Laparoscopic Adrenalectomy
Introduction
The adrenal glands reside in the retroperitoneum just above the kidneys (Fig. 4-1). Histologically, the adrenal glands are divided into an outer cortex comprising three layers—zona glomerulosa, zona fasciculata, and zona reticularis—and an inner medulla (Fig. 4-2). These histologic layers correspond to various hormones produced by the adrenal glands.
FIGURE 4–2 Histology of adrenal glands.
ACTH, Adrenocorticotropic hormone; H&E, hematoxylin and eosin.
1. Functional tumors based on excessive hormone production: hyperaldosteronism or Conn syndrome, hypercortisolism or Cushing syndrome, sex hormone–producing tumors, or pheochromocytomas, which lead to excess catecholamine production.
2. Tumors suspicious for malignancy: primary adrenocortical cancer (ACC) or adrenal metastases.
3. Tumors that initially do not meet criteria for categories 1 or 2 but continue to increase in size and volume on interval radiographic follow-up at a rate concerning for a malignant process, or become hypersecretory on repeat laboratory testing.
