In this case study, UC San Francisco endocrine surgeon Sanziana Roman, MD, performed a posterior retroperitoneoscopic adrenalectomy (PRA) to remove a pheochromocytoma. This approach enabled the patient to be discharged home within hours of surgery and avoid prolonged hospitalization, thereby minimizing COVID-19 risk.
“Reducing the need for in-hospital care has helped us through the pandemic,” Roman said. “This allows the hospital to be utilized for acute cases while not compromising or delaying the care of other patients.”
During PRA, a minimally invasive procedure, the surgeon works through tiny incisions in the patient’s back and uses small, specialized instruments to remove the tumor. By providing a more direct approach to the adrenal gland, PRA reduces surgical time, blood loss, pain, scarring and complications.
Case study: PRA to remove a 3-centimeter pheochromocytoma
A 56-year-old woman with a history of headaches, dizziness, fatigue and hot flashes had assumed her symptoms were menopausal. When they worsened in late 2020, she visited her primary care physician, who found that the patient had very high blood pressure, indicating a potentially serious condition. Concerned, the physician tested the patient’s metanephrine levels, which were significantly elevated.
These results suggested that the patient might have a pheochromocytoma, and a subsequent CT scan revealed a 3-centimeter right adrenal mass. To block the effects of the excess adrenaline produced by the pheochromocytoma, the patient was prescribed doxazosin, with the dosage increasing over a period of weeks. She was referred to Roman at the UCSF Endocrine Surgery and Oncology Clinic for removal of the mass.
The patient was fearful of being hospitalized during the COVID-19 pandemic. Roman conducted a series of telehealth visits with the patient during which they discussed the laboratory and radiology findings, health risks associated with having a pheochromocytoma, a surgical plan and how to optimize treatment before surgery. Roman determined the best way to remove the tumor safely and efficiently, tailoring the plan to the patient’s condition, anatomy and desire to minimize time in the hospital.
In December 2020, the patient underwent a PRA. Immediately following the procedure, she felt well, had minimal pain, and was able to walk and eat in the recovery room. After only six hours of observation, she was discharged home. Her blood pressure and heart rate had returned to normal without additional medications. Free of the tumor that had caused her symptoms for years, the patient has fully recovered.
High-volume PRA specialists at UCSF
Roman and Julie Ann Sosa, MD, MA, FACS, endocrine surgeon and chair of the UCSF Department of Surgery, were among the first in the U.S. to perform PRA, and UCSF is one of the few centers in California to offer the procedure.
“PRA has transformed our practice, and Dr. Roman is the leading expert, having performed many hundreds of procedures over nearly a decade,” Sosa said.
“Twenty years ago, treatment for a pheochromocytoma was very difficult and dangerous, requiring a long hospital stay,” Roman said. “With the advent of newer, more targeted medications, we can optimize treatment before surgery. PRA is safe and quick, and can now be done as an outpatient procedure. Patients have very good outcomes and return to normal much faster.”
UCSF Medical Center is No. 6 in the nation for diabetes and endocrinology according to U.S. News & World Report’s 2021-2022 Best Hospitals survey.
To learn more
UCSF Endocrine Surgery and Oncology Clinic
Phone: (415) 353-7687 | Fax: (415) 353-7781