ABSTRACT
Ketaconazole administration inhibits cholesterol synthesis and blocks cortisol formation. It is safer than mitotane since it is not cytotoxic to adrenal cortical cells, but because it does not destroy the cortisol secreting cells it must be administered for life. It was shown to have better efficacy in treating adrenal dependant hyperadrenocorticism as compared to mitotane. ii. Hyperadrenocorticism can result in fluid and electrolyte imbalances, infection, poor wound healing, pancreatitis and thromboembolic disease. All fluid and electrolyte imbalances are corrected prior to anesthesia. Antibiotics are administered in the perioperative period and the surgeon should rigidly adhere to principles of aseptic surgery. Some surgeons feel that due to poor wound healing and muscle atrophy in these patients, a flank laparotomy may be a better surgical approach to the affected adrenal gland. Although the latter does not provide exposure to the entire abdominal cavity, the flank incision is subject to less tension than a ventral abdominal incision. Adrenalectomy may result in sudden decrease of serum cortisol levels and corticosteroids are administered perioperatively to avoid an acute Addisonian crisis.
