Abstract
You have accessJournal of UrologyAdrenal1 Apr 2015PD3-03 RATIONALE FOR PARTIAL ADRENALECTOMY: REVIEW OF DANGERS TO ADRENAL GLAND Alosh Madala, Michael Daugherty, and Gennady Bratslavsky Alosh MadalaAlosh Madala More articles by this author , Michael DaughertyMichael Daugherty More articles by this author , and Gennady BratslavskyGennady Bratslavsky More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.290AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES When a biochemically active adrenal mass is found surgery is usually recommended. While partial adrenalectomy is gaining popularity for small adrenal masses, it is not clear which patients will benefit from adrenal sparing to preserve adrenal function in case of contralateral adrenal pathology. We reviewed the available literature to evaluate the frequency of bilaterality of adrenal involvement with most common primary adrenal tumors and frequency of other pathologies potentially threatening the health of the adrenal gland. METHODS We reviewed the PUBMED literature to evaluate the reported bilaterality of primary adrenal tumors including hereditary and non-hereditary pheochromocytomas (PHEOs), aldosterone producing adenomas (APAs), and cortisol producing adenomas and identified 25 articles describing the frequency of bilaterality of adrenal masses. We also reviewed the literature to assess the etiologies of adrenal damage due to other pathological processes that may affect the adrenal gland in the lifespan of a patient and calculated the combined probability for adrenal damage. RESULTS Table 1 reports the bilaterality of adrenal tumors in hereditary and non-hereditary diseases and demonstrates that adrenal tumors range in bilaterality between 4.25 – 80%. Hereditary PHEOs were bilateral in up to 80% of cases, while nonhereditary PHEOs were bilateral in up to 25%. APAs were bilateral in about 4% of cases, while only case reports reported bilaterality in cortisol producing tumors. Additionally, review of other processes such as infections, infiltrative etiologies, metastasis to adrenal, and others accounted for about 1% chance for the adrenal damage from all possible causes. CONCLUSIONS Partial adrenalectomy is a valid option for patients with hereditary syndromes as there is an increased likelihood of disease in the contralateral gland. PHEOs followed by APAs appear to have the highest rate of bilateral involvement. Coupled with a possibility that an additional 1% of the population may have adrenals affected by various pathologic processes, partial adrenalectomy in patients with PHEO and APAs should be strongly considered. Percentage of bilaterality of adrenal tumors in hereditary syndromes and non-hereditary disease Bilaterality of Adrenal Tumors % Incidentaloma 7.8 Pheochromocytomas Hereditary MEN Syndrome 35-80 VHL 40-60 Nonhereditary Pediatric 25 Adrenal Incidentaloma 10-15 Aldosterone Producing Adenoma 4.26 Cortisol Producing Adenoma Case reports only. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e82 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alosh Madala More articles by this author Michael Daugherty More articles by this author Gennady Bratslavsky More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
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