Adrenal Tumors Research Articles

This study attempted to evaluate the incidence of incidentalomas based on computed tomography (CT) in colorectal cancer (CRC) patients. CRC patients who obtained plan or enhanced CT for the whole abdominal and pelvis were included at the First Affiliated Hospital of Chongqing Medical University, Chongqing, China. Incidentalomas, including uterine tumors, adrenal gland tumors, renal cancer, pancreatic tumors, prostatic tumors, ovarian tumors, upper-tract urothelial cancer, and gallbladder tumors, were assessed based on all radiology reports by radiologists and surgeons. Moreover, the clinical characteristics of all patients were collected. A total of 7053 CRC patients (mean age, 62.6 ± 12.3; 4139 male) were finally included, 255 (3.6%) patients had an incidentaloma. The proportions of uterine tumors, adrenal gland tumors, renal cancer, pancreatic tumors, and prostatic tumors were 1.3% (92/7053), 1.1% (77/7053), 0.7% (46/7053), 0.1% (15/7053), and 0.1% (10/7053), respectively. Ovarian tumors, upper-tract urothelial cancer, and gallbladder tumors all had an incidence of <0.1%. The prevalence of incidentalomas in CRC patients was 3.6% (255/7053). The most common incidentalomas was uterine tumor, followed by adrenal gland tumor, and renal cancer. These findings highlighted the importance of careful evaluation of abdominal and pelvic CT scans in CRC patients, as timely detection and management of incidentalomas might optimize treatment strategies and improve patient outcomes.

The giant cystic pheochromocytomas (>10 cm) are exceedingly rare. Due to the massive size of tumor, traditional laparoscopic minimally invasive surgery poses significant technical challenges. We present the case of a 53-year-old male patient who was admitted due to poorly controlled hypertension and an ultrasound-detected right adrenal mass. Abdomen computed tomography scans revealed a cystic mass (11 cm × 9 cm) in the right adrenal gland, highly suggestive of pheochromocytoma. The laboratory findings demonstrate significantly elevated levels of catecholamines and their metabolites. Histopathological examination confirmed the diagnosis of cystic pheochromocytoma. After 2 weeks of preoperative α-blockade preparation, the patient successfully underwent robot-assisted laparoscopic resection of the right adrenal tumor. At the 6-week postoperative evaluation, catecholamine levels had normalized. Blood pressure has returned to normal range in the absence of antihypertensive therapy and there are no more symptoms of dizziness and palpitations. The patient remained disease-free with no evidence of recurrence or metastasis during 1 year of surveillance. In this case, we demonstrate the successful resection of a giant cystic pheochromocytoma in the right adrenal gland using robotic-assisted laparoscopy. This approach overcomes the technical limitations of conventional laparoscopy for large-volume adrenal pheochromocytomas and provides a novel therapeutic alternative for these challenging tumors.

Adrenal extramedullary plasmacytoma (EMP) is an exceptionally rare plasma cell neoplasm with fewer than 20 documented cases worldwide. The clinical presentation, optimal management strategies, and long-term outcomes remain poorly defined. We report the case of a 51-year-old woman with synchronous bone and adrenal EMP, without multiple myeloma. The initial presentation involved pathological humeral fracture following minor trauma, with the subsequent discovery of a 40mm left adrenal mass on staging CT. Emergency orthopedic fixation and bone biopsy confirmed the diagnosis of EMP. Immunohistochemical findings showed CD138, MUM1, and kappa light-chain restriction positivity, with negative lambda staining. After declining initial surgical intervention, the patient was lost to follow-up for two years, during which the adrenal lesion enlarged to 70mm. Comprehensive staging including bone marrow biopsy, FDG-PET/CT, and laboratory workup confirmed absence of multiple myeloma features according to International Myeloma Working Group criteria. Complete laparoscopic left adrenalectomy was successfully performed, with uncomplicated recovery. Histopathological examination revealed a 75 × 55 × 30mm encapsulated mass with characteristic plasma cell morphology and extensive hemorrhagic foci. The Ki-67 proliferation index was < 10% and Congo red staining was positive. Adjuvant lumbo-aortic radiotherapy (45Gy) was administered. The patient achieved complete clinical and radiological responses at three-month follow-up. Synchronous EMP without multiple myeloma is an exceptionally rare entity that requires comprehensive systemic evaluation and multidisciplinary management. Contemporary management favors laparoscopic resection combined with adjuvant radiotherapy for optimal local control. Excellent survival outcomes support aggressive therapy, although lifelong surveillance remains essential given the potential progression to systemic disease.

