Bilateral Adrenalectomy - An Overview!

Multiple Endocrine Neoplasia (MEN) refers to a group of disorders affecting the endocrine system. The disease triggers the growth of benign or malignant tumours in multiple endocrine glands and may cause the glands to produce more hormones or become overactive. 

Of the various forms of MEN, Type 1 and Type 2 are the most common ones. 

MEN Type 1

MEN Type 1 involves tumours of the pituitary gland, parathyroid glands, or the pancreas. Most often, the tumour appears first in the parathyroid glands. The initial symptoms of the disease are signs of a hyperactive thyroid gland.

Symptoms -

• Bone thinning

• Kidney stones

• Vomiting and nausea

• High blood pressure

• Fatigue and weakness

MEN Type 2 - 

MEN Type 2 has three subtypes – Type 2A, Type 2B, and Familial Medullary Thyroid Carcinoma. Most patients with Type 2 MEN develop FMTC regardless of their subtype. Some people with the disorder may develop a tumour in the adrenal gland called pheochromocytoma. 

Symptoms -

• Abdominal pain

• Jaundice – pale eyes and yellow skin

• Tenderness

• Bone pain

How is MEN diagnosed?

The condition is typically diagnosed when a person develops tumours in at least two or more of the endocrine glands. The doctor will also take into consideration your family history of multiple endocrine neoplasias. Genetic testing is done to check for specific mutations in genes associated with the disease. 

How does Bilateral Adrenalectomy treat MEN?

Laparoscopic or bilateral adrenalectomy has gained favour and popularity as a preferred surgical approach in the treatment of Multiple Endocrine Neoplasia, particularly in Type 2 patients. 

The minimally invasive procedure involves making small incisions to remove the adrenal tumour. The operation is performed under general anaesthesia. About 3-4 incisions, each measured at 1cm, is made in the abdomen. The surgeon then inserts a small instrument and a telescope into the abdomen through the keyhole incisions. This allows him/her to free and dissect the diseased adrenal gland without having to use the hands. 

The entire procedure, which takes about 3 hours, provides patients with minimal pain, discomfort, and fewer complications. In comparison to traditional open surgery that requires larger incisions, the bilateral adrenalectomy resulted in faster recovery time and shorter hospital stay. Hence, it is becoming a feasible and preferred choice of treatment for Multiple Endocrine Neoplasia.