Laparoscopic adrenalectomy for giant pheochromocytoma. What is the size limit ?

Aim: This case report describes a giant pheochromocytoma in a young female, experienced cardiac symptoms, treated by a transperitoneal laparoscopic right adrenalectomy.

Material And Methods: A 29 years old female with Taki-tsubo syndrome, consequent to the chronic release of catecholamines, with a palpable abdominal mass and vague abdominal symptoms was referred to our department. Abdominal CT scan has demonstrated a solid mass of 13 cm in the right adrenal space so, after pre-operative management with alpha-adrenergic receptor and beta blockade and a 3D CT scan reconstruction a right adrenalectomy laparoscopic approach was performed.

Results: Our result underlines that 13 cm in size for a giant pheochromocytoma is not an absolute contraindication to perform a minimally invasive approach in expert hands, with optimal surgical, oncological and cosmetic results.

Discussion: The only curative option for non-metastatic pheochromocytomas disease is surgical resection. Laparoscopic adrenalectomy is the treatment of choice but the limit size for a safe and feasible minimally invasive approach is not yet defined.

Conclusions: This case report could help to better define more solid recommendations in the next future and also provide landmarks and key steps for laparoscopic surgeons.

Key Words: Giant Pheochromocytoma, Laparoscopic Adrenalectomy, Pheochromocytoma Management.