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Interventional Urology for Adrenal Gland Diseases

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Interventional Urology

Abstract

Adrenal glands can develop a wide variety of pathologies that are both intrinsic to the organ and metastatic from other organs. With the increasing use of cross-sectional imaging like computed tomography, adrenal masses are increasingly being detected in otherwise asymptomatic individuals. As interventional and minimally invasive techniques have been developed and refined, the gold standard intervention has shifted from open surgical excision to less morbid procedures performed percutaneously under image guidance. Interventional techniques to access the adrenal gland are challenging and require complex pre-procedural evaluation prior to intervention. Given the small size and location of adrenal glands in the retroperitoneum adjacent to critical structures such as the aorta, vena cava, liver, spleen, diaphragm, colon, and kidneys, interventional procedures for adrenal gland diseases require a combination of tremendous technical skill as well as broad clinical knowledge. This chapter comprehensively reviews the pathophysiology of the adrenal gland such as cortisol-secreting adenoma, aldosteronoma, myelolipoma, adrenocortical carcinoma, and pheochromocytoma, and adrenal metastases are reviewed with an emphasis on those pathologies that are amenable to interventional procedures. The adrenal gland is a common site for metastasis from primary malignancies arising in the lung, kidneys, prostate, and skin. Indications, workup, equipment requirements, and complications are covered in detail including imaging, blood work, and pre-procedural considerations. Interventional procedures such as adrenal mass biopsy and ablation techniques, adrenal vein sampling, and angioembolization are each thoroughly described. Imaging modalities are described in detail, and their role in evaluating adrenal diseases is explained. These imaging modalities such as computed tomography and magnetic resonance imaging are used not only for preoperative workup but also during interventional procedures for image guidance. Patient selection considerations are addressed, and the benefits of interventional techniques are summarized.

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Abbreviations

AAE:

Adrenal artery embolization

ACC:

Adrenal cortical carcinoma

CT:

Computed tomography

HCC:

Hepatocellular carcinoma

MRI:

Magnetic resonance imaging

PVA:

Polyvinyl alcohol

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Authors and Affiliations

  1. Department of Surgery, Howard University Hospital, Washington, DC, USA

    LaDonna E. Kearse & Anish Jay Jain

  2. Howard University College of Medicine, Washington, DC, USA

    Timothy King

  3. Division of Urology, Department of Surgery, Howard University Hospital, Washington, DC, USA

    Pamela W. Coleman

  4. Division of Urology, Department of Surgery, Howard University College of Medicine, Howard University Hospital, Washington, DC, USA

    Adam R. Metwalli

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  1. LaDonna E. Kearse
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  2. Timothy King
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  3. Anish Jay Jain
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  4. Pamela W. Coleman
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  5. Adam R. Metwalli
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Correspondence to Adam R. Metwalli .

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Editors and Affiliations

  1. Urology and Radiology, Lenox Hill Hospital, New York, NY, USA

    Ardeshir R. Rastinehad

  2. Vascular & Interventional Radiology, North Shore Long Island Jewish Health System, New Hyde Park, NY, USA

    David N. Siegel

  3. National Cancer Institute & Clinica, Bethesda, MD, USA

    Bradford J. Wood

  4. Lefrak Center for Robotic Surgery, Weill Cornell Medicine, New York, NY, USA

    Timothy McClure

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Kearse, L.E., King, T., Jain, A.J., Coleman, P.W., Metwalli, A.R. (2021). Interventional Urology for Adrenal Gland Diseases. In: Rastinehad, A.R., Siegel, D.N., Wood, B.J., McClure, T. (eds) Interventional Urology . Springer, Cham. https://doi.org/10.1007/978-3-030-73565-4_32

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