Robot-assisted transperitoneal and retroperitoneal adrenalectomy for huge adrenal tumors in 45 cases / 现代泌尿外科杂志

【Objective】 To compare the outcomes of robot-assisted laparoscopic transperitoneal and retroperitoneal operation for huge (>6 cm) adrenal tumors. 【Methods】 The clinical data of 45 patients with huge adrenal tumors who underwent robotic surgery during Jan.2017 and Dec.2021 were retrospectively analyzed, including 28 cases via the transperitoneal approach and 17 cases via the retroperitoneal approach. 【Results】 No patients were converted to open operations. There were no significant differences in postoperative drainage time (2.24±0.44 vs. 2.36±0.49) d, operation time (130.88±5.96 vs. 136.61±8.39) min, blood loss (189.41±13.91 vs. 192.5±12.36) mL and postoperative hospital stay (7.06±0.56 vs. 7.46±0.69) d between the retroperitoneal and transperitoneal approaches. Retroperitoneal approach was better than transperitoneal approach in early postoperative feeding [(38.82±6.75 vs. 74.14±6.57) h, P<0.01] . 【Conclusion】 Robotic surgery is safe and effective in the treatment of large adrenal tumors. The choice of surgical approach should be based on patients’ condition, tumor volume and location.

Adrenalectomía laparoscópica: ¿abordaje retroperitoneal posterior o transperitoneal lateral? / Laparoscopic Adrenalectomy: posterior retroperitoneoscopic or lateral transperitoneal approach?

Objetivo: comparar los resultados obtenidos en adrenalectomía retroperitoneoscópica posterior (ARP) con los obtenidos por vía transperitoneal lateral (ATL) a corto y mediano plazo. Material y métodos: estudio de cohortes prospectivo. Se incluyeron 22 pacientes a quienes se les realizaron 24 adrenalectomías (12 ARP y 12 ATL) entre los meses de enero de 2015 y mayo de 2016. En el grupo ARP se realizó a 1 paciente adrenalectomía bilateral simultánea y a 1 paciente, bilateral sincrónica. Fueron comparados datos basales, clínicos, quirúrgicos y evolutivos. Resultados: la mediana de tiempo de seguimiento fue de 6,5 meses (r 1-16). Los grupos ARP y ATL fueron comparables en edad, sexo, BMI y presencia de cirugías previas. Los adenomas fueron las lesiones predominantes (41,7% en cada grupo). El promedio de tiempo operatorio en ART y ATL fue 104,3 ± 21,2 y 146 ± 32,9 minutos, respectivamente (p 0,05). No hallamos diferencias en tiempo de internación, sangrado y complicaciones. Todos los pacientes lograron curación clínica. Conclusiones: la técnica ARP es una vía segura, con resultados comparables a ATL y menor tiempo operatorio. También permite intervenir de manera simultánea y sincrónica ambas glándulas adrenales sin necesidad de reposicionar al paciente.

Objetive: to compare the results of posterior retroperitoneoscopic (PRA) or lateral transperitoneal approach (LTA) in laparoscopic adrenalectomy in the short and medium term. Material y methods: prospective cohort study. We included 22 patients who underwent 24 adrenalectomies (12 PRA and 12 LTA) between January 2015 and May 2016. In the PRA group, two simultaneous bilateral laparoscopic adrenalectomies were performed (1 synchronous bilateral adrenalectomy). Baseline, clinical and surgical outcome were compared. Results: the median follow-up time was 6.5 months (range: 1-16). The PRA and LTA groups were comparable in age, gender, BMI and presence of previous surgeries. Adenomas were the predominant lesions (41.7% in each group). The average operating time in PRA and LTA was 104.3 ± 21.2 and 146 ± 32.9 minutes, respectively (p=0.05). We found no differences in length of hospital stay, bleeding and complications. All patients achieved clinical cure. Conclusions: the PRA technique is a safe approach, with results comparable to LTA and shorter operating time. It also allows to intervene simultaneously and synchronously both adrenal glands without the need of repositioning the patient.

Adenoma corticoadrenal, presentándose como un incidentaloma: presentación de un caso y revisión de la literatura / Adrenocortical adenoma, presenting as an incidentaloma: case report and literature review

Resumen Objetivo: Presentamos un caso clínico con diagnóstico de incidentaloma adrenal no funcionante asintomático y analizamos las implicaciones clínicas y el abordaje realizado. Caso clínico: Se reporta el caso de un masculino de 53 años, asintomático, con hallazgo ecográfico accidental de imagen hipoecoica de contornos bien definidos en la glándula suprarrenal derecha que presentó incremento en su tamaño. Su estudio hormonal fue negativo para hiperfunción adrenal. Resultados: Se realizó suprarrenalectomía laparoscópica con técnica de 4 trocares con resección completa de la lesión. El paciente presentó buena evolución posquirúrgica. El estudio anatomopatológico concluyó el diagnóstico de adenoma corticoadrenal no funcionante. Conclusión: Ante el hallazgo de una masa adrenal mayor de 1 cm corresponde realizar una identificación hormonal y una evaluación del riesgo de malignidad en los pacientes, los cuales, junto con parámetros imagenológicos y los síntomas presentados, permitirán definir las complicaciones en el manejo y el pronóstico del paciente. El diagnóstico diferencial de los adenomas adrenales está basado en la identificación hormonal, el conocimiento radiológico y el grado de compromiso de la lesión. El abordaje laparoscópico es de elección en las lesiones pequeñas y sin sospecha de malignidad.

