Surgical Treatment of Adrenal Gland Tumors

  • J. P. Stein
  • D. G. Skinner
Part of the Medical Radiology book series (MEDRAD)


The adrenal gland is an important structure both anatomically and physiologically. To properly diagnose and treat adrenal disorders, one must have a thorough understanding of the anatomy, the normal physiology, and the pathophysiology of the gland. Adrenal tumors comprise an interesting spectrum of benign and malignant diseases. The most common tumors involving the adrenal gland are metastatic lesions to the adrenal. Management of these metastatic lesions is dependent upon the primary disease entity. The major primary adrenal disorders discussed in this chapter will include: Cushing’s syndrome, hyperaldosteronism, pheochromocytoma, an incidentally discovered adrenal mass, and adrenal cortical carcinoma. These tumors can present with a variability of clinical signs and symptoms which often overlap, making the differentiation on the basis of symptoms and physical examination both difficult and unreliable.


Adrenal Gland Primary Hyperaldosteronism Adrenal Tumor Adrenal Mass Left Renal Vein 
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  1. Abrams HL, Siegelman S, Adam DF, Sanders R, Finberg HJ, Hessel SJ, McNeil BJ (1982) Computed tomography versus ultrasound of the adrenal gland: a prospective study. Radiology 143: 121–128PubMedGoogle Scholar
  2. Anson BJ, Caldwell EW, Pick JW, Beaton LE (1947) The blood supply of the kidney, suprarenal gland and associated structures. Surg Gynecol Obstet 84: 313–320PubMedGoogle Scholar
  3. Bagshawe KD (1960) Hypokalemia, carcinoma and Cushing’s syndrome. Lancet 11: 284–287CrossRefGoogle Scholar
  4. Barzilay JL, Pazianos AG (1989) Adrenocortical carcinoma. Urol Clin North Am 16: 457–468PubMedGoogle Scholar
  5. Belldegrun A, Hussain S, Seltzer SE, Loughlin KR, Gittes RF, Richie JP (1986) The incidentally discovered adrenal mass: a therapeutic dilemma-BWH experience 1976–1983. Surg Gynecol Obstet 163: 203–208PubMedGoogle Scholar
  6. Belldegrun A, deKernion JB (1989) What to do about the incidentally found adrenal mass. World J Urol 7: 117–120CrossRefGoogle Scholar
  7. Bravo EL (1991) Pheochromocytoma: new concepts and future trends. Kidney Int 40: 544–556PubMedCrossRefGoogle Scholar
  8. Bravo EL, Tarazi RC, Fouad FM, Bidt DG, Gifford RW Jr. (1981) Clonidine-suppression test: a useful aid in the diagnosis of pheochromocytoma. N Engl J Med 305:623– 626Google Scholar
  9. Bravo EL, Tarazi RC, Dustan HP, et al. (1983) The changing clinical spectrum of primary aldosteronism. Am J Med 74: 641PubMedCrossRefGoogle Scholar
  10. Brennan MF (1987) Adrenocorticoid carcinoma. Cancer 37: 348Google Scholar
  11. Chandler WF, Schteingart DE, Lloyd RV, McKeever PE, Perez-Ibarra G (1987) Surgical treatment of Cushing’s disease. J Neurosurg 66: 204–212PubMedCrossRefGoogle Scholar
  12. Conn JW (1955) Primary hyperaldosteronism: a new clinical syndrome. J Lab Clin Med 45: 3–17PubMedGoogle Scholar
  13. Conn JW (1967) The evolution of primary aldosteronism: 1954–1967. Harvey Lect 62: 257Google Scholar
  14. Copeland PM (1983) The incidentally discovered adrenal mass. Ann Intern Med 98: 940–945PubMedGoogle Scholar
  15. Cushing H (1912) The pituitary body and its disorders. J.B. Lippincott, PhiladelphiaGoogle Scholar
