Treatment of Unilateral Adrenal Tumor with Clinically Significant Hormone Excess
This page addresses the management of a unilateral benign adrenal tumor presenting with clinically significant adrenal hormone excess — a scenario that warrants a specific, evidence-based treatment pathway.
The clinical situation involves a unilateral adrenal tumor in a patient with confirmed, clinically significant excess of adrenal hormones. Adrenalectomy is established as the standard of care in this setting.
Treatment approach (partial overview)
Surgical removal of the affected adrenal gland is the recommended intervention, with a minimally invasive surgical approach favoured. Important perioperative medical management is also required in selected patients — the full criteria, sequencing, and specifics are detailed in the complete protocol.
References
DOI: 10.1093/ejendo/lvad066
- We recommend adrenalectomy as the standard of care for unilateral adrenal tumors with clinically significant hormone excess.
- If surgery is indicated for a benign adrenal mass causing hormone excess (including MACS), we recommend that a minimally invasive approach is used.
- We recommend perioperative glucocorticoid treatment at surgical stress doses in all patients undergoing surgery and a preoperative morning serum cortisol >50 nmol/L (1.8 µg/dL) after a 1 mg overnight dexamethasone test.
- Due to this uncertainty, the group is clearly in favor of intra- and postoperative glucocorticoid replacement, preferably by hydrocortisone in patients with an adrenal tumor and lack of suppression of serum cortisol on dexamethasone testing.
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