Diagnosis And Treatment Of Adrenal Incidentalomas: A Analysis Of 191 Cases

Objective To evaluate the diagnosis and treatment of adrenal incidentalomas(AI). Materials and Methods From January 2000 to January 2008,191 patients with pathologically confirmed AI were analyzed retrospectively.184 patients underwent a total of 187 operations.Laparoscopic adrenalectomy was performed in 120 cases,open approach in 67 cases.7 patients underwent needle biopsy.Results Of 57(29.8%) hypersecretory AI,39 cases(20.4%) were pheochromocytoma (including 1 malignancy),13(6.8%) were cortisol-prducing adenoma,and 5(2.6%) were aldosterone-producing adenoma.164 cases(85.9%) were benign masses,in which 87 cases(45.5%) were clinically nonhypersecreting cortical adenoma.Among 27(14.1%) malignant tumors,adrenal cortical carcinoma was found in 9 cases(4.7%) and metastatc cancer in 12(6.3%).95.2%of benign cortical adenomas were less than 6 cm,and 88.9%of adrenocortical carcinomas were greater than 6 cm.Conclusions It is essential to evaluate hormonal activity and assess malignant potential.The size of tumor is the strong preditor of malignancy.Operation should be performed for hypersecretory tumors and underlying malignancy.Laparoscopic adrenalectomy has become the optinum approach for benign adrenal tumor and can be performed in the carefully selected patient with adrenal malignancy.