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- W2997138518 abstract "Few studies report on robotic surgery during pregnancy outside of cerclages. Here, we present a case of robotic adrenalectomy performed in the second trimester for a functional adrenal adenoma. A 33 year old G6P3023 at 6 weeks gestation with worsening hypertension was found to have a 4.2 cm right adrenal incidentaloma on CT imaging. Current guidelines recommend resection for adenomas greater than 4 cm due to concerns for malignancy. Maternal fetal medicine and endocrinology recommended surgical resection in the second trimester to optimize maternal-fetal outcomes. Prior to her pregnancy, she had refractory hypertension on amlodipine 10 mg and hydralazine 50 mg TID and was put on labetalol 100 mg BID at 8 weeks for pressure of 130/100. She continued to have worsening hypertension to 160/100 and 147/97 at 14 and 17 weeks, respectively, so her labetalol was increased to 200 mg BID. Biochemical workup revealed a suppressed ACTH. Therefore, the patient was thought to have preclinical Cushing’s syndrome defined by the lack of typical clinical findings of classic Cushing’s syndrome. At 19 weeks, the patient underwent an uncomplicated right robotic adrenalectomy with mild cephalad deviation of port placement and a maximum pneumoperitoneum of 12mmHg. Robotic approach, compared to laparoscopic, allows for better visualization and dissection capability around the gravid uterus. She received perioperative steroid therapy for potential hypothalamic-pituitary axis suppression. Postop day one, adrenal function was tested and found to be decreased thus she was discharged postoperative day one on prednisone 5 mg daily for steroid replacement. Pathology report showed adrenocortical adenoma. After surgery, her blood pressure normalized and she stopped antihypertensive medications 4 weeks postoperatively. Robotic adrenalectomy can be a surgical alternative in second trimester pregnant patients. Treatment of the adrenal adenoma during the pregnancy reversed the hypertensive disease and its maternal-fetal complications. A multidisciplinary team was pivotal to optimize outcomes." @default.
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- W2997138518 date "2020-01-01" @default.
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- W2997138518 title "409: Robotic adrenalectomy for functional adenoma in second trimester treats worsening hypertension" @default.
- W2997138518 doi "https://doi.org/10.1016/j.ajog.2019.11.425" @default.
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