The surgical treatment of adrenal gland tumors - incidentaloma

Analysis of 32 patients operated on because of accidentally discovered adre nal tumors "incidentaloma" is presented. In 12 of them there was subclinica l hormonal activity, in 9 of them tumors turned out:to be pheochromocytoma and 3 of them were cortex adenoma. There were 20 hormonally inactive tumors , in 5 of them there were malignant lesions (4 of the cortex and 1 of the m edulla). For evaluation of hormonal activity of adrenal tumors evaluation o f chromogranin A and cortisol serum blood level or urine free cortisol leve l is recommended. For precise. localization of the tumor beside USG also CT examination is of use. According to the high percentage of malignant lesio ns in "incidentaloma" type tumors, surgery treatment without delay is recom mended. BAC or DHES in blood serum examinations were not found helpful in p reoperative evaluating the lesions as benign or malignant. In case of preop eratively found subclinical hormonal hyperactivity of medulla pharmacologic al treatment with alpha and beta blockers in surgery preparation is recomme nded. Lateral extraperitoneal access for adrenalectomy is considered safe a nd provides good operational view. Laparoscopic procedure because of high p ercentage of malignant lesions in this group of patients is not justified.