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Surgical Management of Elderly Patients pp 111–127Cite as

Surgical Approach to Adrenal Diseases in the Elderly

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Abstract

A wide spectrum of benign and malignant adrenal diseases are referred to surgery in elderly patients. Adrenal causes of secondary hypertension are primary aldosteronism, hypercortisolism either in the form of adenomas or hyperplasia, pheochromocytoma, and paragangliomas. Standard diagnostic protocols are available for the different endocrine features, and adrenal vein catheterization can be used in case of bilateral lesions. Malignant lesions include some forms of pheochromocytoma, metastases, and primary adrenocortical carcinoma. All these malignancies are usually associated to bad prognosis and often are not radically resectable at diagnosis. Especially pheochromocytoma presents with a wide spectrum of clinical features often with surgical indication to control severe hypertension. Asymptomatic adrenal lesions detected during general radiological or ultrasonographic abdominal examination are defined as incidentalomas. Endocrine activity and malignancy should be screened in all incidentalomas. In the elderly, surgery of adrenal disease is feasible, but the outcomes may be worse due to comorbidities, increased postoperative complications, and slower recovery. The indications for adrenalectomy are functional tumor associated with hormone secretion and nonfunctional tumors associated with a suspicion or evidence of malignancy. The feasibility and the safety of the laparoscopic approach in elderly, although higher conversion rate, has been shown. Laparoscopic adrenalectomy represents the gold standard of treatment even in elderly patients with lateral transabdominal access being the most used worldwide. The open adrenalectomy is generally performed in presence of general contraindications to laparoscopy or in presence of large lesions (>12 cm in diameter) or malignant locally invasive tumors. Patient selection and care in containment of complication and comorbidity are key points of the surgical management.

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Authors and Affiliations

  1. General, Emergency and Minimally Invasive Surgery Unit, Careggi University Hospital, Florence, Italy

    Andrea Valeri & Carlo Bergamini

  2. General and Endocrine Surgery Unit, S. Maria University Hospital, University of Perugia, Terni, Italy

    Andrea Polistena & Nicola Avenia

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  1. Andrea Valeri
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Correspondence to Andrea Polistena .

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  1. Department of General and Mininvasive Surgery, Cristo Re Hospital, Rome, Italy

    Antonio Crucitti

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Valeri, A., Polistena, A., Bergamini, C., Avenia, N. (2018). Surgical Approach to Adrenal Diseases in the Elderly. In: Crucitti, A. (eds) Surgical Management of Elderly Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-60861-7_8

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