Objective: We present a clinical case with diagnosis of an asymptomatic nonfunctional adrenal incidentaloma, in which we discuss the clinical implications and the approach. Clinical case: Male patient, 53 years old with an accidental sonographic finding, characterized by a hypoechoic image of well-defined contours in the right adrenal gland of less than 2 cm. The hormonal test showed no adrenal hyperfunctioning. Laparoscopic adrenalectomy technique is performed with 4 trocars with complete excision of the lesion. The patient presented good postoperative evolution. Results: The pathology study showed a well-defined and benign tumor lesion of the adrenal gland, being similar to the fascicular zone and cortical hyperplasia next to it. The diagnosis is a non-functioning adenoma of the adrenal gland derived from the fascicular zone. Conclusion: Given the finding of an adrenal mass greater than 1 cm mass corresponds perform a hormonal identification and risk assessment of malignancy in patients, which with imaging parameters (echogenicity, bilateralism and the adjacent commitment) and symptoms presented allow to identify the complications in the management and prognosis of the patient. The differential diagnosis of adrenal adenomas is based on the hormonal evaluation, radiological knowledge and the commitment of the injury.

Clinical, surgical, and histopathologic outcomes of Filipino patients who underwent adrenalectomy in a tertiary hospital in Cebu, Philippines

Introduction@#Hormone-producing adrenal tumors, adrenal carcinomas and other adrenal diseases can be potentially cured with adrenalectomy. In the local setting, studies are often limited by a small sample size and inadequate patient data. This study aimed to determine the clinical and histopathologic characteristics and perioperative outcomes of patients who underwent adrenalectomy.@*Methods@#This is a retrospective chart review study from January 2007 to June 2017 in a tertiary hospital in Cebu City, Philippines. Clinical profiles, type of surgery, and operative outcomes were determined. Comparative analysis of clinical profile, histopathologic features, and surgical outcome was done. Descriptive as well as appropriate inferential statistical methods were used to analyze the data.@*Results@#A total of 31 patients who underwent adrenalectomy were included with the mean age of 45.7 [SD=17.1] years old and a 1:3 male to female distribution. The distribution of tumors was as follows: hormone-producing adrenal tumor (74.2%), malignant adrenal tumors (12.9%), and other benign lesions (12.9%). Among patients with hormoneproducing tumors, 39.1% had catecholamine excess, 34.8% had aldosterone excess, and 26.1% had cortisol excess. Hormone-producing adrenal tumors were common at age 20 to 40 years old while malignant tumors were more common among those above 40 years old (p-value=0.023). Stage 3 hypertension (p-value=0.010) and improvement of hypertension postoperatively (p-value=0.046) were more common among hormone-producing tumors. On the other hand, large tumor size (>4cm) (p-value=0.011), blood loss needing blood transfusion (p-value=0.001), prolonged operation (p-value=0.046), and longer hospital stay (p-value=0.002) were common among those with malignant tumors. Open adrenalectomy was associated with significant blood loss needing transfusion (p-value=0.001) and prolonged hospital stay (p-value=0.024).@*Conclusion@#Hormone-producing adrenal tumors with secondary hypertension are the most common pathology among patients who underwent adrenalectomy. They are usually seen among patients less than 40 years old, with smaller tumor size, and frequently present with higher blood pressures that improve following adrenalectomy. In contrast, adrenal carcinomas are more common among patients above 40 years old and have larger tumor size. More often they have prolonged operation time, greater blood loss, and longer hospital stay. Patients who underwent open adrenalectomy had more blood loss and had a longer hospital stay than those who underwent laparoscopic surgery.

Adrenocortical carcinoma in children and adults: Two decades experience in a single institution.

CONTEXT: Adrenocortical carcinoma (ACC) occurring in children and adults show distinct characteristics. However, due to rarity of the disease no large series addressing this issue has been published. AIMS: The aim of this study was to study clinico‑pathologic profile and outcome of ACC in children and adults. SETTINGS AND DESIGN: Tertiary referral center. Retrospective study (January 1990‑June 2011). SUBJECTS AND METHODS: Forty‑five patients with ACC were included; 16children (aged < 18 years) and 29 adults. Clinical details, hormonal profile, operation records, pathology reports and follow‑up findings were noted and compared. Survival analysis was performed using Kaplan‑Meier method. Log rank test and Cox regressionan alysis were performed. RESULTS: Mean age was 8 ± 5.7 (M: F = 1:2.1) in children and 44.4 ± 15 years (M: F = 1:1.1) in adult groups. Prevalence of functioning tumors was significantly high in children (87.5 vs. 31% P = 0.001), while prevalence of incidentalomas was high in adults (6.3 vs. 51.7% P = 0.05). Tumor stage distribution at presentation, mean diameter (10.9 vs. 13.7 cm), and weight (392.9 vs. 892.9 g) didn’t differ significantly in two groups. Adults had better albeit non‑significant 5 year overall survival (OS) than children (0 vs. 13%). On univariate analysis stage of disease (P = 0.008), surgical intervention (P = 0.004), Weiss score (P = 0.04) and hormonal secretion (P = 0.04) were significantly associated with OS in adults but not in children. No factor was found significant on multivariate analysis. CONCLUSIONS: Except for high prevalence of functioning tumors in children, clinico‑pathologic attributes and outcome of ACC in the two groups didn’t differ significantly.

