Robotic Adrenalectomy for Large Virilizing Adrenal Mass: a Case Report and Literature Review

Androgen-secreting adrenal tumors are rare causes of virilization in adult women and often raise concerns regarding malignancy, particularly when tumor size exceeds 6 cm. Current guidelines recommend surgical resection in hormonally active adrenal masses, with minimally invasive surgery increasingly adopted in selected cases.

We report the case of a 50-year-old woman presenting with progressive virilization due to a right adrenal mass measuring 10 cm. Hormonal evaluation revealed marked androgen excess, with elevated serum testosterone, androstenedione and dehydroepiandrosterone sulfate levels. Imaging studies showed a well-defined adrenal lesion without radiological signs of local invasion. The patient underwent robot-assisted laparoscopic adrenalectomy (RALA). The postoperative course was uneventful, with complete resolution of virilizing symptoms and normalization of androgen levels. Histopathological examination confirmed a benign androgen-secreting adrenal adenoma.

This case demonstrates that robot-assisted laparoscopic adrenalectomy is a safe and effective treatment option for large, hormonally active adrenal tumors in carefully selected patients. Robotic surgery offers the benefits of minimally invasive approaches while maintaining oncological safety, supporting its role in guideline-concordant management of complex adrenal lesions.