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A Novel Method: Super-selective Adrenal Venous Sampling
Published on: September 15, 2017
Indications and results of surgery for incidentally found adrenal tumors
1Klinik fur Strahlentherapie und spezielle Onkologie, Medizinische Hochschule Hannover, Hannover, Deutschland.
Introduction:
The accidental discovery of an adrenal mass called incidentaloma has become an increasingly frequent clinical problem with the question of a correct and appropriate therapeutic approach being the subject of controversial discussions.
Materials And Methods:
Clinical charts of 52 patients (22 male, 30 female) who underwent adrenalectomy for an incidentaloma at our institution between 1987 and 2001 were reviewed.
Results:
Median age was 56.4 years. Reasons for surgery were unclear significance in 22 patients, suspicion of malignancy in 5, increase in size in 8, maximum tumor diameter of more than 5 cm in 7, fear of malignancy in 1, and subclinical secretion of cortisol in 5 patients. No data were available for 4 patients. Surgical resection was performed using a conventional transabdominal approach in 28 patients, a conventional dorsal approach in 17 patients, and an endoscopic retroperitoneal approach in 7 patients. Histopathologic examination ruled out adrenal adenoma in 32 patients, adrenal myelolipoma in 12, unilateral nodular hyperplasia in 4, cystic lesion in 3, and adrenocortical carcinoma in 1 patient. The mean size of all lesions was 5.5 cm. Evaluating the criteria for surgical treatment regarding age of the patients and size of the lesions, 25 patients (48%), including the patient with the adrenocortical carcinoma, were younger than 60 years and had an adrenal lesion exceeding 4 cm in size. During postoperative follow-up that was available for 39 patients, 3 developed contralateral tumors that were treated by resection in 1 and by close follow-up in 2.
Conclusions:
Size should not be the sole criterion; treatment should be tailored to the individual patient. Especially in patients younger than 60 years with an adrenal lesion exceeding 4 cm in size, an adrenalectomy, predominantly via an endoscopic approach, should be carried out, because a repeated and life-long close follow-up of an anxious patient who has been informed of the diagnosis will in some cases exceed the cost of a single endoscopic operation.