Abstract Pheochromocytomas are uncommon adrenal tumors originating from chromaffin cells, with certain cases exhibiting malignant characteristics and behavior. Malignancy is defined by the presence of metastases to sites that normally lack chromaffin tissue; histologic features alone are insufficient for diagnosis. While typically symptomatic, some tumors are discovered incidentally and lack the classic catecholamine-related triad. We present the case of a 52-year-old man with a history of hypertension and hyperlipidemia who presented for routine evaluation and only reported intermittent left lower quadrant pain. On CT and MRI, a 7 cm right adrenal mass with central necrosis was identified; post-contrast MRI showed peripheral enhancement suggesting a hypervascular malignancy. Biochemical testing showed elevated plasma metanephrines and an elevated urinary metanephrine fraction on confirmatory testing. The patient underwent a right adrenalectomy, and histopathological examination revealed pheochromocytoma with angiolymphatic invasion, extra-adrenal extension, a PASS score of 13, and a Ki-67 index of 15–20%, indicating aggressive histologic features consistent with malignant potential. Postoperative recovery was unremarkable and follow-up showed no recurrence. This case underscores the diagnostic value of multimodal imaging in pheochromocytoma, especially when clinical symptoms are not apparent.

Bilateral adrenalectomy for congenital adrenal hyperplasia (CAH) has been a historical therapeutic option for carefully selected patients who have had unsatisfactory outcomes with conventional medical management, as well as those with large adrenal tumors and hyperplasia. Rarely, adrenalectomy is performed in an undiagnosed patient with CAH due to suspicion of adrenocortical cancer, and after the surgery CAH is diagnosed. However, there are fears of increased risk of adrenal crisis and growth of adrenal rest tumors post-adrenalectomy, especially after bilateral adrenalectomy. Moreover, an adrenalectomy is a quite extensive procedure. Now with the newly approved crinecerfont (a corticotropin-releasing factor type 1 receptor (CRF1) antagonist, approved by FDA in US December 2024), and the coming phase 3 study of atumelnant (a MC2R antagonist), the commenced phase 2 study of Lu AG13909 (an anti-ACTH monoclonal antibody) as well as the preclinical studies with OMass MC2R antagonist compounds, there may be new options to decrease the size of the adrenal tumors/hyperplasia. Thus, these may be used instead of adrenalectomy. However, the cost of these new drugs may be very high so they may not become widely available, and adrenalectomy may prove to be more cost effective. This review will discuss the current use of adrenalectomy in patients with CAH and how the introduction of the new drugs may change it.

