Adrenal tumours: 10-year experience of a tertiary cancer centre

Authors

  • Subbiah Shanmugam Department of Surgical Oncology, Kilpauk Medical College, Chennai, Tamil Nadu, India
  • Sujay Susikar Department of Surgical Oncology, Kilpauk Medical College, Chennai, Tamil Nadu, India
  • Gerald Anand Raja Department of Surgical Oncology, Kilpauk Medical College, Chennai, Tamil Nadu, India
  • Kishore Kumar Reddy government royapettah hospital

DOI:

https://doi.org/10.18203/2349-2902.isj20213139

Keywords:

Adrenal adenoma, Pheochromocytoma, Incidentaloma

Abstract

Adrenal tumours are rare neoplasm. The prevalence of adrenal tumours is estimated to be 3% in those older than 50 years and 6% in those older than 60 years. Diagnostic work-up should assess autonomous hormone production and differentiate between benign and malignant lesions. In 19 patients presenting with adrenal tumours from 2010-2020, 9 (47.4%) were male patients and 10 (52.6%) female patients with a mean age of 44.6 years. Presenting complaints include headache and hypertension in 8 (42.1%) patients, pain abdomen in 4 (21.1%) patients, incidentally diagnosed in 5 (26.3%) patients and 2 (10.5%) patients presented with mass per abdomen. Pheochromocytoma was seen in 10 (52.6%) patients, adrenocortical carcinoma was seen in 5 (26.3%) patients, adenoma was seen in 3 (15.8%) patients each and angiomyolipoma was seen in 1 (5.3%) patient. Open adrenalectomy was done in 13 (68.4%) patients and laparoscopic adrenalectomy was done in 5 (26.3%) patients. One patient presented with multiple metastases and was inoperable. Adrenal tumours are rare neoplasms often presenting with nonspecific symptoms. The majority are non-functioning tumours with an incidence in the 5th or 6th decade. In our study pheochromocytoma is most common followed by adrenocortical carcinoma. Laparoscopic adrenalectomy is now the gold standard for small and medium-sized tumours.

References

Else T, Kim AC, Sabolch A, Raymond VM, Kandathil A, Caoili EM et al. Adrenocortical carcinoma. Endocrine reviews. 2014;35(2):282-326.

Khanna S, Priya R, Bhartiya SK, Basu S, Shukla VK. Adrenal tumors: An experience of 10 years in a single surgical unit. Indian j cancer. 2015;52(3):475.

Daneshmand S, Quek ML. Adrenal myelolipoma: diagnosis and management. J Urol. 2006;3:71-4.

Grumbach MM, Biller BM, Braunstein GD, Campbell KK, Carney JA, Godley PA et al. Management of the clinically inapparent adrenal mass (incidentaloma). Ann internal med. 2003;138(5):424-9.

Terzolo M, Stigliano A, Chiodini I, Loli P, Furlani L, Arnaldi G et al. AME position statement on adrenal incidentaloma. Eur J endocrinol. 2011;164(6):851-70.

Bittner JG, Brunt LM. Evaluation and management of adrenal incidentaloma. J Surgical Oncol. 2012;106(5):557-64.

Fassnacht M, Libé R, Kroiss M, Allolio B. Adrenocortical carcinoma: a clinician's update. Nature Reviews Endocrinol. 2011;7(6):323-35.

Cordera F, Grant C, Van Heerden J, Thompson G, Young W. Androgen-secreting adrenal tumors. Surgery. 2003;134(6):874-80.

Nieman LK. Approach to the patient with an adrenal incidentaloma. J Clin Endocrinol Metabolism. 2010;95(9):4106-13.

Hamrahian AH, Ioachimescu AG, Remer EM, Motta-Ramirez G, Bogabathina H, Levin HS et al. Clinical utility of noncontrast computed tomography attenuation value (Hounsfield units) to differentiate adrenal adenomas/hyperplasia from non-adenomas: Cleveland Clinic experience. J Clin Endocrinol Metabolism. 2005;90(2):871-7.

Aron DC. The adrenal incidentaloma: Disease of modern technology and public health problem. Rev Endocr Metab Disord. 2001;2:335 42.

Wooten MD, King DK. Adrenal cortical carcinoma. Epidemiology and treatment with mitotane and a review of the literature. Cancer. 1993;72(11):3145-55.

Kebebew E, Reiff E, Duh QY, Clark OH, McMillan A. Extent of disease at presentation and outcome for adrenocortical carcinoma: have we made progress? World J Surg. 2006;30(5):872-78.

Kim JH, Moon H, Noh J, Lee J, Kim SG. Epidemiology and prognosis of pheochromocytoma/paraganglioma in Korea: a nationwide study based on the National Health Insurance Service. Endocrinol Metabolism. 2020;35(1):157.

Hong AR, Kim JH, Park KS, Kim KY, Lee JH, Kong SH et al. Optimal follow-up strategies for adrenal incidentalomas: reappraisal of the 2016 ESE-ENSAT guidelines in real clinical practice. Eur J Endocrinol. 2017;177:475-83.

Mantero F, Terzolo M, Arnaldi G, Osella G, Masini AM, Ali A, et al. A survey on adrenal incidentaloma in Italy. Study Group on Adrenal Tumors of the Italian Society of Endocrinology. J Clin Endocrinol Metab. 2000;85:637-44.

Mahmood E, Anastasopoulou C. Adrenal Adenoma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2020.

Barzon L, Sonino N, Fallo F, Palu G, Boscaro M. Prevalence and natural history of adrenal incidentalomas. Eur J Endocrinol. 2003;149(4):273-85.

Mantero F, Terzolo M, Arnaldi G, Osella G, Masini AM, Alì A et al. A survey on adrenal incidentaloma in Italy. Study Group on Adrenal Tumors of the Italian Society of Endocrinology. J Clin Endocrinol Metab. 2000;85(2):637-44.

D’Antonio A, Caleo A, Caleo O, De Dominicis G, Boscaino A. Monotypic epithelioid angiomyolipoma of the adrenal gland: an unusual site for a rare extrarenal tumor. Ann Diagnostic Pathol. 2009;13(5):347-50.

Godara R, Vashist MG, Singla SL, Garg P, Sen J, Mathur SK et al. Adrenal angiomyolipoma: a rare entity. Indian j urol. 2007;23(3):319.

Hu H, Xi X. Giant adrenal angiomyolipoma. J Clin Endocrinol Metabolism. 2012;97(11):3835-6.

Sutter R, Boehler A, Willmann JK. Adrenal angiomyolipoma in lymphangioleiomyomatosis. Eur Radiol. 2007;17(2):565-6.

Yener O, Ozcelik A. Angiomyolipoma of the right adrenal gland. Surgery. 2011;102743:2.

Kerkhofs TM, Roumen RM, Demeyere TB, Van der Linden AN, Haak HR. Adrenal tumors with unexpected outcome: a review of the literature. Int j endocrinol. 2015;2015.

Gagner M, Lacroix A, Bolte E. Laparoscopic adrenalectomy in Cushing's syndrome and pheochromocytoma. N Engl J Med. 1992;327:1033.

Downloads

Published

2021-07-28

Issue

Section

Case Series