Abstract:

Objective: Adrenal incidentolamas have been defined as adrenal lesions less than 1 cm in size with an incidence ranging between 1.4, and 8.7 % median 2.3%. Adrenal masses less than 1 cm are generally non-functional, while those larger than 6 cm in diameter are functional with a probability of 40 percent. Adrenal masses smaller than 4 cm in diameter has a malignancy potential of 2 percent. While those measuring 4-6 cm or greater than 6 cm have malignancy potentials of 6 %, and 25 %, respectively. Besides, non-functional adrenal masses larger than 4 cm are candidates for surgery, however for small myelipomas, benign cysts, and non-functional adenomas surgical treatment may not be required unless they become symptomatic.In this study, in the light of the literature, we aimed to review approach to, and surgical treatment of adrenal masses which we encounter in our clinical practice. Material and Methods: Patients whom we followed up, and treated surgically between January 2010, and January 2015 in our clinics of urology, and general surgery with the indication of adrenal mass, were retrospectively screened, and 14 patients were included in our analysis. The patients underwent ultrasonographic US, computed tomographic CT and magnetic resonance imaging MRI techniques. Biochemical blood analyses of dehydroepiandrosterone DHEA, cortisol, metanephrine, normetanephrine, total testosterone, thyroid stimulating hormone TSH, vanillyl mandelic acid VMA, aldosterone, and renin were performed. Adrenal masses of our patients were evaluated as functional in 3, and nonfunctional in 11 cases. Results: A total of 14 patients 4 male, and 10 female were included in the study. Mean age of the patients was 54.7 years range, 33-74 yrs. Mean diameter of the adrenal masses was 8.8 cm range, 5.5 - 23 cm. These patients underwent open surgical excision n=5 or laparoscopic surgical excision n=9. Histopathology of the adrenal masses was reported as malign n=2 or benign n=12 lesions. Conclusion: Adrenal glands are anatomically small in size, however they possess critically important vital functions. Therefore, approach to adrenal masses, and their treatment should be evaluated preoperatively from endocrinologic perspective, and necessary endocrinologic preparations should be completed before the surgery. Pre-, peri-, and post-operative elaboration of especially hormone-active cases carries utmost importance. Surgical success is directly proportional to multidisciplinary collaboration.

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