Case Presentation: A 50-year-old man experienced unintended weight loss and required more intensive antihypertensive therapy over the preceding several months prior to presentation, as well as new-onset headaches beginning a few days before presentation. On the day of presentation, he suddenly collapsed while playing a Japanese gambling machine. However, no bystander-initiated cardiopulmonary resuscitation was initiated. Emergency medical services personnel delivered two shocks using a defibrillator. Return of spontaneous circulation was briefly achieved but not sustained. He was transported to an emergency department by ambulance. His refractory ventricular fibrillation prompted the initiation of venoarterial extracorporeal membrane oxygenation as a life-saving measure. Differential Diagnosis: Coronary angiography performed immediately after venoarterial extracorporeal membrane oxygenation revealed no significant stenosis. Computed tomography uncovered a large right adrenal mass with a maximum diameter of approximately 95 mm (Image). Abdominal T2-weighted magnetic resonance imaging (MRI) revealed a hyperintense lesion within the right adrenal gland． 123 I-meta-iodobenzylguanidine scintigraphy demonstrated intense radiotracer uptake corresponding to the adrenal mass. Furthermore, transthoracic echocardiography identified ventricular septal hypertrophy measuring approximately 19 mm. Cardiac MRI illustrated that the hypertrophy of ventricular septum was relatively uniform. These findings were highly suggestive of pheochromocytoma-induced cardiomyopathy. Treatment and Management: Venoarterial extracorporeal membrane oxygenation was successfully weaned on hospital day 3. On hospital day 23, he underwent open right adrenalectomy, and histopathological examination confirmed pheochromocytoma. Outcome and Follow-up: To prevent recurrent life-threatening arrhythmia, we implanted a cardioverter–defibrillator on hospital day 35. The postoperative course was uneventful, and he was discharged on hospital day 43. Discussion/Teaching Points: Because cardiomyopathy might not quickly resolve after surgery, we implanted a cardioverter–defibrillator in this patient to prevent recurrent cardiac arrest. Although pheochromocytoma-induced cardiomyopathy is relatively rare, most cases are incidentally discovered using clinical images. As the present case illustrates, early detection and rapid therapy could enable the patient to be discharged without any complications.

Case: A 38-year-old woman with a history of migraine headaches, a stable intracranial aneurysm, no recent stressors and a prior normal echocardiogram and ECG presented with 2 years of episodic headaches, palpitations, chest pain and worsening dyspnea. She was found to be hypertensive and electrocardiogram showed inferolateral ST segment depressions, QT interval prolongation, and elevated troponins concerning for myocardial infarction. She underwent cardiac catheterization which revealed normal coronary arteries and left ventricular basal hypokinesis with apical hyperkinesis, suggestive of reverse Takotsubo cardiomyopathy (rTTC). This left ventriculogram was confirmed with an echocardiogram and cardiac MRI. In addition, computed tomography revealed a 3 cm adrenal nodule and 24-hour urine metanephrine levels were greater than eight times the upper limit of normal, concerning for pheochromocytoma (PCC). Follow-up abdominal MRI a few days later showed the nodule had shrunk to 2.3 cm, with hemorrhagic contents. 2 weeks later, catecholamines normalized. Adrenalectomy was deferred. Repeat echocardiogram 6 months later showed normalized LV wall motion. Repeat abdominal CT showed marked adrenal mass reduction with findings consistent with nodule hemorrhage. She remains asymptomatic with normal catecholamines. Discussion: rTTC is characterized by transient basal LV hypokinesis with apical hyperkinesis and no coronary obstruction. It is attributed to catecholamine surges causing myocardial stunning. PCCs, though rare, have been documented as reversible triggers of rTTC. In this case, elevated metanephrines and an adrenal mass suggested PCC-induced rTTC that resolved after tumor hemorrhage. Early recognition and treatment of PCC is vital. Rarely, PCCs may auto-infarct or hemorrhage, becoming nonfunctional—a scenario that can shift management strategy and avoid unnecessary surgery. While rTTC is often reversible, its 10% recurrence rate underscores the importance of addressing underlying causes and ensuring appropriate follow-up.

