Changing pattern of adrenalectomy at a tertiary referral centre 1970-2000

In 1987, a report from this unit described the changing indications for open adrenalectomy over a 15-year period. The indications for adrenalectomy had switched from it being the principal therapeutic procedure used in advanced breast cancer in the early 1970s, to being predominately performed for Cushing's disease or incidental, asymptomatic, adrenal masses by the early 1980s. The aim of the present study was to evaluate the changes in the presentation and management of adrenal disease in the last 15 years and to compare these findings with our previously published results.

Information was gathered from a prospective database of all patients undergoing adrenalectomy in the University of Sydney Endocrine Surgical Unit at Royal North Shore Hospital from 1 January 1987 to 31 December 2000. Information was obtained on patient presentation, diagnostic investigations, indications for surgery, procedure performed and surgical outcomes. Prior to 1987, information was gathered by retrospective review of case notes of patients who had undergone adrenalectomy at Royal North Shore Hospital. During the period from 1 January 1970 to 31 December 2000, 236 patients underwent adrenalectomy. Excluding the 68 adrenalectomies performed for breast cancer, left 168 patients who underwent adrenalectomy for functional or non--functional masses. There were 97 (58%) women and 71 (42%) men, with a mean age of 48 years.

Of the 168 patients, the principal indications for surgery were hyperaldosteronism (32%), phaeochromocytoma (20%), hypercortisolism (20%), incidentaloma (16%), carcinoma (6%) and other reasons (6%). Examination of the number of cases in each pathological group for the periods 1970-1986 and 1987-2000, revealed an 8-fold increase in the number of operations for hyper-aldosteronism, and a 3-fold increase in cases of phaeochromocytoma. The number of operations for the other pathological groups remained steady. The annual incidence of adrenalectomy in the hospital has steadily risen since 1990, with a linear increase in the adrenalectomy rate since the introduction of laparoscopic adrenalectomy in 1995. There were fewer complications in either the open or laparoscopic group since 1987 compared with the pre-1987 cohort.

In the past 5 years, there has been a linear increase in the number of adrenalectomies performed in this unit for hyperaldosteronism and to a lesser extent phaeochromocytoma. This is a reflection of increased clinical awareness, improved diagnostic modalities and the advent of laparoscopic adrenalectomy.