Adrenal tumour

Adrenal tumours range from asymptomatic to potentially causing lots of unusual symptoms. The most common ones are:

• Adrenal adenoma
• Adrenal carcinoma
• Phaeochromocytoma
• Peripheral neuroblastic tumour

Treatment

Adrenal surgery is mostly performed laparoscopically. Large tumours (> 10 cm, mostly cancers) may be operated in an open fashion instead.

Laparoscopic adrenalectomy (removing the entire gland) is indicated for:

• Cushing syndrome caused by adrenal tumour
• Conn syndrome
• Phaeochromocytoma
• Angiomyolipoma
• Incidentaloma
• Adrenal metastasis

Before surgical treatment of phaeochromocytoma, the patient should receive alpha blocker followed by beta blocker, to prevent hypertensive crisis due to surgical manipulation of the tumour. Surgical removal of phaeochromocytoma involves the “no-touch” technique to minimise the risk of catecholamine-release-induced hypertensive crisis intraoperatively.

Contraindications to laparoscopy:

• Large tumours (> 10 cm)
• Cortical carcinoma
• Malignant phaeochromocytoma

Enucleation refers to removal of the mass while leaving the rest of the gland intact. This is used for bilateral tumours (as one needs at least one gland to survive) or unilateral tumours with massive hormone production.