A Case Series on Adrenal Tumors: Clinical Spectrum, Pathological Diversity and the Role of Laparoscopic Adrenalectomy

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Dr. Ravikumar.B.R, Dr. Amruthraj.G.Gowda, Dr. Salapala Vijay, Dr. Mashook Abdul Khader

Abstract

Adrenal tumors exhibit a broad spectrum of clinical presentations, ranging from asymptomatic incidentalomas to hormonally active lesions causing hypertension, hypokalemia, or symptoms of hormonal excess. This case series is a retrospective study which included 14 patients who underwent laparoscopic adrenalectomy over the last 3 years at our institute. The study included predominantly middle-aged females. Functional tumors constituted 71.4% of cases, including Conn’s syndrome (40%), pheochromocytomas (40%), and Cushing’s syndrome (20%) of these functional tumors. Pathological diagnoses included adrenocortical adenomas (42.9%), pheochromocytomas (28.6%), and rare lesions such as ganglioneuroma and adrenocortical carcinoma. Larger tumors (>6 cm) demonstrated a higher risk of malignancy and surgical complexity. Laparoscopic adrenalectomy, performed in 85.7% of cases, proved to be a safe and effective approach, with a low conversion rate to open surgery (14.3%) due to vascular complications in complex cases. Perioperative stabilization was critical in functional tumors, particularly in pheochromocytoma patients. 75% of pheochromocytoma patients experienced intraoperative hypotension requiring inotropic support. Postoperative outcomes were favorable, with most complications (78.6%) categorized as minor (Clavien-Dindo grade 0-II). Persistent hypertension was noted in a 3 out of 10 patients, requiring ongoing antihypertensive medications postoperatively. This study underscores the spectrum of clinical presentations, diversity of adrenal pathologies, the importance of a multidisciplinary approach for perioperative stabilization, and the safety and efficacy of laparoscopic adrenalectomy as the standard treatment.

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