Diagnosis And Treatment Analysis Of Adrenal Incidentalonns

Objective To improve the diagnosis and differengtial diagnosis of adrenal incidentalomas and summarize strategy for clinical therapy.Methods All the 41 cases were found by using transabdominal ultrasound for general health examination or other complaint, but without any significant clinical symptom .All the patients with incidentalomas occurred between the ages of 26 and 66, 22 were over the age of 50 and average 55, 26 patients were male, 15 female, 16 on left, 24 on right, one bilateral. Diameter was between 2 to 20cm and 5.5cm on average. And for the chief complaint, 29 patient with abdominal or low back pain, one patient with hyperthyroidism and others for general health examination.Computed tomography (CT) and diagnostic ultrasound imaging (US) was done in all the 41 cases and all patients undergoing US and CT, incidentaloma was confirmed, three metastasis were found by MR imaging and CT enhance. Cortisol, aldosterone, adnephrin, norepinephrine in blood and urine, electrolytes in blood were also measured in all patient. Five patients with high plasma cortisol, one with hypertension. One with high adnephrin and norepinephrine,no hypertension. All the blood electrolytes were normal.Twenty-two patients underwent open adrenalectomy, 14 patients underwent retroperitoneal laparoscopic adrenalectomy, one refused adrenalectomy with conservative treatment, one with conservative treatment for hyperthyroidism.Three were without any further treatment for tumor metastasis. For the surgical approaches of open adrenalectomy, 20 through 11th intercostal space, 2 through abdominal incision, 21 tumors were completely excised, one tumor with wide invasion can not be completely cut, only specimen taken. 14 patients underwent retroperitoneal laparoscopic adrenalectomy were completely excised tumors. Result In the forty-one cases of our study, 36 patients underwent surgical treatment. Pathological diagnosis post operation: 5 were pheochromocytoma (phe), 1 ganglioneuroma, 2 leiomyoma, 1 malignant fibrous histiocytoma, 5 sebaceous adenocarcinoma, and 21 cystosteatoma. The five patients with phe, three were nonfunctioning (one case was bilateral) and without any complication, and for the other two, main complication were blood-pressure fluctuation, post-hypotension, heart failure, but after treatment the outcome was good. One tumor recurred and metastasized one year later.Conclusion Adrenal Incidentaloma is a important kind of adrenal tumors, endocrine function and image examination are very useful for its diagnosis, and questionable pheochromocytomas should be treated as pheochromocytomas before surgery. A tumor larger than 3.0cm with possible malignancy should be excised early, except benign tumors such as cyst and myelolipoma. For tumors not larger than 6.0 cm and without adhesion, Laparoscopic adrenalectomy is the beat choice, otherwise the method of open surgery should be chosen.