Indications and results of surgery for incidentally found adrenal tumors.
BACKGROUND
The accidental discovery of an adrenal mass called incidentaloma has become an increasingly frequent clinical problem with the question of a correct and appropriate therapeutic approach being the subject of controversial discussions.


METHODS
Clinical charts of 52 patients (22 male, 30 female) who underwent adrenalectomy for an incidentaloma at our institution between 1987 and 2001 were reviewed.


RESULTS
Median age was 56.4 years. Reasons for surgery were unclear significance in 22 patients, suspicion of malignancy in 5, increase in size in 8, maximum tumor diameter of more than 5 cm in 7, fear of malignancy in 1, and subclinical secretion of cortisol in 5 patients. No data were available for 4 patients. Surgical resection was performed using a conventional transabdominal approach in 28 patients, a conventional dorsal approach in 17 patients, and an endoscopic retroperitoneal approach in 7 patients. Histopathologic examination ruled out adrenal adenoma in 32 patients, adrenal myelolipoma in 12, unilateral nodular hyperplasia in 4, cystic lesion in 3, and adrenocortical carcinoma in 1 patient. The mean size of all lesions was 5.5 cm. Evaluating the criteria for surgical treatment regarding age of the patients and size of the lesions, 25 patients (48%), including the patient with the adrenocortical carcinoma, were younger than 60 years and had an adrenal lesion exceeding 4 cm in size. During postoperative follow-up that was available for 39 patients, 3 developed contralateral tumors that were treated by resection in 1 and by close follow-up in 2.


CONCLUSIONS
Size should not be the sole criterion; treatment should be tailored to the individual patient. Especially in patients younger than 60 years with an adrenal lesion exceeding 4 cm in size, an adrenalectomy, predominantly via an endoscopic approach, should be carried out, because a repeated and life-long close follow-up of an anxious patient who has been informed of the diagnosis will in some cases exceed the cost of a single endoscopic operation.
Meyer
A
A
Klinik fur Strahlentherapie und spezielle Onkologie, Medizinische Hochschule Hannover, Hannover, Deutschland.
Behrend
M
M
D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D000315:Adrenalectomy; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged