title: Cystic adrenal lesions: clinical and surgical management. The experience of a referral centre.
abstract: BACKGROUND
  Cystic adrenal lesions (CALs) represent a rare entity having heterogeneity in etiology and clinical manifestations. Due to their very low incidence and heterogeneity in clinical aspects, many controversials still exist about their management.
  
  
  METHODS
  From 1984 to 2012, 21 patients (7 M, 14 F, mean age 48.2 years) underwent adrenalectomy for CALs. 9 patients suffered from hypertension, and 7 were affected by thyroid disorders.
  
  
  RESULTS
  4 patients presented with vague abdominal pain, while in 17 patients the CAL was incidentally identified during imaging examinations. All patients underwent evaluation of adrenal functionality and imaging study. We found 1 case of cystic pheochromocytoma (confirmed by urinary and blood sampling, and MIBG-scan). All patients underwent adrenalectomy (open approach in the first 10 patients treated from 1984 to 1996, laparoscopic lateral transabdominal approach in the other 11 cases). Indication to surgery included: size over 4.5 cm in 16 cases, suspected malignancy at imaging evaluation (not confirmed by histology) in 4 cases, cystic pheochromocytoma in 1 case. Histology revealed 11 endothelial cysts, 3 pseudocysts, 6 epithelial cysts and 1 cystic pheochromocytoma.
  
  
  CONCLUSIONS
  The presence of CAL, even asymptomatic, requires complete endocrinological evaluation and imaging study. In the presence of large size, endocrine activity or any suspicion of malignancy, patients must be referred to surgery.
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy. Electronic address: giuseppe.cavallaro@uniroma1.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cavallaro
authors.affiliation: Department of Surgery "P. Valdoni", Sapienza University, Rome, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Crocetti
authors.affiliation: Department of Surgery "P. Valdoni", Sapienza University, Rome, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Paliotta
authors.affiliation: Department of Surgery "P. Valdoni", Sapienza University, Rome, Italy.
authors.forename: Antonietta
authors.initials: A
authors.lastname: De Gori
authors.affiliation: Department of Surgery "P. Valdoni", Sapienza University, Rome, Italy.
authors.forename: Maria Rita
authors.initials: MR
authors.lastname: Tarallo
authors.affiliation: Department of Clinical Sciences, Sapienza University, Rome, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Letizia
authors.affiliation: Department of Surgery "P. Valdoni", Sapienza University, Rome, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: De Toma
mesh_terms: D000307:Adrenal Gland Diseases / Q000601:surgery*; D000310:Adrenal Gland Neoplasms / Q000601:surgery; D000315:Adrenalectomy / Q000379:methods; D000328:Adult; D058070:Asymptomatic Diseases; D003560:Cysts / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000601:surgery; D012017:Referral and Consultation; D012189:Retrospective Studies
keywords: Adrenal cysts; Adrenal tumors; Adrenalectomy