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Preoperative workup in the assessment of adrenal incidentalomas: outcome from 282 consecutive laparoscopic adrenalectomies.
[adrenal incidentaloma]
To
confirm
the
efficacy
of
preoperative
workup
,
the
authors
analyse
the
results
of
a
multicentre
study
in
a
surgical
series
of
patients
diagnosed
with
an
adrenal
incidentaloma
.
The
retrospective
review
of
a
prospectively
collected
database
was
conducted
.
The
data
was
obtained
by
six
surgical
units
operating
in
the
Campania
Region
,
Italy
.
Five
-
hundred
and
six
(
506
)
adrenalectomies
performed
between
1993
and
2011
on
498
patients
were
analysed
.
Final
histology
in
patients
with
a
preoperative
diagnosis
of
incidentaloma
and
studied
according
to
guidelines
(
230
/
282
patients
group
A
)
was
compared
with
final
histology
coming
from
patients
presenting
the
same
preoperative
diagnosis
but
studied
not
according
to
guidelines
(
52
/
282
patients
group
B
)
.
In
group
A
preoperative
diagnosis
was
confirmed
at
final
histology
in
76
/
81
(
93
.
8
%
)
cases
of
subclinical
functioning
lesions
presenting
as
an
incidentaloma
.
The
preoperative
detection
of
pheochromocytoma
and
primary
adrenocortical
cancer
(
ACC
)
reached
91
.
6
%
and
84
.
6
%
respectively
.
In
group
B
conversion
rate
to
open
surgery
was
higher
than
in
group
A
(
p
=
0
.
02
)
.
One
pheochromocytoma
was
missed
at
preoperative
diagnosis
whereas
one
ACC
smaller
than
4
centimetres
(
cm
)
and
coming
from
an
incidental
lesion
was
discovered
.
In
both
groups
a
significant
association
between
increasing
dimensions
of
incidentaloma
and
cancer
has
been
observed
(
p
=
0
.
001
)
.
This
surgical
series
confirm
the
high
efficacy
of
suggested
guidelines
.
A
significant
preoperative
detection
rate
of
adrenal
lesions
presenting
as
incidentaloma
is
observed
.
The
unnecessary
number
of
adrenalectomies
performed
in
understudied
patients
,
causing
higher
morbidity
,
was
not
associated
to
a
higher
detection
rate
of
primary
adrenocortical
cancer
.
Diseases
Validation
Diseases presenting
"cancer"
symptom
achondroplasia
acute rheumatic fever
adrenal incidentaloma
alpha-thalassemia
benign recurrent intrahepatic cholestasis
cadasil
canavan disease
carcinoma of the gallbladder
cholangiocarcinoma
coats disease
congenital adrenal hyperplasia
congenital diaphragmatic hernia
cowden syndrome
cushing syndrome
cutaneous mastocytosis
dedifferentiated liposarcoma
dystrophic epidermolysis bullosa
epidermolysis bullosa simplex
erdheim-chester disease
erythropoietic protoporphyria
esophageal adenocarcinoma
esophageal carcinoma
esophageal squamous cell carcinoma
familial hypocalciuric hypercalcemia
familial mediterranean fever
gm1 gangliosidosis
heparin-induced thrombocytopenia
hereditary cerebral hemorrhage with amyloidosis
hirschsprung disease
hodgkin lymphoma, classical
inclusion body myositis
junctional epidermolysis bullosa
kabuki syndrome
kallmann syndrome
kindler syndrome
lamellar ichthyosis
liposarcoma
locked-in syndrome
lymphangioleiomyomatosis
monosomy 21
neuralgic amyotrophy
oculocutaneous albinism
oligodontia
oral submucous fibrosis
papillon-lefèvre syndrome
pendred syndrome
pleomorphic liposarcoma
primary effusion lymphoma
proteus syndrome
pyomyositis
pyruvate dehydrogenase deficiency
severe combined immunodeficiency
sneddon syndrome
systemic capillary leak syndrome
triple a syndrome
von hippel-lindau disease
waldenström macroglobulinemia
well-differentiated liposarcoma
werner syndrome
wiskott-aldrich syndrome
wolf-hirschhorn syndrome
x-linked adrenoleukodystrophy
This symptom has already been validated
