Surgical treatment of adrenal diseases at Nara Medical University and affiliated hospitals.

The effect of advanced diagnostic imaging on the surgical treatment of adrenal diseases was examined in 86 cases of adrenal disease surgically treated at the Department of Urology, Nara Medical University, and affiliated hospitals from August, 1962, to July, 1991. The number of cases included in the present study was 16 for the period before the introduction of CT (from 1962 to 1978), and 70, including 13 cases of adrenal incidental tumor, after the introduction of CT in 1979. There were no malignant tumors histopathologically, among the 13 cases of incidental tumor. Accurate localization of functioning adrenal disease was possible at a rate of 100% with angiography, including selective venous blood sampling, 98.6% with CT and 84.5% with ultrasonography. The rate was 100% with magnetic resonance imaging which was carried out on 19 cases (20 adrenal glands). Signs of malignancy were observed in the removed tissue of three cases from the pheochromocytoma group. As the diagnostic imaging technique has improved, the use of a flank approach has increased in the surgery for adrenal disease.