Description
Adrenal surgery is typically the final episode in the management of patients with adrenal disease. A multidisciplinary approach is essential. Surgery should be confined to specialist units. Surgery for malignant adrenal disease should be carried out in close liaison with liver surgeons. Tumours should be accurately localised by CT or MR imaging. Patients with phaeochromocytomas must have appropriate pharmacological blockade prior to surgery. Incidental adrenal tumours must be fully investigated for hormonal hypersecretion. Non-functioning adrenal tumours account for between 3-4% of CT scans. Small tumours <3 cm may be managed conservatively. Surgery may be undertaken laparoscopically. Tumours <5cm diameter may be removed by a posterior approach, avoiding the peritoneal cavity. Large tumours should be removed by an anterior approach.
