Endocrine Abstracts

Laparoscopic surgery of adrenal tumours is widely used because of its high effectiveness, patients safety and relatively low cost. Current indications to adrenalectomy of oncological and endocrinological origin are highly accepted. However there is still lack of perfect clinical tool identifying malignant lesions. In everyday practice clinicians rely on low specific features, especially considering larger nonsecretory lesions to surgery.

To show the landscape of sporadic adrenal tumours we analysed retrospectively histopathological findings from 101 consecutive adrenalectomies performed in our centre in 71 women and 30 men of average age 57.7 years (S.D. 13.5), between 2009 and 2016 years.

There were 53 (52.47%) adenomas found; 7 (6.93%) of them secreting: 4 (3.96%)-cortisol, 3 (2.97%)-aldosterone. Pheochromocytoma occurrence was notably often-14 cases (13,86%). Adrenal cancer was found in two cases (1.98%), metastatic lesions from lung, kidney and urinary bladder in three cases (2.97%); and 1(0.99%) malignant peripherial nerve seath tumor (MPNST) derived from ganglioneuroma of adrenal gland was found. Thirteen cases (12.87%) of adrenal hyperplasia were found. In 16 cases (15.84%) the histopathological findings were classified as “various” in detail consisting of: 3 myelolipomas, 1 angiomyolipoma, 2 cysts, 6 pseudocysts or secondary posthaemorrhagic/inflammatory lesions, 1 normal adrenal tissue, 1 fatty tissue, 1 mesenteric cyst and 1 teratoma. In two cases benign adrenal lesions coincided with unilateral kidney cancer. Seventeen patients (16,83%) had previous oncological anamnesis positive, while patients with adrenal cancer had negative previous oncological anamnesis.

We observe that adrenalectomy of oncological indications is prevalent: adrenal lesions with positive previous cancer history; lesions suspected of malignancy because of the CT morphological features. In the audit almost half of them occur benign incydentalomas. Are we overtreating, then?

We conclude there is a great need of new specific clinical tools to identify malignancy in adrenal glands in everyday practice.