Advances in the diagnosis and therapy of adrenal tumors

There continues to be controversy regarding the optimal evaluation and treatment of adrenal tumors. Magnetic resonance imaging, metaiodobenzylguanidine scan, single-photon emission tomography imaging, endoscopic ultrasound, and radiolabeled somatostatin analogues are just a few of the newer imaging techniques being investigated to improve our ability to obtain a specific diagnosis of an adrenal mass. Although the diagnosis and treatment of pheochromocytomas are relatively straightforward, the evaluation and treatment of incidentally discovered adrenal masses is less clear-cut. The management of an incidentaloma is guided by two principle considerations: whether the tumor has hormonal activity, and its malignant potential. In addition to diagnostic advances, refinements continue to be made regarding surgical management of these lesions. Laparoscopic adrenalectomy is fast becoming the procedure of choice for benign-appearing adrenal masses with appropriate indications for operative removal.