Adrenal incidentoma

А total of 167 case histories of patients operated on for adrenal diseases are analyzed. There were 23 (13.7%) so-called incidentalomas, 12 patients with hormone-inactive tumors were not operated and are followed up, 22 patients were subjected to traditional adrenalectomy, and 1 to laparoscopic operation. The study included analysis of complaints, physical examination, study of hormone profiles (ACTH, hydrocortisone, 11-hydroxycorticosteroids, 17-ketosteroids, aldosterone, renin, adrenaline, noradrenaline, and vanillylmandelic acid), and instrumental examinations (ultrasonography, computer-aided tomography, magnetic imaging, superselective phlebography with differentiated catheterization of adrenal veins and blood collection at different levels, and fine needle aspiration biopsy monitored by ultrasonography). Results of comprehensive clinical examination were compared with morphological findings in removed adrenals. Polypositional ultrasonic examination, computer-aided tomography, and magnetic imaging helped make a correct topical diagnosis in many cases, and superselective phlebography with blood collection at several levels helped assess the functional activity of involved and contralateral adrenal. Studies of hormonal profiles of patients with so-called incidentalomas showed no changes in the majority of patients. Slight increases of blood hydrocortisone and urinary hydroxy corticosteroids were noted in patients with light-cell adenomas. On the other hand, measurements of hormones in blood specimens collected at different levels revealed a significant increase of hydrocortisone and aldosterone in all patients operated on. Twelve patients were not operated on after comprehensive clinical and instrumental examinations and are followed up for 6 months to 3 years. Surgical treatment was considered not indicated for patients with small (less than 3 cm) tumors and in cases without signs of malignant growth and hormone activity confirmed by instrumental studies. Such patients were repeatedly examined after 6 and 12 months. No changes in the clinical picture and tumor characteristics were detected.

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