Adrenal cysts: an institutional experience

Abstract

Introduction: Adrenal cysts are rare clinical entities. We report our institutional experience with adrenal cysts and also assess various management options.

Material and methods: Over the past 15 years the Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, has had seven cases of adrenal cysts, of which two were functional: one patient had Cushing's syndrome and the other patient had pheochromocytoma. The other five cases were incidentally detected. Ultrasound scan and computerized tomography (CT) scan were the imaging modalities. Four patients had a single cyst, two patients had two cysts, and one patient had multiple unilateral cysts.

Results: None of these cysts had foci of malignancy. Laparoscopic adrenalectomy was possible in three patients with no morbidity or mortality.

Discussion: The reported incidence in clinical series has been 5.4%. Pseudocysts, endothelial cysts, epithelial cysts, and hemorrhagic cysts have been commonly described. The management can be conservative or surgical. It is generally agreed that a hormonal work-up is necessary in all cases of adrenal cysts to rule out a sub-clinical disease. Adrenal neoplasms, including adrenocortical carcinomas, can be associated with cysts that are benign in appearance. Percutaneous aspiration has been suggested as an alternative treatment option if the cyst is not hormonally active and if there is no suspicion of malignancy. However, surgical excision provides a definite histopathological diagnosis and also removes the fear of future complications such as hemorrhage into the cyst and local pressure effects due to the tumor.

Conclusions: Given that the adrenals are a vascular gland and taking into consideration the possibilities of bleeding and complications in the cyst, our treatment of choice is the elective excision of adrenal cysts.