Trained By The Masters
My first mentor, Dr. Darracott Vaughan was a master of adrenal physiology, pathology and traditional “open” adrenal surgery. Dr. Vaughan gave me this note, on a copy of his portrait, on the day I completed my residency training. I was extremely fortunate to train under this titan in the field and past-president of the American Urological Association (AUA). Later, I studied under Dr. Louis Kavoussi, the godfather of adrenal laparoscopic surgery, to become a master at laparoscopic, robotic, and single-port adrenal surgery. Whether you have a hyperfunctioning adrenal adenoma, a pheochromocytoma, or adrenal cancer, I am highly skilled at all surgical techniques to cure the condition through the least invasive techniques possible, anywhere.
ADRENAL CANCER
The image on the right shows a very large adrenal tumor (circled in thin red line). It is above the kidney, outlined in yellow. This patient came to me with flank pain, weight gain, excessive growth of body hair, and weakness caused by excessive adrenal hormone production. Given the large size of this tumor (14 centimeters) I removed the adrenal gland and tumor using “open” surgery through an incision under the rib cage. Removing a tumor this large through laparoscopic or robotic surgery is not safe and can risk cancer spread, unlike with smaller tumors. Despite the large size of this adrenal cancer, I am thrilled to say she is alive and well five years later without any recurrence or spread.
ADRENAL PHEOCHROMOCYTOMA
In this case, a 58 year old man was experiencing high blood pressure, anxiety, panic attacks, a racing heart beat, and sweating. The CT scan to the right shows the 6 cm adrenal mass (circled in yellow) that was a PHEOCHROMOCYTOMA. This is a tumor of the adrenal gland that produces excess adrenaline, leading to his symptoms. I removed the adrenal gland and tumor laparoscopically through tiny incisions, and he was cured of the symptoms. Fortunately for my patient, the tumor has behaved in a benign and non-cancerous manner, although 10% of these tumors are malignant.
ADRENAL ANATOMY and FUNCTION
We are born with two adrenal glands. In the illustration you can see how the adrenal glands sit “on top” of the kidneys. The adrenal glands are endocrine glands, making hormones: cortisol, aldosterone, adrenaline, and androgens. Some of these hormones act to help our bodies react to stress, and some we cannot live without, as they regulate blood pressure, electrolytes, and other vital functions. Tumors can arise in the adrenal gland - or the adrenal glands can become swollen (hyperplasia) - and overproduce these hormones causing an excess of the hormones in your bloodstream. This can lead to a range of symptoms from high blood pressure, panic attacks, weight changes, electrolyte abnormalities, among other signs and symptoms.
ADRENAL ADENOMA - CONNS SYNDROME
This patient was experiencing high blood pressure and had an abnormally low potassium level detected in blood testing. This is characteristic of CONN’S SYNDROME, where a benign (not-cancerous) tumor of the adrenal gland makes excess aldosterone hormone. The excessive aldosterone leads to high blood pressure, high sodium, and low potassium. She had a CT scan that showed the adrenal tumor (to the left, circled in green line). I removed her adrenal gland laparoscopically through tiny incisions, which cured her of the problems.
