Abstract Book - 26th ESPU Congress, Joint Meeting with ICCS + SPU + AAP/SOU + AAPU + SFU

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VR-15 (VS)
RECURRENCE AFTER PARTIAL ADRENALECTOMY IN A CHILD WITH
METACHRONIC BILATERAL PHEOCHROMOCYTOMA - LAPAROSCOPIC APPROACH
Francisco DENES1, Lorena OLIVEIRA 1, Roberto LOPES1, Alessandro TAVARES1, Marcos MACHADO1, Maria Helena
SIRCILI2 and Berenice MENDONCA2
1) Hospital das Clinicas - University of Sao Paulo, Urology, Sao Paulo, BRAZIL - 2) Hospital das Clinicas - University of
Sao Paulo, Endocrinology, Sao Paulo, BRAZIL
PURPOSE
To present a case of laparoscopic resection of a recurrent tumor after partial adrenalectomy in a child with metachronic
bilateral pheochromocytoma associated with von HippelLindau's disease.
MATERIAL AND METHODS
The patient, whose father had been diagnosed with von HippelLindau's disease and treated of an unilateral adrenal
pheochromocytoma, presented at age 7 symptoms of night sweating and palpitation, and had the diagnosis of a 2.7cm
right adrenal pheochromocytoma. He was then submitted to a successful total right laparoscopic adrenalectomy, with
complete remission of the symptoms. At age 12, the symptoms recurred, and a left 2.6cm adrenal tumor was
diagnosed. Prospective preoperative US showed that besides the tumor there was a non-affected postero-lateral
segment of the gland that could be preserved. He was submitted to a transperitonial laparoscopic procedure, that
included section of the main adrenal vein and complete resection of the tumor, leaving the well vascularized remnant
adrenal in situ. Cortisone replacement was initiated but interrupted after two weeks, since laboratory controls showed
that the remnant adrenal was functioning, with physiologic corticosteroid levels. After 21 months of follow up, a 2.3cm
recurrent left adrenal tumor was diagnosed. The patient underwent laparoscopic surgery with total resection of the
residual left adrenal.
RESULTS
Pathological examination of the specimen showed a benign pheochromocytoma with free margins. The patient had a
pancreatic fistula managed conservatively and was discharged from the hospital after 6 days. The child has a follow-up
of 23 months without any symptoms, currently receiving cortisone replacement.
CONCLUSIONS
Laparoscopic resection of a recurrent adrenal tumor after partial adrenalectomy is a feasible technique in children with
bilateral benign adrenal lesions.