Laparoscopic adrenalectomy technique has the advantage of reduction in morbidity and peri-operative mortality. This technique has been established in the management of benign small masses (<5-6 cm). A dilemma exists in the management of bigger lesions or potentially malignant tumours. This study aimed to assess the procedure in terms of preoperative requirements, technique itself, the outcome and complications. This mixed design (retrospective and prospective) cohort study was conducted in the Department of Urology and Renal Transplant, at one of the largest tertiary care centre of north-western India. A total of 27 patients who underwent laparoscopic adrenalectomy from January 2022 to December 2023 were included in the study. Data was collected regarding patient's demographic profile, characteristics of adrenal lesions, surgical procedures, postoperative results, and histological diagnosis. Age of patients ranged from 9 to 65 years, 15 (55.6%) were male. Common indication for laparoscopic adrenalectomy was Pheochromocytoma (40.7%), Non-Functioning Adrenal Tumour (29.6%), and Conn's syndrome (18.5%). Histopathology confirmed pheochromocytoma in 10 (37%) patients. Adenoma was found in eight (29.6%) patients. The average intra op blood loss was 174.63 ± 90.98 ml, and nine (33.3%) required post operative blood transfusion. The mean duration of surgery was 140.19 ± 26.51 min. Conversion to open surgery was required in two (7.4%) patients. Post op complications included deranged LFT (3.7%), fever (3.7%), and ileus (7.4%). The duration of the hospital stay ranged from 3 to 5 days. Laparoscopic adrenalectomy can be considered a safe and effective procedure with relatively low rate of morbidity.

Adrenocortical oncocytic neoplasms (ACONs) are very rare in adrenal cortical tumors. One case was reported in this paper. During the physical examination, a soft tissue density shadow was about 6 cm × 5.7 cm in the right adrenal gland. A preoperative diagnosis was adrenal pheochromocytoma with concurrent laparoscopic resection of the right adrenal tumor. Postoperative pathological results rewarded the adrenal cortical oncocytic neoplasms ACONs. After 11-months of postoperative follow-up, the patient had no signs of tumor recurrence and related complications.

Introduction Pheochromocytomatosis, defined as the implantation of pheochromocytoma cells to the intraoperatively opened surfaces during surgical manipulation, is an infrequent complication of surgical intervention of pheochromocytomas. Only a handful of pheochromocytomatosis cases have been reported since the first case was described in 2001. Case report In 2011, a 33-year-old male patient presented with episodic palpitations and hypertensive surges triggered by physical activity. Imaging revealed a left adrenal tumor, which showed intense radiopharmaceutical uptake on 131 I-metaiodobenzylguanidine ([ 131 I]MIBG) scintigraphy. Urinary analysis of metanephrines confirmed pheochromocytoma, and laparoscopic left-sided adrenalectomy was performed. Owing to the large tumor size, intraoperative fragmentation was necessary for removal. The patient remained asymptomatic for five years. In 2016, recurrent paroxysmal symptoms prompted imaging, revealing a lesion at the left renal hilum. During the reoperation in 2017, multiple peritoneal tumor deposits were observed and later confirmed histologically. Over the following years, the patient received conservative, symptomatic treatment with tolerable paroxysmal symptoms. In 2023, worsening symptoms led to the decision to commence three cycles of ([ 131 I]MIBG) therapy, followed by alleviation of symptoms, and a decrease in biochemical parameters. Discussion An extensive literature search for publications from the past 25 years identified 22 pheochromocytomatosis cases whose details were also summarized and analyzed. This condition appears to have a longer recurrence-free survival compared to patients’ cohorts with metastatic pheochromocytomas. Pheochromocytomatosis is usually characterized by a prolonged asymptomatic postsurgical interval, emphasizing the need for long-term follow-up with close biochemical and radiological surveillance. Treatment strategies parallel those used for advanced/metastatic pheochromocytomas.

