Incidental adrenal findings on abdominal imaging performed for another condition have increased in recent years. That is, X-rays or MRIs done to investigate inflammation of the abdomen, kidney stones, lung disease, spinal pain, discover tumors in the adrenal gland which were not known.

The question automatically arises as to what we should do about these tumors, which are scientifically named random or adenomas adrenal gland.

“In general, the adrenal gland is probably the most unknown organ – even to many medical specialists – with the result that many patients are not properly investigated following practices of decades past. Each person has two separate adrenal glands in the deepest part of the abdomen, the posterior retroperitoneum, right in the waist area. They are very small in size and secrete hormones that regulate blood pressure, sugar, metabolism, energy, fatigue, beautiful mood, etc., says Mr. Aristotelis Kechagias MD PhD FACS, Digestive & Endocrine SurgeonDirector of the Ith Surgical Clinic of the Metropolitan General and continues:

“If an adenoma is found then special measurements on the CT/MRI should be repeated in a specialized adrenal center for its correct interpretation and clinical examination with taking a targeted medical history.

It is a common phenomenon that the conclusion of the imaging from a general radiology center underestimates the dimensions of the tumor, while the description of suspicious secondary findings such as unclear shape, calcifications, and inhomogeneity is absent. Also, the patient must do special urine and blood tests to see if any hormones are high.

In super-specialized European centers there are specific rules for when an adenoma is operated on and when it is monitored: The adenomas that have a high secretion of hormones they must always be removed regardless of their size to treat patients with hormonal syndromes and to discontinue various medications they are taking (eg pressure, sugar): 1) Cushing’s syndrome (high cortisol) with secondary hypertension, diabetes, weakness, abdominal/facial fat with thin limbs, musculoskeletal algae 2) high aldosterone with correctable hypertension, low potassium 3) pheochromocytoma (high adrenaline) with episodes of hypertension, headache, tachycardia 4) high androgens (testosterone) with hair growth or high estrogens (gynecomastia , osteoporosis).

Also, non-hormone-secreting adenomas should always be operated on if they are greater than 4 cm (in the US they have a lower limit of 3cm), or if they increase in size. Their removal is needed for two reasons: A) To prevent or treat cancer. The larger the size of the tumor, the higher the genetic material mutations and the chance of cancer. Adenomas 6 cm or larger have a greater than 25% chance of cancer, but we shouldn’t wait until we get there.

The patient should be aware that without the tumor being removed and sent for histology, then there is no certainty as to whether it is cancer or not. In other words, the images give percentages of the probability of cancer, but only the histology gives a definitive answer. B) Valid studies have shown that patients with adrenal adenomas, cysts, or hyperplasias and apparently normal blood/urine measurements have a greater risk of cardiovascular event or death in their lifetime if they do not undergo surgery, compared to peers with a similar problem, who were operated on.

This is because the adenoma may have a cyclic (hidden) hormone secretion that escapes the laboratory, at least in the early stages. Finally, tumors smaller than 3-4 cm, without suspicious features in the axial or hypersecretion of hormones, must be monitored with tests and imaging for 5 years (they are operated on if they grow by 5 millimeters or if they start to hypersecrete)” points out Mr. Kehagias.

“In summary, operations on adrenal tumors may extend life expectancy, treat secondary hypertension, or spare the patient from drugs or cancer. THE Retroperitoneal Adrenal Tumor Removal 2 or 3 small holes (PRA Technique) it is the most perfect surgical method (superior to laparoscopic) offering safety, minimal trauma, 24-hour hospitalization, immediate recovery and return to everyday life. It is carried out in very few centers worldwide, among them our Clinic at Metropolitan General, which has a leading role internationally with new techniques and speeches at the most important European Conferences”, concludes Mr. Kehagias.