Examination of Clinicopathological Characteristics of Patients who Underwent Surgery for Adrenal Mass in a Tertiary University Hospital

Year 2023, Volume: 1 Issue: 3, 100 - 102, 31.10.2023

Fuat Şentürk , Murat Kartal , Erdem Karadeniz , Müfide Nuran Akçay

Abstract

Objective: This study aimed to present the clinicopathological characteristics of patients who underwent adrenalectomy due to adrenal mass in a tertiary university hospital. Material and Method: Patients who underwent surgery for adrenal mass at Ataturk University Research Hospital between January 2010 and January 2023 were evaluated retrospectively. Cases under the age of 18 (n=2) and cases who underwent adrenalectomy for reasons other than adrenal adenoma (n=6) were excluded from the study. Preoperative, intraoperative and postoperative data of patients who met the study criteria were examined. Quantitative variables were expressed as mean ± standard deviation (SD) and minimum-maximum values. On the other hand, qualitative variables were presented as numbers and percentages. Results: There were 42 patients who met the study criteria, and 29 (69%) of the cases were female. The mean age of the patients was 50.21 years (18-77). According to preoperative laboratory results, there was pheochromocytoma in 14 (33.3%) cases, Cushing syndrome in two (4.8%) cases, Cushing syndrome and Conn syndrome coexistence in one (2.4%) case, non-functional adrenal adenoma in 18 (42.8%) cases, and adrenocortical carcinoma in seven (16.7) cases. While the surgery of 30 cases was completed laparoscopically, five cases started laparoscopically but continued with open surgery due to adhesion (four cases) or bleeding (one case). Direct open surgery approach was performed in seven cases. The most common diagnosis in the pathological examination of the surgical materials was adrenal adenoma. Discussion: Adrenal masses are usually detected incidentally, and it is crucial to perform laboratory examinations and evaluate imaging methods in detail to determine the functional characteristics of the masses in the preoperative period. Size and functional status are the most important parameters in the decision for surgery, and surgery can be performed laparoscopically or open surgery. Key Words: Adrenal Gland Neoplasm, Cushing’s Syndrome, Conn Syndrome, Adrenocortical Carcinomas.

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Üçüncü Basamak Bir Üniversite Hastanesinde Adrenal Kitle Nedeniyle Cerrahi Uygulanan Hastaların Klinikopatolojik Özelliklerinin İncelenmesi

Abstract

Amaç: Bu çalışmada üçüncü basamak bir üniversite hastanesinde adrenal kitle nedeniyle adrenalektomi uygulanan hastaların klinikopatolojik özelliklerinin sunulması amaçlanmıştır. Gereç ve Yöntem: Ocak 2010 ile Ocak 2023 tarihleri arasında Atatürk Üniversitesi Tıp Fakültesi Araştırma Hastanesi’nde adrenal kitle nedeniyle cerrahi uygulanan hastalar retrospektif olarak değerlendirildi. 18 yaş altı olgular (n=2) ve adrenal adenom dışı nedenler ile adrenalektomi uygulanan olgular (n=6) çalışma dışı bırakıldı. Çalışma kriterlerine uyan hastaların preoperatif, peroperatif ve postoperatif verileri incelendi. Nicel değişkenler ortalama ± standart sapma (SD) ve minimum-maksimum olarak ifade edildi. Buna karşın nitel değişkenler sayı ve yüzde olarak verildi. Bulgular: Çalışma kriterlerine uyan 42 hasta mevcuttu. Olguların 29 (%69)’u kadın,13 (%31)’i erkekti. Hastaların ortalama yaşı 50,21 yıl (18-77) idi. Preoperatif laboratuvar sonuçlarına göre 14 (%33,3) olguda feokromasitoma, 2 (%4,8) olguda Cushing sendromu, 1 (%2,4) olguda Cushing sendromu ve Conn sendromu birlikteliği, 18 (%42,8) olguda non-fonksiyonel adrenal adenom, 7 (%16,7) olguda ise adrenokortikal karsinom şüphesi mevcuttu. 30 olgunun cerrahisi laparoskopik olarak tamamlanırken, 5 olgu laparoskopik olarak başlandı fakat yapışıklık (4 olgu) veya kanama (1 olgu) nedeniyle cerrahiye açık cerrahi ile devam edildi. 7 olguya ise direkt açık cerrahi uygulandı. Cerrahi materyallerin patolojik incelemesinde en sık konulan tanı adrenal adenomdu. Sonuç: Adrenal kitleler genellikle insidental olarak saptanan kitleler olup; preoperatif dönemde kitlelerin fonksiyonel özelliklerini tespit etmek için laboratuvar tetkikleri yapılması ve görüntüleme yöntemlerinin ayrıntılı değerlendirilmesi önemlidir. Cerrahi kararında boyut ve fonksiyonel durum en önemli parametreler olup, cerrahi laparoskopik veya açık cerrahi ile yapılabilmektedir.