BackgroundLimited data exist comparing the detection of microscopic fat in adrenal adenomas on two-dimensional chemical shift dual-echo (2D CSI) magnetic resonance imaging (MRI) and three-dimensional two-point Dixon techniques (3D Dixon).PurposeTo compare the sensitivity of 2D CSI versus 3D Dixon techniques for the diagnosis of adrenal adenomas.Material and MethodsA retrospective analysis was conducted of 33 patients with adrenal masses who underwent both 2D CSI and 3D Dixon sequences on a 1.5-T scanner. Two blinded radiologists measured and calculated signal intensity (SI) index (SII) (100×(SI in phase - SI out of phase)/SI in phase) of nodules on each technique. Reference standard diagnosis of 30 adrenal adenomas was established. Sensitivity for adrenal adenoma diagnosis was determined using a SII >16.5%.ResultsIn total, 33 nodules were investigated (mean size=22 mm, range=11-55 mm). Of the 30 adenomas, the mean SII on 2D CSI was 48% for reader 1 and 44% for reader 2, compared to 34% on 3D Dixon for both readers (P < 0.001). Sensitivity for the diagnosis of adenoma with 2D CSI was 90% (95% confidence interval [CI]=82-98) for both readers, while 3D Dixon demonstrated a sensitivity of 73% (95% CI=65-82) for reader 1 and 63% (95% CI=55-72) for reader 2.Conclusion2D dual gradient-echo CSI demonstrated a higher sensitivity for the diagnosis of adrenal adenoma than the 3D Dixon technique. Adrenal MRI evaluation of the adrenal glands at 1.5 T should include 2D dual gradient-echo CSI and not rely solely on 3D two-point Dixon techniques for the diagnosis of adrenal adenomas.

Adrenocortical carcinoma (ACC) is a rare but aggressive malignancy with a heterogeneous prognosis. To date, there are no reliable circulating biomarker to predict clinical outcomes in ACC. Agouti-related peptide (AgRP), an orexigenic hypothalamic neuropeptide is also produced by the adrenal gland. However, its expression in adrenal tumours remains unexplored. To evaluate AgRP levels in tissue and plasma of patients with ACC, benign adrenal tumours (BAT), and other malignancies. AgRP mRNA expression was assessed in silico, and protein levels were analysed by immunohistochemistry in ACC and BAT. Plasma AgRP (pAgRP) was measured using ELISA in patients with ACC, BAT, and other cancers. Tumour burden of ACC was quantified using RECIST1.1. AgRP mRNA levels were higher in ACC than in BAT (3.0 vs.2.4, p<0.0001). AgRP tissue expression was higher in ACC compared to BAT (H-score 120[49] vs.80 [48], p<0.0001). pAgRP was more elevated in ACC than BAT and other malignancies (1.3 vs.0.3vs. 0.2ng/ml, all p<0.0001), and was higher in ACC with high tumour burden than those with low and those ACC-free after surgery (2.7 vs.0.6 vs.0.3ng/ml, p<0.0001). pAgRP increased with the number of metastatic sites (>4 sites: 2.7ng/ml vs. 2-3: 1.5ng/ml vs.1: 0.5ng/ml, p<0.05). In multivariable Cox regression, elevated pAgRP was independently associated with worse progression-free (HR=2.654) and overall survival (HR=2.624) (both p<0.05). AgRP is more highly expressed in both tissue and plasma of ACC compared to BAT and other cancers. Its strong association with tumour burden and prognosis highlights its potential as biomarker in ACC.

Adrenal oncocytomas are rare adrenal tumors, typically benign and non-functioning. Their clinical and imaging features often overlap with malignant lesions, making diagnosis difficult. We report a 25-year-old male with right hypochondrial pain. Imaging revealed an 18 cm right adrenal mass with indeterminate features on CT and MRI. Hormonal evaluation confirmed a non-functioning lesion. The patient underwent right adrenalectomy. Histology confirmed a benign adrenocortical oncocytic neoplasm based on the Lin-Weiss-Bisceglia criteria. No recurrence was noted at 1-year follow-up. This case highlights the diagnostic challenges of large adrenal tumors and the importance of surgical excision in indeterminate cases. Despite benign histology, imaging features can mimic adrenocortical carcinoma. Adrenal oncocytomas can present diagnostic dilemmas. Surgery remains both diagnostic and therapeutic, with favorable outcomes following complete resection.

