SU23.3 | Adrenal Tumors — Summary & Reflection

KEY TAKEAWAYS

Adrenal tumours are classified by region — cortical (benign adenoma, functioning or not, vs malignant adrenocortical carcinoma), medullary (phaeochromocytoma; extra-adrenal counterpart = paraganglioma), and secondary metastases — and by two independent axes: functioning vs non-functioning and benign vs malignant. Investigation answers both questions in parallel: function by hormone screening (dexamethasone suppression for cortisol, metanephrines for catecholamines, aldosterone:renin ratio for aldosterone) applied to every mass, and malignancy by size (concern above ~4 cm; ACC often >6 cm), growth, and imaging characteristics (lipid-rich low-attenuation adenoma <10 HU on unenhanced CT vs high-attenuation, poorly washing-out malignant features). Biopsy is generally avoided, and a phaeochromocytoma must be excluded by metanephrines before any intervention. Management is by the grid: surveillance for the small, non-functioning, benign incidentaloma; laparoscopic adrenalectomy for benign functioning tumours (with alpha-before-beta for phaeochromocytoma and steroid cover where needed); open radical resection without capsular rupture plus mitotane and follow-up for adrenocortical carcinoma.

REFLECT

Imagine you are the clinician explaining an incidentally discovered adrenal mass to an anxious, well patient. Could you justify in plain language why a lump that is causing no symptoms still needs blood and urine tests and a careful look at its size and CT appearance — and why, paradoxically, you do NOT want to stick a needle in it? Now reflect on the two-axis way of thinking: how does separating 'is it making a hormone?' from 'is it a cancer?' keep you from the two classic errors — operating on a harmless adenoma and missing an adrenocortical carcinoma? Finally, consider how the safety rules you learned for phaeochromocytoma — exclude it before any intervention, alpha-block before beta-block — are not isolated facts but expressions of the same disciplined, confirm-first approach that governs all adrenal surgery.