[Surgery of the adrenal gland]

Aldosterone-producing adenoma, Cushing's syndrome, pheochromocytoma, and adrenocortical carcinoma are well known but are not common diseases, and few surgeons have experience in adrenalectomy. Laparoscopic adrenalectomy has been increasingly performed in Japan, and the number of procedures exceeded 1,000 in 2009. Laparoscopic adrenalectomy comprised less than 20% of all adrenalectomies reported in the USA in 2006. The actual numbers of open and laparoscopic adrenalectomies in Japan are not reported. Single-port laparoscopic adrenalectomy has recently been performed. Surgical treatment is the gold standard for adrenocortical carcinoma. Open adrenalectomy is recommended when malignant adrenal tumor is suspected. Adjuvant treatment with mitotane should be administered when indicated for adrenocortical carcinoma. Combination therapy with mitotane and chemotherapy was reported to be beneficial in patients with advanced and metastatic adrenocortical carcinoma. The diagnostic procedures for aldosterone-producing adenoma are still controversial. Plasma metanephrine measurement for the diagnosis of pheochromocytoma and gene diagnoses for hereditary pheochromocytoma/paraganglioma syndrome are promising. National surveys of pheochromocytoma and multiple endocrine neoplasia have been carried out and they clarified the current status of these diseases in Japan.