[Our experience regarding a series of adrenal surgical diseases].

AIMS

The problems of positive and differential clinic-pathologic diagnosis, the optimal therapeutic decision and importance of surgery in a series of patients with adrenal gland (AG) diseases was studied.

MATERIAL AND METHODS

Between 1987-1999, 91 patients (pts.) with adrenal diseases were operated on. Sex ratio was 63 f/28 m and the medium age 42.3 years (extremes 14 and respectively 75 years old). The lesions were localized in medullar, cortical and in the both components of AG. 1) The cortical determinations were represented by 40 (44%) pts. with: a) Cushing's syndrome 37 pts. histologically grouped: 24 pts. (63%/37) with benign, diffuse hyperplasia of cortico-adrenal glands; 4 pts. with cortical benign adenoma; 7 adenocarcinoma; 2 with borderline lesions. b) Conn syndrome--3 pts. 2) Medullary lesions (Phaeochromocytoma)--30 pts. (33%/91) with following microscopically lesions: 22 typical phaeochromocytoma; 3 benign adenoma; 5 carcinoma and 1 medullo-adrenal paraganglioma. One patient have had bilateral medullo-adrenal lesions: left carcinoma and right benign adenoma). 3) Non functioning tumors (Incidentaloma)--21 pts. (23%/91) (17 malignant and 5 benign). The distribution of the whole group of 91 pts. was: 62 with benign lesions (diffuse hyperplasia or tumors), 26 malignant tumors, 1 both of them and 2 borderline lesions. The diagnosis was the result of clinically, biochemical-hormonal tests and imagery examinations (computed tomography especially) with postoperative pathological confirmation. The surgery applied was:--bilateral adrenalectomy 16 pts.;--right adrenalectomy 20 pts.;--left 26 pts. (two through laparoscopic approach);--tumor exeresis 26 and--3 biopsy of the tumors. The dimensions of the operatory specimens were: < 10 cm--67 pts.; 10-20 cm--16 pts.; > 20 cm--2 pts.; undetermined 6 pts. For malignant lesions the main parameters (in various associations) were: neighborhood invasion--18 pts.; distant metastasis--5; metastatic lymphnodes--13; the microscopic grading (G1-1; G2-9; G3-7 pts.). Three cases imposed iterative interventions for a recurring adenoma of the cortically AG or for restant tissue in Cushing's syndrome. There were necessary 28 supplementary operative (partially or totally) organs exeresis. All pts. with malignant lesions were postoperative treated with chemio- or/and radiotherapy.

RESULTS

Postoperative morbidity: 18 (20%) pts.; depending of the surgery 8 pts., secondary of the patient general status 12. General postoperative mortality 4 (4.8%) pts. determined by severe cardio-vascular complications.

CONCLUSIONS

1--The surgical diseases of adrenal glands are difficult to diagnose and are based primarily on the clinical information's and confirmed by the hormonal and imagery examinations (errors are possible). 2--Operatory indications, especially for hyperplasic bilateral forms in Cushing's syndrome (one step or two steps surgery) must be very well documented and carefully established. 3--There are cases which impose recurrent operations. 4--A correct operative indication and technical surgery procedure are followed by good results. 5--The laparoscopic approach of the surgical lesions of the AG is a good alternative for the open surgical approach with the condition of a very correct indication. 6--Postoperative, the malignant lesions must be mandatory submitted to the adjuvant treatment.