BILATERAL ADRENAL-TUMORS - 12 CONSECUTIVE CASES

Objectives: When abdominal imagery reveals bilateral adrenal tumours, diagnosis and treatment may have severe consequences leading to life-long hormone substitution. We report our series of 12 consecutive cases in order to evaluate the diagnostic procedures and propose an adapted therapeutic strategy. Methods: Over a 5-year period we observed bilateral adrenal tumours in 12 patients (9 males and 3 females; mean age 49.2 years; range 22-67) among a population of 10,000 hypertensive subjects. Routine laboratory tests and hormonal levels were determined in all 12 patients. Abdominal computed tomography with opaciflcation (n=12) and magnetic resonance imagery (n=5) was also performed. Other tests including echography and scintigraphy were performed as needed for diagnosis. All patients underwent laparotomy. Results: Hormone levels were normal in 6 patients and led to the diagnosis of pheochromocytosis (n=5) and primary hyperaldosteronism (n=1) in the others. After laparotomy, the pathology diagnosis was bilateral pheochromocytosis (n=5), bilateral metastasis (n=2) and benign bilateral adenoma (n=5). In 5 cases, hormone levels were insufficient for establishing diagnosis before laparotomy. In these cases the pathology diagnosis was benign tumour in 4 and malignant tumour in 1. Images of adrenal masses (metastases) led to the diagnosis of the primary cancer in one case. Conclusions: Search for pheochromocytosis and primary neoplasia, after eliminating adrenal myelolipoma and pseudotumours on the basis of the tomography images, should be the first exploration of fortuitously discovered bilateral adrenal masses. Exploratory puncture biopsy should be avoided and, for tumours greater than 30 mm, exploratory laparotomy is indicated. Tumours less than 30 mm should be followed echographically for six months to eliminate malignancy. Masses which increase in size should be explored surgically. Until larger series enable a standardized approach, malignancy should always be suspected in non-secreting bilateral tumours of the adrenal glands.