Asymptomatic Adrenal Tumours: Criteria for Endoscopic Removal

Objective: Assessment of criteria for videoscopic removal of adrenal lesions discovered incidentally. Design: Open prospective study. Subjects: 63 patients operated on for 65 adrenal tumours. Outcome Measures: Relevance of proposed criteria: secreting adrenal lesion; diameter larger than 4 cm or increase in size at any re-evaluation; computed tomogram of intratumoral necrosis, haemorrhage, or irregular margins; high concentrations of dehydroepiandrosterone (DHEAS). Results: Laparoscopic adrenalectomy was successful in 61 patients (97%). There were 4 minor complications. Criteria allowed us to identify correctly : phaeochromocytoma (n = 23), primary hyperaldosteronism (n = 18), Cushing's adenoma or disease (n = 7), single metastasis (n = 4), adenoma with DHEAS or cortisol hypersecretion (n = 3). 8 non-secreting incidental tumours (13%) were operated on. Conclusion: Simple criteria for videoscopic adrenalectomy for lesions discovered incidentally allowed us to reduce the number of doubtful indications (positive predictive value 87%).