Editing CUA: Adrenal Mass (2011) (section)

== Indications for surgery ==

# '''Size ≥4.0 cm'''
#* Most adrenocortical carcinomas are >4cm in size
#* Radiologically benign masses >4 cm may be followed in patients who are not prime candidates for surgery
# '''Size increases ≥0.5-1.0 cm during follow-up'''
# '''Imaging suspicious of malignancy or pheochromocytoma, regardless of size'''
# '''Adrenal hyperfunction'''

** Some patients with primary aldosteronism may be managed medically, especially if they are poor surgical candidates
** '''Clinically silent adrenal hyperfunction is an area of debate.'''
*** Due to the potentially life-threatening complications, it is accepted that '''any lesions exhibiting silent pheochromocytoma''', an adrenal incidentaloma with hormonal and radiologic signs of pheochromocytoma but without clinical symptoms, '''should be surgically removed after adequate adrenergic blockade'''
*** '''Surgery may be elected for younger patients with subclinical Cushing syndrome''' or those with new onset, medically resistant or deteriorating disease attributable to cortisol excess'''.''' The remainder should be admitted to follow-up and recommended for surgery '''if''' they develop clinical signs of Cushing’s syndrome.
* Laparoscopic adrenalectomy should be the gold standard for the surgical removal of adrenal masses [Campbell’s suggests that adrenal cancer should not be done laparoscopically]