Indications for laparoscopic adrenalectomy for non-functional adrenal tumor with hypertension: usefulness of adrenocortical scintigraphy.
OBJECTIVE
Laparoscopic adrenalectomy is currently indicated for biochemically and clinically functional adrenal tumors and potentially malignant tumors of the adrenal glands. Non-functional adenomas greater than 5 cm in diameter of the adrenal gland are generally considered to represent potentially malignant tumors. The present study shows indications of laparoscopic adrenalectomy for non-functional adrenal tumors with hypertension in a retrospective fashion.


METHODS
Between 1994 and 2004, 110 laparoscopic adrenalectomies were performed at Tokushima University Hospital. All 110 patients underwent detailed endocrinological examination before surgery. Medical and operative records of these 110 patients (57 men, 53 women), including operative parameters, histopathological findings and pre- and postoperative hypertension, were reviewed. Forty-five patients underwent laparoscopic adrenalectomy for non-functional adrenal tumors, and [(131)I]6beta-iodomethyl-19-norcholest-5(10)-en-3beta-ol (NP-59) scintigraphy was performed for patients with preoperative hypertension.


RESULTS
Mean patient age was 55.0 years (range, 22-77 years). Mean maximum tumor diameter was 42 mm (range, 20-105 mm). All adrenal tumors were removed successfully by laparoscopic surgery. Hypertension was postoperatively improved in seven of the 11 patients with preoperative hypertension, without subclinical Cushing syndrome. Importantly, all patients who improved hypertension after adrenalectomy displayed strong accumulation in adrenal tumors with visualization of the contralateral gland on NP-59 scintigraphy. Conversely, blood pressure did not improve in four patients for whom scintigraphy yielded negative results.


CONCLUSIONS
The indication of laparoscopic adrenalectomy for non-functional adrenal tumors is generally considered for lesions more than 5 cm diameter. However, the present study suggests that laparoscopic surgery should be considered even in patients with tumors less than 5 cm in diameter, if both hypertension and accumulation in tumors on NP-59 scintigraphy are present.
Izaki
Hirofumi
H
Department of Urology, The University of Tokushima Graduate School Institute of Health Bioscience, Tokushima, Japan.
Fukumori
Tomoharu
T
Takahashi
Masayuki
M
Taue
Ryuichi
R
Kishimoto
Tomoteru
T
Tanimoto
Syuji
S
Nishitani
Masa-Aki
MA
Kanayama
Hiro-Omi
HO
D000236:Adenoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*; D000315:Adrenalectomy / Q000379:methods; D000328:Adult; D000368:Aged; D001794:Blood Pressure; D003480:Cushing Syndrome / Q000000981:diagnostic imaging / Q000628:therapy; D005260:Female; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging / Q000628:therapy; D007564:Japan; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011859:Radiography; D011877:Radionuclide Imaging / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome