Introduction: Partial adrenalectomy is an essential approach for patients with von Hippel-Lindau (VHL) associated pheochromocytoma. One key benefit of partial adrenalectomy is avoidance of lifelong hormone replacement therapy. The purpose of this report is to demonstrate one case of robotic bilateral partial adrenalectomy for treatment of bilateral pheochromocytoma in a patient with VHL. Methods: The patient was an 18-year-old male with a history of VHL diagnosed at birth who did not follow surveillance. The patient presented for hypertensive crisis leading to partial loss of vision in one eye, at which time plasma free metanephrines and normetanephrines were found to be significantly elevated. Patient was stabilized but continued to have persistent hypertension in the 130’s to 150’s systolic despite doxazosin and lisinopril therapy. Computed tomography (CT) of the abdomen and pelvis showed multiple bilateral large heterogeneously enhancing adrenal lesions consistent with bilateral pheochromocytomas (4 cm and 3 cm lesions on the right and 3.3 cm lesion on the left). The patient then underwent robotic bilateral partial adrenalectomy after adequate pre-operative adrenergic blockade. Results: Robotic bilateral partial adrenalectomy was successfully performed with approximately 30% sparing of the adrenal glands bilaterally. Patient was hemodynamically stable with no post-operative complications. Pathology report showed complete excision of pheochromocytomas bilaterally. Patient has not required continued hydrocortisone replacement since time of surgery. Conclusions: This case demonstrates that bilateral partial adrenalectomy can be an effective management for bilateral pheochromocytoma to prevent the need for lifelong hormone replacement that would occur as a result of total adrenalectomy. SOURCE OF Funding: None.
