Diagnosis and treatment of adrenal tumors: a single-center experience with 238 cases.

Gomha Abdul-Monem, Osman Yasser, El-Mekresh Mohsen, Abou El-Ghar Mohamed, Eraky Ibrahim

Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

Urol Int. 2009;83(4):433-7. doi: 10.1159/000251184. Epub 2009 Dec 8.

OBJECTIVE

It was the aim of this study to review and analyze clinical data on the diagnosis and management of patients with adrenal masses.

PATIENTS AND METHODS

Between 1976 and 2005, 238 patients admitted to our institute with adrenal masses were reviewed. Incidence, clinical features, imaging technique findings, surgical approaches, morbidity and mortality, as well as pathological diagnoses were reported.

RESULTS

The series comprised 134 males and 104 females (mean age 33.3 +/- 20.3 years). Right-sided masses were more common (63.4%), with a mean size of 7.7 +/- 4 cm. Pain was the most frequent presenting symptom (53.4%), while 62 (26%) had a functional tumor. Incidentaloma was diagnosed in 49 patients (20.6%). Both computed tomography and magnetic resonance imaging showed a high diagnostic yield (sensitivities of 98.9 and 100%, respectively). Open adrenalectomy was performed in 153 patients (64.3%), while a laparoscopic approach was employed in 53 patients (22.3%). The intraoperative complication rate was 14.7%, the postoperative complication rate 6.1% and perioperative mortality 1.7%. Most of the excised masses were pheochromocytomas (26.4%).

CONCLUSIONS

Computed tomography is recommended as the first diagnostic modality to define and characterize adrenal masses. Laparoscopic adrenalectomy is currently replacing open surgery as the standard surgical management of adrenal masses.