Anesthetic management of a child with adrenocortical virilizing tumor excision

What is it about?

A multidisciplinary team which includes endocrinologist, radiologist, anesthesiologist, and surgeon is a prerequisite for adrenal gland surgeries. The prime indications for adrenal gland surgery can include both hormonal secreting and non-hormonal secreting tumors. Adrenal hormonal secreting tumors usually present to the anesthesiologist with a unique set of challenges which require 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 the endocrine issues and anesthetic management during hormone secreting adrenal gland tumor resection.

Featured Image

Photo by National Cancer Institute on Unsplash

Photo by National Cancer Institute on Unsplash

Why is it important?

Adrenocortical carcinoma, also called adrenal cortical carcinoma (ACC) and adrenal cortex cancer, is an aggressive cancer with poor prognosis originating from the cortex of the adrenal gland. Adrenocortical tumors (ACT) are a rare with an have incidence of one to two cases per million population and are still rarer in the pediatric age group. group. Theses carcinomas can be functional or may be associated with syndromes of hormone overproduction with a 5-year survival rate of below 30 %. ACC can be diagnosed by the various the endocrine signs of steroid excess, symptoms due to tumor growth. Hormonal investigations in ACC usually demonstrates steroid over secretion dominated by a co-secretion of cortisol and androgens. Imaging by CT scan or MRI will show a large heterogeneous tumor with a low-fat content4,5. Complete surgical resection is the mainstay treatment for patients with ACC6. Surgical removal of a localized tumor and absent metastatic disease are associated with improved survival7. In patients diagnosed with functional adrenal tumors undergoing adrenalectomy, epidural anesthesia in addition to general anesthesia is a very safe and effective modality prevent the fluctuations in hormone levels8. Hemodynamic instabilities can be solved by glucocorticoid replacement given at the start of tumor resection at a dose equal to full replacement of adrenal output during periods of extreme stress. 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 hemodynamic to a great extent

Perspectives