Adrenal Tumors

Question 1

Gostelow, JVIM, 2013:
Plasma-free metanephrine and normetanephrine measurement for diagnosis of pheochromocytoma

1. Sensitivity and specificity of plasma-free metanephrine for diagnosis of pheochromocytoma?
2. Sensitivity and specificity of plasma-free normetanephrine for diagnosis of pheochromocytoma?

Answer 1

Gostelow, JVIM, 2013:

1. Plasma-free metanephrine: moderate sensitivity, excellent specificity
2. Plasma-free normetanephrine: excellent sensitivity, excellent specificity

Question 2

Lo, JVIM, 2014:
Aldosterone-secreting adrenocortical tumors in cats

1. Intra-op complications?
2. What % of tumors had vascular invasion?
3. Mortality rate?
4. Overall MST?
5. Risk factor for lower MST?

Answer 2

Lo, JVIM, 2014:

1. Intra-op complications: hypotension (70%), haemorrhage (70%), ventricular arrhythmias (10%)
2. 70% had vascular invasion
3. 20% mortality rate
4. Overall MST: 1297 days
5. Anesthesia >4hrs was associated with lower MST - for every 1hr increase in anesthesia time, the hazard of death increased by 9

Question 3

Barrera, JAVMA, 2013:
Risk factors for outcome following adrenalectomy

1. Intra-op vs post-op complication rates?
2. Intra-op vs post-op mortality rates?
3. Pre-op and post-op factors negatively associated with short-term survival?
4. Which dogs were more likely to develop DIC post-op?

Answer 3

Barrera, JAVMA, 2013:

1. Complication rates: 82% intra-op vs 44% post-op (hypotension most common intra-op, V+/D+ most common post-op)
2. Mortality rates: 8% intra-op vs 19% post-op (86% of the intra-op deaths were in dogs with pheochromocytomas, and 71% of the intra-op death were in dogs with naval invasion)
3. Factors negatively associated with short-term survival: pheochromocytoma, canal invasion, post-op DIC, post-op pancreatitis, post-op hypoxemia, post-op renal failure, post-op hypotension
4. Dogs with pheochromocytoma and dogs that received intra-op transfusions with blood products were more likely to develop DIC post-op

Question 4

Andrade, Vet Surg, 2014:
Intercostal approach for right adrenalectomy in dogs

1. Intra-op complications?
2. Post-op complications?

Answer 4

Andrade, Vet Surg, 2014:

1. Intra-op complications: hypotension, hypothermia, hemorrhage
2. Post-op complications: hypoxemia, hypertension, UTI, incisional infection, hemorrhage, seizure, aspiration pneumonia, premature ventricular contractions

Question 5

Oblak, Vet Surg, 2016:
Bilateral adrenalectomy

1. Intra-op complication rate?
2. Post-op complication rate?
3. Mortality rate?
4. What % of dogs had coexisting pheochromocytoma and pituitary hyperadrenocorticism?

Answer 5

Oblak, Vet Surg, 2016:

1. Intra-op complication rate: 11%
2. Post-op complication rate: 33%
3. Mortality rate: 11%
4. 22% had coexisting pheochromocytoma and pituitary hyperadrenocorticism

Question 6

Mayhew, Vet Surg, 2018:
Phrenicoabdominal venotomy for tumor thrombectomy

1. What % of dogs required extension of the phrenicoabdominal venotomy into a cavotomy due to fragmentation of the thrombus during removal?
2. Intra-op complication rate?
3. Post-op mortality rate?
4. What is the key to using this technique?

Answer 6

Mayhew, Vet Surg, 2018:

1. 13% required extension of the phrenicoabdominal venotomy into a cavotomy due to fragmentation of the thrombus during removal
2. Intra-op complication rate: 13%
3. Post-op mortality rate: 25%
4. The key to using this technique is the presence of a modestly sized thrombus whose maximal width does not greatly exceed the width of the phrenicoabdominal vein at its entry point into the vena cava

Question 7

Mayhew, Vet Surg, 2019:
Per-op morbidity and mortality associated with adrenalectomy and cavotomy

1. Distribution of tumor types?
2. What % of the thrombi terminated caudal to the diaphragm and what % terminated cranial to the diaphragm?
3. Mortality rate?
4. What was associated with a greater risk of death?

Answer 7

Mayhew, Vet Surg, 2019:

1. 80% pheochromocytomas, 16% adrenocortical carcinomas, 4% unknown type
2. 80% of thrombi terminated caudal to the diaphragm, and 11% terminated cranial to the diaphragm (remaining 9% were unknown)
3. Mortality rate: 24%
4. Termination of the thrombus cranial to the diaphragm was associated with a greater risk of death, but not tumor type or size

Question 8

Knight, Vet Surg, 2019:
Variations in surgical technique for adrenalectomy and cavotomy

1. Mortality rate?
2. Effect of extension of caval thrombus beyond the hepatic hilus on outcome?

Answer 8

Knight, Vet Surg, 2019:

1. Mortality rate: 21%
2. No effect of extension of caval thrombus beyond the hepatic hilus on outcome