By Eren Berber, MD, and Georgiana Dobri, MD

Cleveland Clinic’s Endocrinology & Metabolism Institute offers a Multidisciplinary Adrenal Clinic  that evaluates about 300 patients with adrenal disorders every year. Patients presenting at the Multidisciplinary Adrenal Clinic receive a workup of their adrenal tumors based on guidelines from the National Institutes of Health and the American Association of Clinical Endocrinologists/American Association of Endocrine Surgeons.

The center holds monthly Multidisciplinary Tumor Boards, where complex adrenal cases are discussed and treatment plans are developed. The Endocrine Surgery Department performs 40 to 50 adrenalectomies every year.

Multidisciplinary expertise

Some of the experts within the Adrenal Clinic from various disciplines include:

• Eren Berber, MD, Director — from Endocrine Surgery
• Georgiana Dobri, MD, from Endocrinology
• Erick Remer, MD, from Diagnostic Radiology
• Charis Eng, MD, PhD, from the Genomic Medicine Institute
• Donald Neumann, MD, PhD, from Nuclear Medicine
• Brian Rini, MD, from Oncology

Case study

This patient case illustrates the accessibility of Cleveland Clinic’s adrenal disease experts, as well as the quality of our care based on a multidisciplinary approach:

A 50-year-old woman who was working overseas for the U.S. government presented at a hospital in Germany in hypertensive crisis. Imaging was performed and the patient was found to have a 4-cm right adrenal mass.

The treating physician contacted Dr. Berber seeking his expertise in adrenal disorders. Dr. Berber coordinated the appropriate workup, which included checking serum and 24-hour urine collections for catecholamines and metanephrines. The patient’s catecholamines and metanephrines were four-fold elevated.

The Cleveland Clinic Endocrine Surgery team stayed in communication with the physicians in Germany and the patient was started on alpha blockade with phenoxybenzamine, which stabilized her blood pressure.

Arrangements were made for her to have a minimally invasive adrenalectomy at Cleveland Clinic. Three weeks later, the patient traveled to Cleveland Clinic. The details of the operation were discussed with her, and she provided consent for a robotic adrenalectomy. The surgery was performed uneventfully.

The patient stayed one day in the hospital. She was discharged and at two-week followup, she was recovering well and did not have any complications. Plasma catecholamine and metanephrine levels at one month were normal, suggesting the patient was cured.

Figure 1.  Preoperative CT scan demonstrating the right-sided pheochromocytoma.

Figure 2.  Intraoperative photo showing the dissection of the adrenal mass during robotic adrenalectomy. 

Dr. Berber is Director of the Multidisciplinary Adrenal Clinic and Director of Robotic Endocrine Surgery in the Department of Endocrine Surgery. Dr. Dobri is an endocrinologist in the Department of Endocrinology, Diabetes and Metabolism, with a special interest in adrenal and pituitary disease. For more information contact Dr. Berber at berbere@ccf.org or 216.445.0555, or Dr. Dobri at dobrig@ccf.org or 216.636.5554.