Partial adrenalectomy: evaluation and management—a clinical practice review

Abstract

: Since the initial description of adrenalectomy, surgical management of adrenal masses has continued to evolve. In this article, the clinical evaluation, indications for partial adrenalectomy, surgical approaches and technical aspects of partial adrenalectomy, and outcomes are reviewed. The advantages and disadvantages of different operative approaches are discussed in the context of performance of pADX, including anterior, posterior, laparoendoscopic single site (LESS) surgery and robot-assisted approaches. Finally, post-operative management and outcomes are reviewed. The published literature (English language) was reviewed by searching PubMed between the years January 1, 1990 to December 31, 2021. Expert consensus and personal experiences were included to highlight nuances in planning and management. Partial adrenalectomy, in specific situations, is preferred to bilateral total adrenalectomy to avoid the need for long-term steroid supplementation, as steroid dependence is associated with decreased quality of life and increased morbidity and mortality. Various types of adrenal pathology may involve both adrenal glands, either concurrently or sequentially, especially in those with hereditary syndromes. Advancements in understanding the underlying disease processes, indications and contraindications to pADX, and minimally invasive surgery, including robotic assistance and other intraoperative adjuncts, have allowed for more widespread offering of pADX to appropriate patients. Partial adrenalectomy is a safe and effective operation in patients who otherwise would be relegated to bilateral adrenalectomy, permanent postoperative adrenal insufficiency and the need for lifelong steroid supplementation. Preoperative planning and intraoperative conduct of the operation are key to selecting appropriate patients and managing patients over the long-term, especially for those expected to have disease recurrence due to genetic mutations.