Robotic-Assisted Adrenalectomy of a Giant Dopamine-Only Secreting Pure Adrenal Ganglioneuroma: A Case Report and Operative Video

Introduction: Ganglioneuromas (GNs) are rare, differentiated tumors that originate from neural crest cells and can occasionally develop in the adrenal medulla. Adrenal GNs (AGNs) are typically hormonally silent and asymptomatic. Hormone-secreting pure AGNs in adults are uncommon; however, dopamine-secreting pure AGNs are extremely rare, with only a few cases reported in the literature. Giant AGNs are usually managed with open surgical intervention. Case Presentation: We present a case of a giant dopamine-secreting pure AGN in a 19-year-old woman who complained of mild left flank pain with no other symptoms. On physical examination, a mass was felt in left upper abdomen. MRI showed a left retroperitoneal mass extending from the left suprarenal region inferiorly, anterior to and compressing the left kidney, measuring 9 × 7.5 × 14 cm. Hormonal investigations ruled out Cushing syndrome, and catecholamine studies were negative for metanephrines, normetanephrines, adrenaline, and noradrenaline but were positive for dopamine levels more than 3 times the upper normal level. The patient underwent robotic-assisted adrenalectomy with minimal morbidity. Conclusion: Robotic-assisted adrenalectomy is a feasible and effective treatment option for rare dopamine-secreting pure AGNs. Careful patient selection and thorough preoperative preparation are essential to minimize risks and ensure favorable outcomes.