ADRENAL SURGICAL APPROACH IN A WOMAN WITH SYNCHRONOUS BILATERAL ADRENAL TUMORS
CLINICAL CASE
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.