ADRENALECTOMY - DIAGNOSIS AND OUTCOME

From 1982 to 1992, 33 patients underwent adrenalectomy for disease of the adrenal gland: 18 patients with adrenal cortex adenoma or hyperpla sia (Cushing's syndrome n = 11, Conn's syndrome n = 6, adrenogenital s yndrome n = 1), 3 with pituitary-dependent Cushing's disease, 7 with p heochromocytoma (malignant n = 1), 2 with a metastasis of lung cancer and 1 with cystic adrenal necrosis. Multiple endocrine neoplasia exist ed in four cases. Various preoperative symptoms were noted, including complaints typical of the respective syndromes and general abdominal s ymptoms. Other patients were symptom-free with incidental findings. An intercostal approach was used in 30 cases, a transabdominal approach in 3 cases. In 6 cases bilateral and in 27 cases unilateral adrenalect omy was performed. In two cases additional nephrectomy became necessar y because of extensive adhesions. Intraoperatively, one patient suffer ed a blood pressure crisis. 31 patients are still alive and symptom-fr ee after a mean follow-up of 5.4 years (range 1-11 years). Two patient s have died (one with benign pheochromocytoma and one with a metastasi s of lung cancer). Detailed preoperative hormone analysis and adequate perioperative medication substantially lowers the risk involved in ad renal surgery. However, the indications for surgical treatment of horm onally inactive, symptom-free adrenal tumors that are found incidental ly remain controversial, and surgery should perhaps be restricted to l arge tumors.