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  • Review Article
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Surgical management of adrenocortical tumours

Nature Reviews Endocrinology volume 10, pages 282–292 (2014)Cite this article

Subjects

Key Points

  • A thorough biochemical evaluation is required before a patient with an adrenal tumour can be considered for surgery

  • Careful assessment of imaging characteristics is required to provide an optimum operative approach for patients with suspected adrenocortical carcinoma

  • Transperitoneal and posterior retroperitoneal open or laparoscopic approaches have distinct advantages and disadvantages

  • The treatment of patients with adrenal cancer should be managed by clinicians with experience in treating this rare disease

Abstract

The surgical treatment of adrenal tumours has evolved over the past century, as has our understanding of which hormones are secreted by the adrenal glands and what these hormones do. This article reviews the preoperative evaluation of patients with adrenal tumours that could be benign or malignant, including metastases. The biochemical evaluation of excess levels of hormones is discussed, as are imaging characteristics that differentiate benign tumours from malignant tumours. The options for surgical management are outlined, including the advantages and disadvantages of various open and laparoscopic approaches. The surgical management of adrenocortical carcinoma is specifically reviewed, including controversies in operative approaches as well as surgical management of invasive or recurrent disease.

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Figure 1: CT images showing a benign adrenal tumour.
Figure 2: CT image of a tumour amenable to an anterior open or a laparoscopic approach.
Figure 3: CT image of a tumour amenable to a posterior laparoscopic approach.
Figure 4: CT image demonstrating adenoma emanating off the posterior limb of the right adrenal gland in a patient with Conn syndrome that is amenable to partial adrenalectomy.
Figure 5: Illustration of a technique for removing a portion of the adrenal gland from a peripheral or central location within the adrenal gland.
Figure 6: Classification schema for intracaval tumour thrombus.

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Authors and Affiliations

  1. University of Michigan Health System, 1500 East Medical Center Drive, 2920F Taubman Center, Ann Arbor, 48109-5331, MI, USA

    Barbra S. Miller

  2. Department of Surgery, Boston University, 75 East Newton Street, Boston, 02118, MA, USA

    Gerard M. Doherty

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  1. Barbra S. Miller
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B.S.M. researched data for the article, contributed to discussion of the content and wrote the article. G.M.D. reviewed/edited the manuscript before submission.

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Correspondence to Barbra S. Miller.

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Miller, B., Doherty, G. Surgical management of adrenocortical tumours. Nat Rev Endocrinol 10, 282–292 (2014). https://doi.org/10.1038/nrendo.2014.26

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