Adrenal masses may be found incidentally when computed tomography (CT) scans or magnetic resonance imaging (MRI) is done for other reasons. In a study of 61,054 abdominal CT scans performed from 1985 to 1990, an incidental adrenal tumor (incidentaloma >1 cm) was detected in 259 patients ( percent of all CT scans) [ 3 ]. A subsequent study, utilizing higher resolution scanners, reported a prevalence of adrenal incidentaloma on abdominal CT of percent [ 4 ]. The prevalence of adrenal incidentaloma is higher in older patients (10 percent) [ 5 ].
Adrenalectomy can be performed transabdominally, retroperitoneally, or transthoracically. Transabdominal adrenalectomy is more commonly performed and can be accomplished with either open or minimally invasive surgery (MIS) techniques. Open transabdominal adrenalectomy can be performed via an anterior or thoracoabdominal approach. Open retroperitoneal adrenalectomy is accomplished through a posterior approach. MIS approaches include laparoscopic transabdominal and posterior retroperitoneoscopic (RPA). Thoracoabdominal adrenalectomy is an uncommon procedure and is used in the rare settings of very large tumors usually with diaphragmatic involvement or tumor extension into the chest [ 2,3 ].