Multiple endocrine neoplasia type 2a(MEN 2a) is an inherited syndrome characterized by the occurrence of medullary thyroid carcinoma, parathyroid hyperplasia and adrenal pheochromocytoma. Adrenal medullary disease varies from hyperplasia to
bilateral
multiple pheochromocytomas. In anesthetic view, stabilization of severely fluctuating vita signs has become an issue. But fluctuation of vital signs is not always seen especially large pheochromocytoma, and catecholamine releasing activity is
higher in
right pheochromocytoma than left. It suggests catecholamine releasing activity is affected by the site of pheochromocytoma and size of pheochromocytoma. Surgically, right adrenalectomy is more difficult than left because the vein ofright adrenal
gland
is shorter and larger in diameter than left and it drains into the inferior vena cava directly, but in left, it drains into the renal vein. Pathologically, nonfunctional or hypofunctional pheochromocytomas which have high ratio of inactivating
amines.
Another factor is the size of pheochromocytomas. Lager sized pheochromocytomas frequently has necrotic, hemorrhagic, cystic and myxomatous areas compared to smaller ones. In conclusion, case of bilateral adrenalectomy, more careful anesthetic
management
is required in right adrenalectomy and in smaller pheochromocytomas.
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