The TP53 p.R337H variant is a well-characterized founder mutation with an unusually high prevalence in Brazil, particularly in the South and Southeast regions, where it affects approximately 1 in 300 individuals. It is recurrently associated with pediatric adrenocortical tumors and malignancies within the Li-Fraumeni syndrome spectrum but exhibits markedly incomplete penetrance, suggesting the influence of additional genetic and/or environmental modifiers. Although TP53 p.R337H occurs at low frequencies in the Iberian Peninsula, its origin, timing, and dissemination pattern within Brazil have remained unresolved. We integrated population-genetic inference with historical demographic modeling to reconstruct the introduction and expansion of the TP53 p.R337H in Brazil. Our analyses support a founder effect arising from a single founding event of European origin during the early Portuguese colonization period. The subsequent geographic dissemination of the variant parallels historical population growth, particularly in southern Brazil. The striking regional enrichment can be explained without invoking multiple introduction events or complex migratory scenarios. These findings clarify the evolutionary and demographic history of TP53 p.R337H in Brazil and underscore its founder effect origin during European colonization. This study highlights the value of integrating population genetics with historical data to elucidate the spread of medically relevant founder variants. Understanding the dissemination of TP53 p.R337H enhances public health planning and genetic counseling strategies in Brazil.

This study aims to characterize the clinical spectrum of pediatric adrenocortical tumors (P-ACTs) in individuals aged <20years and to compare the distinguishing features of pediatric adrenocortical adenomas (P-ACAs) and carcinomas (P-ACCs). This retrospective study consisted of P-ACT patients who presented to our institute over the past 24years (2001-2024). They were categorized as P-ACC or P-ACA based on Wieneke score. Data on clinical presentation, hormonal evaluation, imaging, management, and outcomes were recorded. A total of 30 (22 females) P-ACT patients (7P-ACA and 23 P-ACC) were identified. The median age at presentation was 7 (range, 1.0-20) years, with a median symptom duration of 6.0months (range 0.6-42months). All patients, except one 16-year-old having P-ACC, had hormonal hypersecretion. Cortisol and androgen co-secretion was most common (56.6 %), followed by isolated cortisol (26.6 %) and androgen hypersecretion (13.3 %). On steroid profiling by LCMS/MS, P-ACC patients had raised levels of multiple steroid metabolites (6-9) as compared to P-ACA (2-5). P-ACA patients were relatively older (17.0 vs. 6.0 years, p=0.045), more often had isolated cortisol secretion (57.1 vs. 17.3 %, p=0.060), had smaller tumors (2.8 vs. 8.5 cm, p=0.002), a lower incidence of calcification (0 vs. 80 %) and a lower percentage venous enhancement (PVE 109.6 vs. 187.8 %, p=0.008) and achieved higher disease remission rates (100 vs. 21.4 %, p=0.005). CECT features, particularly PVE, may aid in differentiating P-ACT from P-ACC. Serum steroid panels may have a role in preoperative assessment, but their utility remains to be validated.

This study aimed to compare perioperative outcomes between laparoscopic and robotic transabdominal lateral adrenalectomies. Despite growing interest in robotic adrenalectomy (RA), its benefits compared with those for laparoscopic adrenalectomy (LA) need to be identified. Two previously published randomized studies used out-of-date technologies and included only pheochromocytoma patients, respectively. A prospective randomized clinical trial was conducted by a single surgeon between May 2024 and February 2025. Patients with adrenal tumors eligible for minimally invasive lateral transabdominal adrenalectomy were randomized to LA or RA. The trial was powered to detect a 30-min difference in operative time. The secondary outcomes were perioperative outcomes, cost, and ergonomics, measured by the NASA Task Load Index (NASA-TLX) and the Rapid Upper Limb Assessment (RULA). In the study, 27 patients were randomized to each group. The groups were similar in demographics, clinical characteristics, and operative indications. The operative times and secondary outcomes were similar between the groups except that the RA group had a lower median operating surgeon NASA-TLX score (16 vs 48; P ≤ 0.001) and a lower overall RULA score (14 vs 17; P = 0.001) than the LA group. Operation room, hospital, and total costs were similar between the groups. Although all the procedures were completed as planned in the RA group, the LA group had four conversions from the original minimally invasive plan (conversion to open, hand-assistedprocedure, and partial adrenalectomy and abortion of the procedure inone patient each). Perioperative outcomes, including cost, were similar between LA and RA, with better ergonomics and fewer conversions from the original minimally invasive surgical plan in the RA group.

