Therapeutic Concepts

Complete removal of the tumor is the primary goal of adrenal surgery. In the past, this almost routinely meant complete adrenalectomy. In case of bilateral tumors, bilateral adrenalectomy resulted in adrenal insufficiency necessitating for life-long hormonal replacement therapy. The hormonal replacement often consists of fixed dosage schedule, without respect for the physiological diurnal circadian rhythm. This may lead to overtreatment with increased incidence of osteoporosis, hypertension, diabetes, and other adverse effects of steroid replacement therapy. These patients are also at risk for undertreatment during periods of stress. Hypoandrogenism in females and addisonian crisis have been reported in 25% to 33% of cases (11,12). The quality of life is also significantly affected because 30% of patients experience significant fatigue and 48% consider themselves disabled (13). Hence, the concept of organ- and function-preserving surgery—partial adrenalectomy—was developed to address these concerns.

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