  16. Dolan LM, Carey RM (1989) Adrenal cortical and medullary function: diagnostic tests. In: Vaughan ED Jr, Carey RM (eds) Adrenal disorders. Thieme Medical, New York, p 81Google Scholar
  17. Donohue JP (1990) Surgically treatable adrenal disorders. Part IAUA Update Series 19: 146–151Google Scholar
  18. Dunnick NR, Heaston D, Halvorsen R, et al. (1982) CT appearance of adrenal cortical carcinoma. J Comput Assist Tomogr 6: 978–982PubMedCrossRefGoogle Scholar
  19. Ferriss JB, Beevers DG, Brown J J, et al. (1978) Clinical, bio-chemical and pathological features of low-renin (“primary”) hyperaldosteronism. Am Heart J 95: 375–388PubMedCrossRefGoogle Scholar
  20. Figueroa AJ, Stein JP, Lieskovsky G, Skinner DG (1997) Adrenal cortical carcinoma associated with venous tumor thrombus extension. Br J Urol 80: 397–400PubMedGoogle Scholar
  21. Geisinger MA, Zeich MG, Bravo EL, et al. (1983) Primary hyperaldosteronism: comparison of CT, adrenal venography and venous sampling. AJR 141: 299PubMedGoogle Scholar
  22. Glazer GM, Woolsey EJ, Borrello J, et al. (1986) Adrenal tissue characterization using MR imaging. Radiology 158: 73–79PubMedGoogle Scholar
  23. Goldfarb DA (1993) Surgical adrenal disease in the National Center for Advanced Medical Education. Urology Review, pp 1–13, Cook County Hospital, ChicagoGoogle Scholar
  24. Halberg FE, Sheline GE (1987) Radiotherapy of pituitary tumors. Endocrinol Metab Clin North Am 16: 667–684PubMedGoogle Scholar
  25. Hall WA, Luciano MG, Doppman JL, Patronas NJ, Oldfield EH (1990) Pituitary magnetic resonance imaging in normal human volunteers: occult adenomas in the general population. Ann Intern Med 120: 817–820Google Scholar
  26. Hengstmann JH (1985) Evaluation of screening tests for pheochromocytoma. Cardiology 72: 153–156PubMedCrossRefGoogle Scholar
  27. Hume DM (1960) Pheochromocytoma and hypertension: an analysis of 207 cases. Int Abstr Surg 99: 458–465Google Scholar
  28. Jubiz W, Meikle AW, West CD, et al. (1970) Single dose metyrapone test. Arch Intern Med 125: 472–474PubMedCrossRefGoogle Scholar
  29. Klibanski A, Zervas NT (1991) Diagnosis and management of hormone-secreting pituitary adenomas. N Engl J Med 324: 822–831PubMedCrossRefGoogle Scholar
  30. Libertino JA (1988) Surgery of adrenal disorders. Surg Clin North Am 68: 1027–1056PubMedGoogle Scholar
  31. Liddle GW (1960) Tests of pituitary-adrenal suppressibility in the diagnosis of Cushing’s syndrome. J Clin Endocrinol Metab 20: 1539–1560PubMedCrossRefGoogle Scholar
  32. Ludecke DE (1991) Transnasal microsurgery of Cushing’s disease 1990. Overview including personal experiences with 256 patients. Pathol Res Pract 187: 608–612PubMedGoogle Scholar
  33. Luton J-P, Cerdas S, Billaud L, et al. (1990) Clinical features of adrenocortical carcinoma, prognostic factors, and the effect of mitotane therapy. N Engl J Med 322: 1195–1201PubMedCrossRefGoogle Scholar
  34. Mitty HA, Yeh HC (1982) Radiology of the adrenals for sonography and CT. W.B. Saunders, PhiladelphiaGoogle Scholar
  35. Moore TJ, Dluhy RG, Williams GH, et al. (1976) Nelson’s syndrome: frequency, prognosis and effect of prior pituitary irradiation. Ann Intern Med 85: 731–734PubMedGoogle Scholar
