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MANAGEMENT APPROACHES TO ADRENAL INCIDENTALOMAS (ADRENALOMAS)

2000; Elsevier BV; Volume: 29; Issue: 1 Linguagem: Inglês

10.1016/s0889-8529(05)70121-3

1558-4410

Dimitrios Linos,

Hormonal Regulation and Hypertension

From 1984 to 1999, I had the opportunity to operate on 217 patients with adrenal pathology. The patients included 82 men and 135 women with a mean age of 44 years (range, 14 to 78 years). A total of 96 anterior adrenalectomies were performed in 89 patients, 67 posterior adrenalectomies in 61 patients, 68 laparoscopic adrenalectomies in 65 patients, and 2 thoracoabdominal adrenalectomies in 2 patients. Sixteen patients underwent bilateral adrenalectomies (7 via the anterior approach, 6 via the posterior approach, and 3 via the laparoscopic approach). The pathology of the resected tumors included 76 cases of adrenocortical adenoma and 13 of nodular hyperplasia. Thirty-seven of these patients had Cushing's adenoma and 14 had Cushing's disease. Forty patients had pheochromocytoma, 38 had adrenal carcinoma (30 primary and 8 metastatic), 24 had aldosteronoma, 9 had myelolipoma, 11 had adrenal cysts, and 6 had other pathology (e.g., ganglioneuromas, lymphangiomas). Of the 217 patients who underwent adrenalectomies, 76 had an adrenaloma (incidentaloma) as the preoperative diagnosis (color Fig. 1; see pages 143–144). A report on 57 of these patients has been published previously.23 The recommendations herein are based on these surgical cases as well as several others that have been followed up conservatively.