Adrenal masses: A urological perspective

Abstract

Adrenal masses have become increasingly common due to widespread use of sectional imaging. Urologists are commonly faced with management decisions in patients with adrenal masses. Systemic review of available literature related to surgical adrenal disease was performed to summarise the most pertinent information related to adrenal masses, diagnostic evaluation and surgical treatment. Detailed hormonal evaluation of adrenal disease was not included, being part of endocrinological rather than urological practice. Adrenal masses exhibit a wide spectrum of presentation and pathology, and treatment requires different surgical techniques. Full understanding of the pathology and management of such masses should be completely familiar to practicing urologists.

Keywords: Adrenal incidentaloma; Adrenal mass; Adrenalectomy; Adrenocortical carcinoma; LESS, laparoendoscopic single-site; Laparoscopic adrenalectomy; MIBG, metaiodobenzylguanidine; PET, positron emission tomography; SCS, subclinical Cushing’s syndrome; SUV, standardised unit uptake.

Figure 1

1.8 × 1.3 cm right adrenal incidentaloma. Density measurements on unenhanced scan are 3 HU, consistent with a benign adenoma. No further radiological evaluation is indicated.

Figure 2

Heterogeneous enhancement in a patient with a right adrenal mass 1 min after i.v. contrast. Unenhanced images measured at 36 HU, at 15 min enhancement was 98 HU. CT findings highly suggestive of adrenocortical carcinoma, pathologically confirmed after adrenalectomy.

Figure 3

Left adrenocortical carcinoma with renal vein and inferior vena cava tumour thrombus reaching the right atrium. Additional radiological features of malignancy are large size and heterogeneous enhancement.

Figure 4

Solitary adrenal metastasis in a patient with previous history of treated ovarian carcinoma. Patient was symptomatic with flank pain necessitating an open adrenalectomy.