Rationale:Continuous invasive blood pressure monitoring is crucial during the perioperative period, particularly in high-risk and critically ill patients. In patients with Takayasu arteritis (TAK) and severe vascular stenosis, conventional arterial cannulation is often technically challenging because of vessel occlusion or fragile tissue. This case report explores the feasibility of using a central venous catheter instead of an arterial puncture kit for invasive blood pressure monitoring when standard arterial catheterization is impractical.Patient concerns:A 56-year-old female with a history of TAK presented for adrenalectomy.Diagnoses:Medical imaging revealed an adrenal tumor and TAK with multi-territorial vascular involvement (radial, brachial, and dorsalis pedis arteries).Interventions:The patient underwent adrenal tumor resection. Continuous invasive blood pressure was monitored under ultrasound guidance using an 18-gauge central venous catheter for femoral artery puncture.Outcomes:The procedure was completed uneventfully with timely hemodynamic monitoring guided by reliable invasive measurements.Lessons:This alternative method has the potential to reduce the risk of intraoperative catheterization and ensure reliable intraoperative blood pressure monitoring when conventional puncture is impossible.

The cytoskeleton has been described as a regulator of adrenal physiology and tumour behaviour. In the adrenal cortex, both cytoskeletal filaments, by mediating cholesterol transfer to mitochondria, and their binding proteins, such as cofilin and diaphanous-related formin 1 (DIAPH1), have been implicated in modulating steroidogenic processes. Beyond hormone production, the cytoskeleton participates in oncogenic signalling and contributes to the acquisition of malignant behaviour in adrenocortical carcinoma (ACC). Cytoskeleton-associated proteins such as filamin A (FLNA), fascin-1 (FSCN1), RASSF1A, and the guanine nucleotide exchange factor VAV2 are involved in signal transduction, cell cycle regulation, and cytoskeletal remodelling. In ACC, dysregulation of the expression or activity of these proteins correlates with ACC aggressiveness, including increased proliferation, motility, and invasion as well as poor prognosis, making them attractive candidates for targeted therapeutic strategies. To date, no review has systematically addressed the role of cytoskeleton and its binding partners in both adrenal physiological regulation and pathological context. This review is the first to provide a comprehensive overview of cytoskeletal involvement in adrenal cortex function and cancer, highlighting emerging molecular players and their possible therapeutic implications.

