Incidentaloma surgery
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Incidentaloma Microchapters |
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Incidentaloma surgery On the Web |
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American Roentgen Ray Society Images of Incidentaloma surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Surgery is the mainstay of treatment for [disease or malignancy].
Surgery
- The decision to operate should take into account the presence of the metabolic consequences of cortisol excess.
- A reasonable strategy may be to consider adrenalectomy for younger patients and those with new onset or a worsening of underlying comorbidities such as diabetes mellitus, hypertension, obesity, or osteoporosis (1, 21, 72)
- There was a significant improvement in blood pressure and fasting blood glucose in patients who underwent surgery, but a worsening of blood pressure and fasting blood glucose in those who chose to be managed conservatively during a follow-up period of 18–48 months (71).
- Although adrenal myelolipomas may grow over time, they can usually be followed without surgical excision However, when larger than 6 cm in diameter or when causing local mass-effect symptoms, surgical removal should be considered. 52
- Patients with bilateral adrenal masses should be investigated for congenital adrenal hyperplasia [53].
Indications
- All patients with documented pheochromocytoma and adrenocortical cancer should undergo prompt surgical intervention because untreated pheochromocytoma may result in significant cardiovascular complications.
- Patients with adrenocortical cancer or lesions suspicious for adrenocortical cancer should also undergo prompt adrenalectomy as their disease may progress rapidly.
- Patients with aldosterone-producing adenomas should be offered surgery to cure aldosterone excess.
- Some patients with documented subclinical Cushing's syndrome should be selected for surgery based upon the clinical parameters discussed above [47].
- Adrenal masses with either suspicious imaging phenotype or size larger than 4 cm should be considered for resection because a substantial fraction will be adrenocortical carcinomas [2,14].
- The clinical scenario and patient age frequently guide the management decisions in patients who have adrenal incidentalomas that fall on either side of the 4 cm diameter cutoff.
Adrenalectomy
Adrenalectomy for patients with aldosteronomas, pheochromocytoma, cortisol-secreting tumors, and adrenal incidentalomas is safe and effective [54].