  36. Nelson DH, Meakin JW, Dealy JB Jr., Matson DD, Emerson K Jr., Thorn GW (1958) ACTH–producing tumor of the pituitary gland. N Engl J Med 259: 161–164PubMedCrossRefGoogle Scholar
  37. Neville AM, O’Hare MJ (1982) The human adrenal cortex: pathology and biology-an integrated approach. Springer-Verlag, New York Berl in HeidelbergGoogle Scholar
  38. Newhouse JH (1990) MRI of the adrenal gland. Urol Radiol 12: 1PubMedCrossRefGoogle Scholar
  39. Orth DN (1995) Cushing’s syndrome. N Engl J Med 32: 791–803CrossRefGoogle Scholar
  40. Orth DN, Liddle GW (1971) Results of treatment in 108 patients with Cushing’s syndrome. N Engl J Med 285: 243–247PubMedCrossRefGoogle Scholar
  41. Pepe GJ, Albrecht ED (1990) Regulation of the primate fetal adrenal cortex. Endocr Rev 11: 151–176PubMedCrossRefGoogle Scholar
  42. Pommier RF, Brennan MF (1992) An eleven-year experience with adrenocortical carcinoma. Surgery 112: 963–971PubMedGoogle Scholar
  43. Richie JP, Gittes RF (1980) Carcinoma of the adrenal cortex. Cancer 45: 1957–1964PubMedGoogle Scholar
  44. Ross NS, Aron DC (1990) Hormonal evaluation of the patient with an incidentally discovered adrenal mass. N Engl J Med 323: 1401–1405PubMedCrossRefGoogle Scholar
  45. Scott EM, Thomas A, McGarrigle HHG, Lachelin GC (1990) Serial adrenal ultrasonography in normal neonates. J Ultrasound Med 9: 279–283PubMedGoogle Scholar
  46. Shapiro B, Sisson JC, Eyre P, Copp JE, Dmucowski C, Beierwaltes WH (1985) 131I-MIBG- new agent in diagnosis and treatment of pheochromocytoma. Cardiology 72:137– 142Google Scholar
  47. Sipple JH (1961) The association of pheochromocytoma with carcinoma of the thyroid gland. Am J Med 31: 163–166CrossRefGoogle Scholar
  48. Stackpole RH, Melicow MM, Uson AC (1963) Pheo-chromocytoma in children. J Pediatr 66: 315Google Scholar
  49. Teasdale E, Teasdale G, Mohsen F, Macpherson P (1986) High-resolution computed tomography in pituitary microadenoma: is seeing believing? Clin Radiol 37: 227–232PubMedCrossRefGoogle Scholar
  50. Thomas JL, Bernardino ME, Samaan NA, Hickey RC (1980) CT of pheochromocytoma. AJR 135: 477PubMedGoogle Scholar
  51. Tikkakoski T, Taavitsainen M, Paivansalo M, et al. (1991) Accuracy of adrenal biopsy guided by ultrasound and CT. Acta Radiol 32: 371–374PubMedCrossRefGoogle Scholar
  52. van Heerden JA, Sheps SG, Hamberger B, et al. (1982) Pheochromocytoma: current status and changing trends. Surgery 91: 367–373PubMedGoogle Scholar
  53. Vaughan DE Jr (1997) Diagnosis of surgical adrenal disorders. AUA Update Series 16: 306–311Google Scholar
  54. Wilson CB, Tyrell JB, Fitzgerald PA, Pitts LH (1980) Cushing’s disease and Nelson’s syndrome. Clin Neurosurg 27: 19–30PubMedGoogle Scholar
  55. Wooten MD, King DK (1993) Adrenal cortical carcinoma. Epidemiology and treatment with mitotane and a review of the literature. Cancer 145: 3145–3155Google Scholar
  56. Zovickian J, Oldfield EH, Doppman JL, Cutler GB, Loriaux DL (1988) Usefulness of inferior petrosal sinus venous endocrine markers in Cushing’s disease. J Neurosurg 68:205– 210Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1999

Authors and Affiliations

  • J. P. Stein
    • 1
  • D. G. Skinner
    • 1
  1. 1.Department of Urology, Norris Comprehensive Cancer CenterUniversity of Southern CaliforniaLos AngelesUSA

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