Disclosure: O. Lavrynenko: None. A. DeMarsilis: None. C. Jiang: None. M.K. Konopka: None. A. Gavrila-Filip: None. P. Sinha: None. K. Chen: None.Background: Pheochromocytomas are rare catecholamine-secreting tumors arising from the adrenal medulla, often presenting with hypertension and sometimes are associated with diabetes. While they frequently present with symptoms, such as palpitations and sweating, pheochromocytomas can also manifest no symptoms and are discovered incidentally during imaging studies for unrelated conditions. The prevalence of asymptomatic or "silent" pheochromocytomas has increased due to advancements in imaging modalities, such as CT and MRI, which frequently detect adrenal masses during evaluations for other diseases. Case Presentation: A 73-year-old man with a history of hypertension and type 2 diabetes mellitus (diagnosed 3 years ago) presented with abdominal pain. Imaging revealed a suspicious colon mass suspicious for malignancy, along with a 7 cm right adrenal mass. He was admitted for surgical evaluation, and an endocrine consultation was obtained for preoperative hormonal assessment of the adrenal mass. Imaging confirmed a 7.1 × 6.7 × 6.7 cm adrenal mass, raising concern for pheochromocytoma, adrenal cortical carcinoma, or metastatic disease. During hospitalization, he experienced persistent hyperglycemia (blood glucose levels of 200-300 mg/dL), requiring basal-bolus insulin therapy.Initial hormonal evaluation revealed elevated normetanephrine and total free metanephrines. Urinary metanephrine and catecholamine levels were within normal limits, except for a slight elevation on one test. The patient was started on doxazosin for possible pheochromocytoma. The patient underwent a low anterior resection of the colon cancer, right adrenalectomy, and colorectal anastomosis. Postoperatively, the patient remained hemodynamically stable without signs of adrenal insufficiency and was discharged in good condition. Pathology confirmed the right adrenal mass was a benign pheochromocytoma. Following surgery, the patient felt well, and his blood pressure was well-controlled on lisinopril alone. Importantly, his diabetes improved significantly. He stopped insulin and did not resume glipizide and maintain good control of diabetes on metformin alone (blood glucose consistently less 200 mg/dl). He has since initiated chemotherapy for colon cancer. Conclusion: This case highlights the incidental discovery and asymptomatic nature of a large pheochromocytoma in a patient undergoing evaluation for another malignancy. The removal of the pheochromocytoma led to improved glycemic control, demonstrating the role of catecholamine excess in exacerbating diabetes.Presentation: Saturday, July 12, 2025

Disclosure: H.M. Heshmati: None. N. Zameni: None.Background: Robotic surgery is quickly replacing traditional surgery performed by humans. It has significantly influenced the field of endocrine surgery. This review presents an update on the use of robotic surgery and artificial intelligence for adrenal tumors. Methods: A systematic search of literature was conducted using the search terms robotic surgery, artificial intelligence, adrenal tumors, safety, outcome, and cost. Results: Adrenal tumors are found in 10% of people who have imaging of the adrenal gland. They are typically unilateral and benign in the majority of cases. Robotic systems such as da Vinci Surgical System provide surgeons with enhanced dexterity and 3D visualization. Autonomous surgical robots can be categorized into various levels of autonomy including supervised autonomy (e.g., performance of specific tasks with human oversight), collaborative autonomy (e.g., robots working alongside human surgeons, sharing tasks and responsibilities), and fully autonomous systems (e.g., robots performing entire surgical procedures independently with human intervention when necessary). Robotic surgery allows access through tight spaces to remove adrenal tumors with small incision and minimal impact on surrounding tissues. The review of 1,162 patients who underwent adrenalectomy (robotic surgery in 747 patients, laparoscopic adrenalectomy in 415 patients) showed comparable blood loss and complications with the two techniques but patients with robotic surgery had significantly shorter hospital stay. The future of robotic surgery can be revolutionized by the integration of autonomous robots and artificial intelligence (AI), a field rapidly advancing. These innovations promise to further enhance the precision, safety, and effectiveness of surgery involving the adrenal glands. AI-powered systems provide real-time guidance and feedback to surgeons, enhancing decision-making and surgical precision. Autonomous systems can ensure consistent execution of surgical tasks, reducing variability and enhancing patient safety. AI algorithms can analyze extensive surgical data to refine techniques and predict potential complications, improving surgical outcomes. AI can customize surgical plans based on individual patient anatomy and pathology, potentially leading to better outcomes. The current high cost of these new procedures is a potential limitation for their use. Conclusion: Robotic surgery represents significant progress in minimally invasive techniques for the removal of adrenal tumors. It has improved dexterity and precision, and is associated with shorter recovery time compared to laparoscopic adrenalectomy. Collaboration between human surgeons and robotic systems can improve patient care and surgical outcomes. The precision, safety, and effectiveness of the adrenal surgery can be further enhanced by the integration of AI and robotics.Presentation: Saturday, July 12, 2025