EVOLUTIONARY ASPECTS OF DIAGNOSTIC AND SURGICAL TREATMENT OF ADRENAL GLAND PATHOLOGIES

Abstract

Introduction. Surgical treatment of pathologies of the adrenal glands is currently performed to remove tumors of any character (benign or malignant) of these organs or in order to correct endocrine disorders, usually after failed medical management.

Materials and methods. Literature sources from the PubMed, HINARI, Google Scholar databases were studied, regarding the evolutionary aspects of diagnosis and surgical treatment of adrenal gland pathologies, using the keywords: "adrenalectomy", "laparoscopic surgery", "adrenocortical carcinoma", "incidentaloma", "pheochromocytoma", "minimally invasive techniques", selecting the most relevant literature sources published on the given topic.

Results. The major indications of adrenalectomy are functional or non-functional tumor formations of the adrenals or suspicion of primary adrenal malignancy or solitary metastases in the adrenals. Although surgical pathology of the adrenal glands is not so frequent, the problem has become topical through the prism of laparoscopic surgery, which has become a "gold standard" in their resolution.

Currently, there is no consensus opinion on the role of laparoscopic adrenalectomy in adrenal cortical carcinoma. National Comprehensive Cancer Network (NCCN) and AACE-AAES guidelines have recommended open adrenalectomy for adrenal cortical carcinoma. According to several sources in the literature, laparoscopic adrenalectomy may be considered in small incidentalomas, large indeterminate incidentalomas without necrosis or evidence of invasion, and small adrenal cortical carcinoma, with adherence to the principles of oncologic vigilance.

Conclusions. Minimally invasive adrenal surgery should be performed in large centers with experience in open adrenal surgery. Laparoscopic adrenalectomy should be viewed with certain reservations in the setting of malignant tumors.