[Adrenal gland carcinoma--status of diagnostic and therapeutic possibilities]

Innovations in diagnosis and therapy of adrenal neoplasms require a discussion about these tumors. Especially, the articles deal with the radiologic evaluation of the adrenal gland, technical as well as perioperative considerations of adrenalectomy, and adrenocortical carcinoma. Several conclusions can be drawn from our own results and a review of the literature. Firstly, the diagnostic accuracy should improve with advances in magnetic resonance imaging. Secondly, all asymptomatic nonfunctional adrenal masses about 3 cm require removal. Thirdly, adrenocortical carcinomas are generally curable only if small and localized. Fourthly, among the adrenal tumors, pheochromocytomas--especially malignant pheochromocytomas--deserve a careful approach: adequate preparation and early ligation of the adrenal vein after transabdominal access are the main goals. Finally, adjuvant treatment regimens for more advanced adrenocortical carcinomas using mitotane and conventional multiagent chemotherapy need to be evaluated in randomized trials.