Adrenal Tumors in Older Persons



Adrenal tumors are common, especially in older individuals. Numerous autopsy studies have examined the frequency of adrenal tumors, and in a review of 87,065 autopsies, adrenal lesions (>1 cm) were identified in 6% of patients [1]. Similarly, the prevalence of adrenal “incidentalomas” is 4% when detected by abdominal CT or magnetic resonance imaging (MRI). The incidence of adrenal tumors increases with age. For instance, the likelihood of detecting an unsuspected adrenal lesion on an abdominal CT scan in individuals between 20 and 29 years of age is only 0.2% versus 7% in individuals over 70 years of age [1, 2]. The majority of adrenal tumors are clinically nonfunctioning, benign adrenocortical adenomas and usually do not require surgical intervention. However, surgeons also may encounter elderly patients with functioning benign adrenal tumors (cortisol-, aldosterone-, and catecholamine-producing) as well as malignant adrenal tumors (adrenocortical carcinoma; ACC, malignant pheochromocytoma, and metastasis to the adrenal). The management principles of adrenal tumors in older patients are similar to those in their younger counterparts. However, the diagnosis as well as the management may provide unique challenges in the elderly that are exemplified in the above case presentation: (1) the symptoms of hormone excess may be absent, subtle, atypical, and/or masked by medications, (2) the biochemical diagnosis of endocrine hypersecretion may be cumbersome due to drug interference, (3) the index of suspicion may be too low for an alternative diagnosis to essential hypertension, (4) laparoscopic surgery may be more difficult due to previous open abdominal procedures, (5) unanticipated complications may occur (e.g., urinary retention).


Adrenal Tumor Adrenal Mass Laparoscopic Adrenalectomy Adrenocortical Carcinoma Adrenal Adenoma 
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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of SurgeryYale University School of MedicineNew HavenUSA

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