Adrenalectomy

Surgery is the primary treatment for adrenal masses that are hormonally functional or malignant. Adrenal disorders present with a wide variety of clinical manifestations, depending on the underlying pathophysiology. Specific indications for adrenalectomy are listed in the box. Over the last decade, laparoscopic adrenalectomy has become the procedure of choice for removal of most adrenal neoplasms. Factors to consider in choosing the best method of adrenalectomy for a given patient include the preoperative diagnosis, the size of the adrenal mass, the potential for malignancy, the occurrence of extra-adrenal or bilateral disease, invasion of adjacent structures, and individual patient characteristics. The traditional anterior transabdominal approach through a midline or bilateral subcostal incision is now used primarily for large primary adrenal malignancies or invasive adrenal tumors. The open posterior approach provides more limited access to each adrenal and has been almost completely replaced by laparoscopic adrenalectomy.