of the head, neck, thorax, and pelvis was normal. Under the clinical diagnosis of ACTH-dependent pheochromocytoma, laparoscopic right total adrenalectomy was performed. As endocrinologic examination showed residual ACTH-dependent pheochromocytoma after surgery, laparoscopic left subtotal adrenalectomy was performed. Pathology analysis revealed pheochromocytoma with stained ACTH lesions in both adrenal tumors.Conclusion:This is a rare case of ACTH-secreting bilateral pheochromocytoma effectively treated with staged laparoscopic unilateral total and contralateral subtotal adrenalectomy, in which the production of ACTH was confirmed by immunohistochemical staining.
authors.affiliation: Department of Urology, Interdisciplinary Graduate School of Medicine, University of Yamanashi , Yamanashi, Japan .
authors.forename: Masanari
authors.initials: M
authors.lastname: Fukasawa
authors.affiliation: Department of Urology, Interdisciplinary Graduate School of Medicine, University of Yamanashi , Yamanashi, Japan .
authors.forename: Norifumi
authors.initials: N
authors.lastname: Sawada
authors.affiliation: Department of Urology, Interdisciplinary Graduate School of Medicine, University of Yamanashi , Yamanashi, Japan .
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Miyamoto
authors.affiliation: Department of Urology, Interdisciplinary Graduate School of Medicine, University of Yamanashi , Yamanashi, Japan .
authors.forename: Satoru
authors.initials: S
authors.lastname: Kira
authors.affiliation: Department of Urology, Interdisciplinary Graduate School of Medicine, University of Yamanashi , Yamanashi, Japan .
authors.forename: Tadashi
authors.initials: T
authors.lastname: Aoki
authors.affiliation: Department of Urology, Interdisciplinary Graduate School of Medicine, University of Yamanashi , Yamanashi, Japan .
authors.forename: Hidenori
authors.initials: H
authors.lastname: Zakoji
authors.affiliation: Department of Urology, Interdisciplinary Graduate School of Medicine, University of Yamanashi , Yamanashi, Japan .
authors.forename: Takahiko
authors.initials: T
authors.lastname: Mitsui
authors.affiliation: Department of Urology, Interdisciplinary Graduate School of Medicine, University of Yamanashi , Yamanashi, Japan .
authors.forename: Masayuki
authors.initials: M
authors.lastname: Takeda
keywords: CT scan; bilateral ACTH-secreting pheochromocytoma; immunostaining of ACTH; iodine-123-MIBG scintigraphy; laparoscopic unilateral total and contralateral subtotal adrenalectomy