ADRENAL SURGICAL APPROACH IN A WOMAN WITH SYNCHRONOUS BILATERAL ADRENAL TUMORS

Simona Elena Albu1,2,Maria Carsote2,3, Cristina Căpaţînă2,3,Adina Ghemigian 2,3, Anda Dumitraşcu2,4

1The Department of Gynecology, The University Emergency Hospital, Bucharest, Romania
2The University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
3The Department of Endocrinology, The National Institute of Endocrinology “C. I. Parhon”, Bucharest, Romania
4The Department of Radiology, The National Institute of Endocrinology “C. I. Parhon”, Bucharest, Romania

Corresponding author: Maria Carsote
Phone no. 0040213172041
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Abstract

Bilateral adrenal tumours are very rare and display various endocrine profiles. The unilateral approach is indicated if a nonsecretor contralateral pattern is suspected in order to avoid adrenal insufficiency.We present a 48-year-old woman with a history of bradimenorrhea at the age of 44. The gynecological evaluation was negative but two adrenal tumours were found. CT revealed a right adrenal tumour of 2 cm and a left one of 2.4 cm. Low-normal ACTH and high serum chromogranin A were confirmed. After one year, the left tumour increased to 4 cm so laparoscopic transabdominal left adrenalectomy (with 3 trocars) was successfully performed without any incident. No conversion was required. Neither intraoperative nor postoperative complications occurred. The patient was hospitalised 5 days and the wounds healed normally. The pathological report revealed a benign corticoadenoma. The endocrine evaluation after one week showed that after surgery ACTH de-suppressed to normal and chromogranin A normalised. The right adrenal tumour was followed-up for another year and the diameters were stationary. The patient was still hypertensive and she was offered adequate therapy (which we considered essential for high blood pressure). Life-long periodical check-up is necessary.Unilateral adrenalectomy in patients with both side tumours allows an adequate pathological report and avoids unnecessary contralateral surgery if an incidentaloma is revealed, thus allowing the preservation of adrenal function.

 

Keywords: bilateral adrenal tumors, adrenalectomy, incidentaloma

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