Adrenal Tumor Surgery: Insights and Patient Concerns

Q: Adrenal Tumor Surgery: Insights and Patient Concerns

Hello： <br>1. <br>I previously inquired about the adrenal tumor issue, and I ultimately went for an examination at National Taiwan University Hospital. <br>I will be undergoing surgery on the 10th. <br>I would like to ask if an adrenal tumor can change from non-functional to func

Surgery for adrenal tumors?

Hello Dr.
Du, it's me again.

1.
I have a question regarding the adrenal tumor issue I previously inquired about.
I ultimately went for an examination at National Taiwan University and will undergo surgery on the 10th.
I would like to ask if an adrenal tumor can change from non-functional to functional pheochromocytoma? Will I need chemotherapy post-surgery? The urologist at NTU mentioned sending the specimen for pathological examination and also said they would address the cyst on my liver at the same time.

2.
The decision to operate was made by the endocrinologist, who stated that a size of 3 to 4 cm is the standard for surgery in Taiwan.
My tumor has grown from 2.5 cm in 2017 to 3.1 cm this year, which he thinks is a bit fast.
The chief surgeon informed me that they would make four incisions: three 1 cm each and one 4 cm, to remove the tumor.
However, why do I need to stay one day in the intensive care unit after the surgery? That sounds a bit concerning.

3.
The endocrinologist prescribed me a blood pressure medication (DOXABEN), but I can only take 4 mg for one day.
He mentioned that I should be on at least 8 mg and actually wanted to increase the dosage, but my body cannot tolerate it.
Although I have arrhythmia and angina, I haven't been on blood pressure medication; my blood pressure occasionally rises to 180-200.
The doctor said this is caused by the tumor.
Is it safe for me to undergo surgery under these circumstances?
4.
Additionally, I still want to ask why I consistently have 1+ hematuria during urine tests.
I apologize for the numerous questions.

Sincerely,
Doctor Q&A Teams

Er Mao, 60~69 year old female. Ask Date: 2023/06/07

Dr. Du Shixi reply Urology

Hello:
1.
I previously inquired about the adrenal tumor issue, and I ultimately went for an examination at National Taiwan University Hospital.
I will be undergoing surgery on the 10th.
I would like to ask if an adrenal tumor can change from non-functional to functional pheochromocytoma? Will I need chemotherapy after the surgery? The urologist at NTU mentioned sending the specimen for pathological examination and also said they would address the cyst on my liver—this will depend on the pathology report.

2.
The decision to operate was made by the endocrinologist, who stated that a size of 3 to 4 cm is the standard for surgery in Taiwan.
My tumor has grown from 2.5 cm in 2017 to 3.1 cm this year, which he thinks is a bit fast.
The chief surgeon informed me that they will make four incisions: three of 1 cm and one of 4 cm to remove the tumor.
However, I am concerned about needing to stay one day in the intensive care unit after the surgery; it sounds a bit alarming.
You have already received treatment at a medical center, so there is no need to worry too much.
The ICU stay is for postoperative observation.
Please cooperate with the treatment, and everything will go smoothly.
It is natural for patients to feel concerned, and I can understand that.
3.
The endocrinologist prescribed a blood pressure medication (DOXABEN) for me, but I can only take 4 mg for one day.
He mentioned that I should be on at least 8 mg and actually wanted to increase the dosage, but my body cannot tolerate it.
Although I have arrhythmia and angina, I have not yet taken blood pressure medication; my blood pressure occasionally rises to 180-200.
The doctor said this is caused by the tumor.
Will I be okay for the surgery? The anesthesiologist will manage your blood pressure during the procedure, and it should be controlled beforehand.
You can measure and record it for the doctor’s reference.
4.
Additionally, I would like to ask why I still have 1+ hematuria every time I do a urine test.
This may not necessarily be related; sometimes, microscopic hematuria can be caused by other factors and may not indicate a significant problem.
Wishing you good health.

Reply Date: 2023/06/07

More Info

Dear Patient,
Thank you for reaching out with your questions regarding your upcoming adrenal tumor surgery. I understand that this is a significant moment for you, and I will do my best to provide clarity on your concerns.

1. Functionality of Adrenal Tumors: Adrenal tumors can indeed change in functionality over time. A non-functional adrenal tumor may become functional, leading to conditions such as pheochromocytoma, which is characterized by excessive production of catecholamines (like adrenaline). This can result in symptoms such as hypertension, palpitations, and anxiety. It’s crucial to monitor these tumors closely, especially if they show growth or changes in size, as you mentioned. Your endocrinologist's decision to recommend surgery is likely based on the tumor's growth rate and size, which can indicate a higher risk of malignancy or functional changes.

2. Postoperative Chemotherapy: Generally, the need for chemotherapy after adrenal tumor surgery depends on the pathology results. If the tumor is confirmed as a pheochromocytoma and is benign (which is often the case), chemotherapy is typically not required. However, if there are signs of malignancy or if the tumor is functional and causing significant symptoms, further treatment may be necessary. Your surgical team will send the tumor for pathological examination, which will provide critical information regarding the tumor's nature and whether any additional treatment is warranted.

3. Surgical Procedure and Recovery: The decision to perform laparoscopic surgery with multiple small incisions is common for adrenal tumors, especially when they are 3-4 cm in size. The reason for a one-day stay in the intensive care unit (ICU) post-surgery is to monitor for any complications, particularly given your history of hypertension and heart conditions. This precaution is standard practice to ensure that any potential issues can be addressed promptly. While it may feel concerning, it is a routine measure to ensure your safety.

4. Blood Pressure Management: It’s understandable to be apprehensive about your blood pressure management, especially with your existing conditions like arrhythmia and angina. The tumor's influence on your blood pressure is significant, and managing it pre- and post-surgery is crucial. Your doctor’s plan to adjust your medication is aimed at stabilizing your blood pressure, which is essential for a successful surgical outcome. If you experience side effects or feel that the dosage is too high, communicate this with your healthcare provider. They can adjust your treatment plan to find a balance that works for you.

5. Hematuria (Blood in Urine): The presence of blood in your urine (hematuria) can be concerning and may be related to several factors, including the tumor itself or other underlying conditions. It’s important to discuss this symptom with your healthcare team, as they may want to investigate further to determine the cause and ensure that it is not related to any complications from the tumor or surgery.

In conclusion, it’s essential to maintain open communication with your healthcare team as you prepare for surgery. They are best equipped to address your specific concerns and tailor your treatment plan accordingly. I wish you the best for your surgery and a smooth recovery. Please do not hesitate to reach out if you have further questions or concerns.

Best regards,
Doctor Q&A Teams

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