Surgical Approach to Adrenal Diseases in the Elderly

  • Andrea Valeri
  • Andrea PolistenaEmail author
  • Carlo Bergamini
  • Nicola Avenia


A wide spectrum of benign and malignant adrenal diseases are referred to surgery in elderly patients. Adrenal causes of secondary hypertension are primary aldosteronism, hypercortisolism either in the form of adenomas or hyperplasia, pheochromocytoma, and paragangliomas. Standard diagnostic protocols are available for the different endocrine features, and adrenal vein catheterization can be used in case of bilateral lesions. Malignant lesions include some forms of pheochromocytoma, metastases, and primary adrenocortical carcinoma. All these malignancies are usually associated to bad prognosis and often are not radically resectable at diagnosis. Especially pheochromocytoma presents with a wide spectrum of clinical features often with surgical indication to control severe hypertension. Asymptomatic adrenal lesions detected during general radiological or ultrasonographic abdominal examination are defined as incidentalomas. Endocrine activity and malignancy should be screened in all incidentalomas. In the elderly, surgery of adrenal disease is feasible, but the outcomes may be worse due to comorbidities, increased postoperative complications, and slower recovery. The indications for adrenalectomy are functional tumor associated with hormone secretion and nonfunctional tumors associated with a suspicion or evidence of malignancy. The feasibility and the safety of the laparoscopic approach in elderly, although higher conversion rate, has been shown. Laparoscopic adrenalectomy represents the gold standard of treatment even in elderly patients with lateral transabdominal access being the most used worldwide. The open adrenalectomy is generally performed in presence of general contraindications to laparoscopy or in presence of large lesions (>12 cm in diameter) or malignant locally invasive tumors. Patient selection and care in containment of complication and comorbidity are key points of the surgical management.


Adrenal surgery Elderly Laparoscopic adrenalectomy Secondary hypertension 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Andrea Valeri
    • 1
  • Andrea Polistena
    • 2
    Email author
  • Carlo Bergamini
    • 1
  • Nicola Avenia
    • 2
  1. 1.General, Emergency and Minimally Invasive Surgery UnitCareggi University HospitalFlorenceItaly
  2. 2.General and Endocrine Surgery UnitS. Maria University Hospital, University of PerugiaTerniItaly

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