Surgical approach in adrenal incidentalomas: Report of thirteen cases and review of the literature

Abstract

Objective: The rate of adrenal incidentalomas detected in routine diagnostic imaging techniques is approximately 4-7%. Although the lesions are generally benign, carcinoma and functional adenomas can be diagnosed with careful clinic and laboratory evaluation.Material and Methods: Data of 13 patients who underwent surgery for an adrenal mass between January 2010-June 2014 were analyzed retrospectively.Results: Seven (54%) patients were male, 6 (46%) were female, and the mean age was 38.2. The clinical diagnosis was pheochromacytoma in 5 patients (38.4%), non-functional adenoma in 5 (38.4), and metastatic lesion, Cushing syndrome, and adrenal carcinoma each in one patient (7.6%). Conventional open adrenalectomy was performed in 8 patients, while 5 patients underwent laparoscopic adrenalectomy. Conclusion:Adrenal incidentalomas should be carefully evaluated for hormonal activity even if asymptomatic, and non-functional lesions should be considered as suspicious-for-malignancy. Laparoscopic adrenalectomy has become the gold standard for patients with a mass less than 6 cm, and without infiltration to adjacent organs.

Is laparoscopic left adrenalectomy with the anterior submesocolic approach for Conn’s or Cushing’s syndrome equally safe and effective as the lateral and anterior ones?

“…The authors analyzed and compared the pre and postoperative outcomes after left laparoscopic adrenalectomy for Conn's or Cushing's syndrome, hypothesizing to observe different results among the three different approaches that were employed: lateral transperitoneal, anterior transperitoneal and anterior transperitoneal submesocolic. To evaluate the results of the submesocolic approach, which is not widely reported in the literature [10,24], as compared to the other two approaches, and to obtain a homogeneous patient sample only left adrenocortical lesions were included in the study. Moreover, the data regarding pheochromocytomas and non-functional lesions have been previously reported [6][7][8].…”

“…According to the literature, the most common pathologies setting the indication to perform LA are benign functioning adenomas such as primary hyperaldosteronism (Conn's syndrome) and primary hypercortisolism (Cushing's syndrome), which both have an incidence of 0,002%, or nonfunctioning adenomas [9][10][11][12]. During LA, hemodynamic instability is one of the major challenges to consider, especially in case of functioning adenomas [13,14].…”

Clinical presentation of incidentally discovered adrenal tumors ‒ our experience

“…About 30% of all pheochromocytoma are detected incidentally and their prevalence is increasing. Prevalence of pheochromocytoma in adrenal incidentalomas very from 1 to 11% according to different autors [4][5][6][7]16 . In our study, there were 4 patients (11.4%) with pheochromocytoma, with average tumor size of 4.5±3.1cm (range 1.8 -6.1cm).…”

“…Adrenal incidentaloma are most often found in the right adrenal gland (50-60%), in left (30-40%) and in 10-15% of patients are in both glands. The average size of these changes is 3-3.5cm and ranges from 0.5cm to 25cm[4][5][6][7] . Similarly, in our investigated group 75.3% patients were over 50 years old, with a peak in the seventh decade in 38.5% of patients.…”

Incidental giant adrenal lymphangioma presenting as nonfunctional cystic mass

“…Despite the general knowledge that adrenal mass lesions are typically benign and do not release any hormones, each mass should also be evaluated and differential diagnosis should be done for hypersecretory syndromes or tumor development (2). The management of hormonally inactive adrenal masses is primarily on lesion size.…”