Case report
Two tumours of the right adrenal gland treated videoscopically by the posterior retroperitoneal approach

Pheochromocytomas are a rare cause of arterial hypertension, necessitating surgical resection. Coexistence of a pheochromocytoma with an ipsilateral adenoma in the right adrenal gland has sporadically been reported. No reports on their videoscopic resection by the posterior retroperitoneal approach are available. We describe a case of a 49-year old female patient with a pheochromocytoma of the right adrenal gland, 43 mm in diameter, diagnosed in the course of assessment for arterial hypertension. During the imaging studies, a second tumour (34 mm in diameter) was found in the ipsilateral gland. The patient underwent right videoscopic adrenalectomy by the posterior retroperitoneal approach. After applying a clip to the central adrenal vein, the gland was removed together with two tumours. The postoperative period was uncomplicated. On the second postoperative day the drain was removed and the patient was discharged. In pathological examination pheochromocytoma with no malignant features along with adrenocortical adenoma was diagnosed. The presented case demonstrates a very rare coincidence of two ipsilateral adrenal tumours and the possibility of their safe videoscopic removal using the posterior retroperitoneal approach. Our finding of double tumour in the adrenal gland emphasizes the importance of detailed preoperative imaging and evaluation of hormonal status in every patient.

Pheochromocytomas are a rare cause of arterial hypertension, necessitating surgical resection. Coexistence of a pheochromocytoma with an ipsilateral adenoma in the right adrenal gland has sporadically been reported. No reports on their videoscopic resection by the posterior retroperitoneal approach are available. We describe a case of a 49-year old female patient with a pheochromocytoma of the right adrenal gland, 43 mm in diameter, diagnosed in the course of assessment for arterial hypertension. During the imaging studies, a second tumour (34 mm in diameter) was found in the ipsilateral gland. The patient underwent right videoscopic adrenalectomy by the posterior retroperitoneal approach. After applying a clip to the central adrenal vein, the gland was removed together with two tumours. The postoperative period was uncomplicated. On the second postoperative day the drain was removed and the patient was discharged. In pathological examination pheochromocytoma with no malignant features along with adrenocortical adenoma was diagnosed. The presented case demonstrates a very rare coincidence of two ipsilateral adrenal tumours and the possibility of their safe videoscopic removal using the posterior retroperitoneal approach. Our finding of double tumour in the adrenal gland emphasizes the importance of detailed preoperative imaging and evaluation of hormonal status in every patient.