Outcomes and timing for intervention of partial adrenalectomy in patients with a solitary adrenal remnant and history of bilateral phaeochromocytomas

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? At the present time, outcomes of the patients treated with partial adrenalectomy on a solitary adrenal are described in less than 100 patients in the world literature. In patients with bilateral pheochromocytomas, the timing for intervention as well as size threshold to allow for steroid independence is not known. This manuscript provides evidence that staged adrenal surgery as well as operating on the solitary adrenal before the largest tumour reaches 4 cm may allow for best functional outcomes and steroid independence. OBJECTIVE To evaluate the outcomes and timing of intervention for adrenal‐sparing surgery in patients left with a solitary adrenal remnant after bilateral adrenal surgeries. PATIENTS AND METHODS Patients were included in the study if they had undergone bilateral adrenal surgery as a treatment for phaeochromocytoma and were left with a solitary adrenal remnant. Perioperative, functional and oncological outcomes were evaluated in 21 patients who met the inclusion criteria. RESULTS There was minimal perioperative morbidity and no perioperative mortality. After a median (range) follow‐up of 21 (3–143) months, there were two cases of persistent disease. Ten patients (48%) required steroid supplementation upon discharge, with four subsequently discontinuing this treatment. Patients were more likely to require steroid supplementation after surgery if they underwent simultaneous adrenalectomy and contralateral partial adrenalectomy, rather than staged procedures (86 vs 40%, P= 0.02). Patients who underwent surgery for tumours >4 cm were more likely to require long‐term steroids than patients who underwent surgery for lesions