Anesthetic Management of a Child with Adrenocortical Virilizing Tumour
Excision

Sonal      Khatavkar; Chhaya      Suryawanshi; Shahbaz      Haroon; Deepali      Patil

doi:10.2174/04666230203113909

Abstract

Introduction: A multidisciplinary team that includes an endocrinologist, radiologist, anesthesiologist, and surgeon is a prerequisite for adrenal gland surgeries. The prime indications for adrenal gland surgery can include both hormonal and non-hormonal secreting tumors. Adrenal hormone secreting tumors usually present to the anesthesiologist with a unique set of challenges that require a good preoperative evaluation and hemodynamic control, corrections of all electrolytes and metabolic imbalances, a carefully planned anesthetic strategy, detailed knowledge about the specific diseases, maintaining of postoperative adrenal function, and finally a good collaboration with other involved colleagues. This review will mainly focus on endocrine issues and anesthetic management during the resection of a hormone secreting adrenal gland tumor.

Case Presentation: This is a case report of a 1.5-year-old boy weighing 13.5 kg who was admitted to our hospital with complaints of an increase in height and weight more than appropriate for age, macroglossia, facial oedema, abnormally enlarged genitals and development of pubic hair for 6 months. On examination along with signs of precocious puberty, he had presented raised blood pressure for which he was started on medication.

Results: On ultrasonography, a 6*4 cm mass was seen in the right supra renal fossa which was confirmed on the CECT scan. He underwent surgery for the excision of the tumor mass under general anesthesia with a regional blockade (epidural). The histopathological report of the tumor specimen revealed Adrenocortical Carcinoma. The child required post-operative steroid treatment and subsequently was started on chemotherapy as well.

Conclusion: The perioperative medical management of active Adreno Cortical Carcinomas is complex enough, but anesthesia causes even more substantial changes in physiology. Treatment with steroids helps to maintain hemodynamics to a great extent.

[1]
Mansmann G, Lau J, Balk E, Rothberg M, Miyachi Y, Bornstein SR. The clinically inapparent adrenal mass: Update in diagnosis and management. Endocr Rev  2004; 25(2): 309-40.
 [http://dx.doi.org/10.1210/er.2002-0031] [PMID: 15082524]

[2]
Viani GA, Stefano EJ, Afonso SL. Higher-than-conventional radiation doses in localized prostate cancer treatment: A meta-analysis of randomized, controlled trials. Int J Radiat Oncol Biol Phys  2009; 74(5): 1405-18.
 [http://dx.doi.org/10.1016/j.ijrobp.2008.10.091] [PMID: 19616743]

[3]
Figueiredo BC, Sandrini R, Zambetti GP, et al. Penetrance of adrenocortical tumours associated with the germline TP53 R337H mutation. J Med Genet  2005; 43(1): 91-6.
 [http://dx.doi.org/10.1136/jmg.2004.030551] [PMID: 16033918]

[4]
Libè R, Fratticci A, Bertherat J. Adrenocortical cancer: Pathophysiology and clinical management. Endocr Relat Cancer  2007; 14(1): 13-28.
 [http://dx.doi.org/10.1677/erc.1.01130] [PMID: 17395972]

[5]
Etxabe J, Vazquez JA. Morbidity and mortality in Cushing’s disease: An epidemiological approach. Clin Endocrinol  1994; 40(4): 479-84.
 [http://dx.doi.org/10.1111/j.1365-2265.1994.tb02486.x] [PMID: 8187313]

[6]
Miller BS, Ammori JB, Gauger PG, Broome JT, Hammer GD, Doherty GM. Laparoscopic resection is inappropriate in patients with known or suspected adrenocortical carcinoma. World J Surg  2010; 34(6): 1380-5.
 [http://dx.doi.org/10.1007/s00268-010-0532-2] [PMID: 20372905]

[7]
Chiche L, Dousset B, Kieffer E, Chapuis Y. Adrenocortical carcinoma extending into the inferior vena cava: Presentation of a 15-patient series and review of the literature. Surgery  2006; 139(1): 15-27.
 [http://dx.doi.org/10.1016/j.surg.2005.05.014] [PMID: 16364713]

[8]
Nizamoğlu A, Salihoğlu Z, Bolayrl M. Effects of epidural-and-general anesthesia combined versus general anesthesia during laparoscopic adrenalectomy. Surg Laparosc Endosc Percutan Tech  2011; 21(5): 372-9.
 [http://dx.doi.org/10.1097/SLE.0b013e31822dd5e1] [PMID: 22002277]

[9]
Mulita F, Verras GI, Iliopoulos F, et al. Analgesic effect of paracetamol monotherapy vs. the combination of paracetamol/parecoxib vs. the combination of pethidine/paracetamol in patients undergoing thyroidectomy. Przegl Menopauz  2021; 20(4): 226-30.
 [http://dx.doi.org/10.5114/pm.2021.110955] [PMID: 35069077]

[10]
Mulita F, Parchas N, Solou K, et al. Postoperative pain scores after open inguinal hernia repair: Comparison of three postoperative analgesic regimens. Med Arh  2020; 74(5): 355-8.
 [http://dx.doi.org/10.5455/medarh.2020.74.355-358] [PMID: 33424089]

[11]
Mulita F, Karpetas G, Liolis E, Vailas M, Tchabashvili L, Maroulis I. Comparison of analgesic efficacy of acetaminophen monotherapy versus acetaminophen combinations with either pethidine or parecoxib in patients undergoing laparoscopic cholecystectomy: A randomized prospective study. Med Glas  2021; 18(1): 27-32.