Preoperatively asymptomatic adrenal incidentaloma

Since the introduction of new, very sensitive imaging procedures (ultrasono graphy, CT, MRI) the incidence of incidentally discovered, asymptomatic adr enal masses has clearly increased. These tumours are a new challenge to dev elop therapy and preoperative evaluation strategies, as the following case report shows. In a 29-year-old asymptomatic female patient a large adrenal tumour on the left side was discovered on abdominal ultrasonography during pregnancy. The further endocrinological examinations were normal. The patie nt was operated on post partum. During intraoperative manipulation of the t umour we observed an excessive increase in blood-pressure and heart rate. S hortly after removal of the tumour and immediate sympatholytic treatment th e situation was under control. The intraoperative clinical situation and hi stological work-up of the tumour led to the diagnosis of phaeochromocytoma. The problem of adrenal incidentalomas is discussed on the basis of the curr ent literature and an algorithm for preoperative evaluation is presented.