Adrenal adenomas: what to do with them? Review 2

Abstract

Adrenal incidentalomas (AI) are a collective, working category that contains a wide range of different forms of patho­logy of these glands. They differ in the original tissue structures from which they originate, in clinical and hormonal characte­ristics, in diagnostic and tactical approaches. Such a wide range of emergencies, which are hidden under the guise of accidentally detected AI, puts before the clinician the task of identifying them (establishing a clinical and, if possible, morphological diagnosis) with the definition of tactical approaches. Based on the analysis of these data, as well as numerous publications, their working classification is proposed. When deciding on surgical treatment, the surgeon must have a clinical diagnosis — what nosological form of adrenal pathology is to be operated on. Interventions with the diagnosis AI are unacceptable and are a gross error. The optimal operation for most such tumors is laparoscopic adrenalectomy with the tumor. Open operations are indicated for malignant tumors of significant size, especially with signs of invasion into surrounding structures. Given that most AI are benign formations, it is equally important to determine further tactics for them — the mode and duration of observation, the order and scope of control clinical and hormonal and imaging studies, the principles of evaluation of the results. Several guidelines indicate that in the presence of hormonally inactive adenomas, without signs of malignancy, less than 3–4 cm in size, no further observation is indicated. It is noted that in such tumors the tendency to growth, malignancy, emergence of hormonal activity is extremely seldom observed. In other cases, especially with the slightest doubt of the initial results, follow-up examinations are recommended after 3, 6, 12 months and then after 1–2 years, the maxi­mum period is set to five years. These parameters are the subject of discussion in various clinics.