Keywords

Adrenal Bez Neoplazmı, Cushing Sendromu, Conn Sendromu, Adrenokortikal Karsinomlar

Ethical Statement

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Supporting Institution

ATATÜRK ÜNİVERSİTESİ TIP FAKÜLTESİ

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Thanks

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References

• Terzolo M, Bovio S, Pia A, Reimondo G, Angeli A. Management of adrenal incidentaloma. Best Pract Res Clin Endocrinol Metab. 2009;23(2):233-43.
• Barzon L, Sonino N, Fallo F, Palu G, Boscaro M. Prevalence and natural history of adrenal incidentalomas. Eur J Endocrinol. 2003;149(4):273-85.
• Megha R, Wehrle CJ, Kashyap S, Leslie SW. Anatomy, abdomen and pelvis: adrenal glands (Suprarenal Glands). StatPearls [Internet]: StatPearls Publishing; 2022.
• Paschou SA, Vryonidou A, Goulis DG. Adrenal incidentalomas: A guide to assessment, treatment and follow-up. Maturitas. 2016;92:79-85.
• Toktas O, Batur A, Eryılmaz R, Kalaycı T, Özdemir A. A case of ruptured pheochromocytoma causing loss of life of a patient due to delay in diagnosis. Int Med. 2019; 1(4): 237-240
• Kalaycı T, Deniz Ö. Hormon-negatif retroperitoneal ekstra-adrenal paraganglioma. Hitit Med J. 2022;4(1):34-8.
• Moreira Jr SG, Pow-Sang JM. Evaluation and management of adrenal masses. Cancer Control. 2002;9(4):326-34.
• Prager G, Heinz-Peer G, Passler C, et al. Surgical strategy in adrenal masses. Eur J Radiol. 2002;41(1):70-7.
• Bovio S, Cataldi A, Reimondo G, et al. Prevalence of adrenal incidentaloma in a contemporary computerized tomography series. J Endocr Invest. 2006;29:298-302.
• Terzolo M, Stigliano A, Chiodini I, et al. AME position statement on adrenal incidentaloma. Eur J Endocr. 2011;164(6):851-70.
• Eser ZE, Ramazan G, Kadir E, Sezer K, Akbay E. Adrenal insidentaloma’lı hastalarda klinik, biyokimyasal ve radyolojik retrospektif analiz. Mersin Üniversitesi Sağlık Bilimleri Dergisi. 2022;15(2):382-92.
• Hsieh LB, Mackinney E, Wang TS. When to intervene for subclinical Cushing's syndrome. Surg Clin North Am. 2019;99(4):747-58.
• Fergany AF. Adrenal masses: a urological perspective. Arab J Urol. 2016;14(4):248-55.
• Corssmit EP, Dekkers OM. Screening in adrenal tumors. Curr Opin Oncol. 2019;31(3):243-6.
• Vaidya A, Hamrahian A, Bancos I, Fleseriu M, Ghayee HK. The evaluation of incidentally discovered adrenal masses. Endocr Pract. 2019;25(2):178-92.
• Platzek I, Sieron D, Plodeck V, Borkowetz A, Laniado M, Hoffmann R-T. Chemical shift imaging for evaluation of adrenal masses: a systematic review and meta-analysis. Eur Radiol. 2019;29:806-17.
• Zeiger MA, Thompson GB, Duh Q-Y, et al. American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons medical guidelines for the management of adrenal incidentalomas. Endocr Pract. 2009;15:1-20.
• Young Jr WF. The incidentally discovered adrenal mass. New Engl J Med. 2007;356(6):601-10.
• Pivonello R, De Leo M, Cozzolino A, Colao A. The treatment of Cushing's disease. Endocr Rev. 2015;36(4):385-486.