J.Jpn. Surg. Soc.. 88(9): 1157-1160, 1987

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Report on the annual meeting

SURGICAL MANAGEMENT OF ADRENAL TUMORS ; ENDOCRINE TUMORS AND INCIDENTALLY DISCOVERED MASSES

The surgical management of endocrine adrenal tumors appears to be rationalized utilizing many recent advancements in endocrinology and radiographic techniques. Dynamic CT scan is especially useful not only in localization of tumors but also in differentiation of benignancy from malignancy. Aldosterone-producing adenomas are small, 1-2cm in diameter, and appear as the low density mass, which are not enhanced on dynamic CT scan. Cortisol-producing adenomas are strongly but evenly enhanced and easily diagnosed. Pheochromocytomas have a tendency to degenerate and show large or small cyst-like foci which are not enhanced but surrounding parenchymas are heavily enhanced.
On the contrary, malignant tumors of the adrenal, whether they are primary or metastatic, show irregular patchy mixture of enhanced parenchymas and degenerated foci of low density. According to these observations, when an incidentally found adrenal mass shows no endocrine activity and appears on dynamic CT as smooth-surfaced low density mass which is hardly enhanced, the patient is not operatedand carefully observed.
Surgical treatment of adrenal tumors were performed on 76 patients (endocrine tumors 73, incidental tumors 3). Posterior or lateral approach was made for benign small tumors, whereas thoraco-abdominal incision or laparotomy was done for pheochromocytomas or for incidentally discovered masses

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