ACCURACY OF PREOPERATIVE DIAGNOSIS IN ADRENALECTOMIZED PATIENTS

Abstract

The aim of this study was to analyze our experience to determine the efficiency of preoperative diagnostic methods in predicting the histopathologic diagnosis and outcome. Diagnosis of adrenal diseases might be a challenge as the presenting symptoms are insidious. Hormonal workup might be wrong leading to wrong preoperative diagnosis and suboptimal surgical procedure. One hundred one patients with adrenalectomy were evaluated retrospectively, Preoperatively pituitary-dependent Cushing's syndrome was correctly diagnosed in 100%, cortical adenoma in 76%, primary bilateral hyperplasia 81%, pheochromocytoma in 73%, hyperaldosteronism in 100%. In 21 patients preoperative diagnosis was incidentaloma. Histopathologic examination revealed 10 cortical adenoma, two cortical hyperplasia, one cortical carcinoma, two pheochrornocytoma, three myelolipoma, one hamartoma, one ganglioneuroma and one hematoma. However, preoperative hormonal workup was positive for three patients, two with Cushing's syndrome, one with pheochrornocytoma. Thirty-day operative mortality was 6% (n=6). Morbidity was 20%. A total of 9 patients (9%)did not have the optimal surgical treatment. It should be remembered that there might be a certain discrepancy rate between the preoperative diagnosis and the actual disease when adrenalectomy indication is made. This fact is a cause of suboptimal medical care in patients with adrenal diseases. Adrenalectomy is a procedure associated with morbidity and mortality, so diagnostic tools should be used very carefully.