What is adrenal vein sampling (AVS), and when is it indicated? AVS is an interventional radiology procedure in which endovascular catheters are used to selectively cannulate and sample blood from the right and left adrenal veins. There are technical limitations to accurate sampling, and the technique may not be universally available. APAs are typically < …
What are the possible laparoscopic approaches for adrenalectomy? The most common technique is via an anterolateral laparoscopic transabdominal approach in which the patient is placed in the lateral decubitus position with the side of the lesion up. This provides excellent exposure but does not permit removal of both glands without repositioning the patient. A supine …
Is adrenalectomy best performed with an open technique or the laparoscopic technique? Laparoscopic adrenalectomy is the approach of choice for benign adrenal tumors except when very large (> 8 cm). Laparoscopic adrenalectomy has been associated with shorter hospital stay, less postoperative pain, less blood loss, faster recovery, and overall increased patient satisfaction compared with the …
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Should all adrenal nodules be evaluated with percutaneous biopsy? No. Percutaneous biopsy is reserved for patients who have a history of extraadrenal malignancy with an adrenal mass, and only if the results of the biopsy will alter the treatment plan for the extraadrenal malignancy. Pheochromocytoma must be excluded with biochemical testing prior to biopsy to …
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What findings on CT help distinguish between benign and malignant tumors? Adrenal nodule size and imaging characteristics are the two major predictors of malignancy. Adrenocortical carcinoma (ACC) accounts for only 2% of lesions < 4 cm but up to 25% of those > 6 cm. Benign adenomas are typically < 4 cm, are homogeneous with …
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What imaging studies are available for evaluating adrenal pathology? There are three main imaging techniques for the differentiation of malignant from benign adrenal tumors: CT, magnetic resonance imaging (MRI), and positron emission tomography with fluorodeoxyglucose (FDG-PET/CT). CT and MRI are mainly techniques to identify benign lesions and exclude adrenal malignancy. FDG-PET/CT is mainly used for …
What is the lab workup of an adrenal mass? Up to 20% of adrenal incidentalomas are found to be biochemically hyperfunctional and should be resected. Therefore, patients should be screened for hypercortisolism, hyperaldosteronism (if hypertensive), and pheochromocytoma with the following tests: 1 mg overnight dexamethasone suppression test (8:00 am cortisol): ≦ 1.8 mcg/dL—excludes autonomous cortisol secretion 1.9–4.9 …