Malignant adrenal tumors:CT and MRI findings with corresponding pathological basis / 实用放射学杂志

Objective To study the CT and MRI features of malignant adrenal tumors(MAT)for improving the understanding of the disease and imaging diagnosis.Methods CT and MRI findings were retrospectively reviewed in 1 7 patients with MAT proved by surgical pathology.CT scan was performed in 1 7 cases,and CT enhancement scan was performed in 14 cases;MRI scan was comple-ted in 3 cases,and MRI enhancement scan was performed in 2 cases;CT and MRI scans were examinated in 3 cases.Results Among 1 7 patients with MAT,there were 3 adrenocortical carcinomas,2 neuroblastomas,1 malignant pheochromocytoma,1 lymphoma,1 leiomyosarcoma,and 9 adrenal metastatic tumors.The CT and MRI characteristics in size,shape,boundary,density or signal,and en-hancement features,can discriminate MAT.Conclusion CT and MRI findings of some MAT have a certain characteristic;The ima-ging findings combined with clinical data are helpful in correctly making preoperative diagnosis.

Adrenalectomía laparoscópica en patología benigna / Laparoscopic adrenalectomy in benign disease

Introduction: Nowadays the laparoscopic approach is the procedure of choice in adrenal diseases, except malignant adrenal tumors. Methods: A descriptive and retrospective study of the first 55 cases of laparoscopic adrenalectomy performed in our hospital between 1998 and 2011, we reviewed the short and long term results. Results: We had one case of conversion to open surgery in a patient with accidental section of the right renal vein. One case of reoperation due to hepatic injury. One case of postoperative mortality in a 71 year old woman with high anesthetic risk operated for Cushing's syndrome. Other complications were a case of hydropneumothorax and three cases of abdominal wall hematoma in site of laparoscopic trocar. In the follow up at 45 months all the patients remain asymptomatic, except one with ectopic Cushing's syndrome due to bronchial carcinoid. Conclusions: Laparoscopic adrenalectomy has good results and is an easily reproducible procedure, but must be performed by expert laparoscopic surgeons with a good knowledge of adrenal anatomy and experience in open surgery which allow them to solve the complications that may arise during the laparoscopic procedure.

Introducción: Al día de hoy el abordaje laparoscópico es el procedimiento de elección en la mayoría de lesiones que asientan sobre la glándula suprarrenal, a excepción del tumor maligno suprarrenal. Material y Métodos: Estudio descriptivo y retrospectivo de los 55 primeros casos de adrenalectomía laparoscópica realizados en nuestro centro en el período comprendido entre 1998 y 2011, evaluando los resultados a corto y largo plazo. Resultados: Hubo un caso de conversión a cirugía abierta (1,8 por ciento) en un paciente con sección accidental de la vena renal derecha. Un caso de reintervención por laceración hepática que pasó inadvertida durante la cirugía. Un caso de mortalidad en el postoperatorio inmediato por parada cardiorrespiratoria en una paciente de 71 años con riesgo anestésico ASAIII, intervenida por síndrome de Cushing. Otras complicaciones menores fueron un caso de hidroneumotórax y 3 casos de hematoma parietal en el trayecto del trocar. Se consiguió el control de la enfermedad de base después de un seguimiento medio de 45 meses en todos los casos menos en un paciente con síndrome de Cushing ectópico por un carcinoide bronquial. Conclusiones: La adrenalectomía laparoscópica es una técnica con buenos resultados y fácilmente reproducible, pero ha de ser realizada por cirujanos laparoscopistas expertos con un buen conocimiento de la anatomía de las glándulas suprarrenales y con experiencia en la cirugía abierta que les permita resolver las complicaciones que puedan surgir durante el procedimiento laparoscópico.

Manejo quirúrgico del incidentaloma suprarrenal / Surgical management of adrenal incidentaloma

Background: The adrenal incidentaloma is a lesion found on imaging studies for diagnosis of non-adrenal disorders. Most of these patients are not of surgical treatment. Our objective was to describe the clinical features and results of surgical management of adrenal incidentalomas in the Hospital de la Universidad de Chile. Material and Methods: Retrospective descriptive study. Period 2000 to 2009. Information was gathered from medical records and biopsies registers of patients with operated adrenal incidentaloma. Results: We evaluated 24 patients undergoing surgery, 66.7 percent female, 58.3 percent between 41 and 70 years. 58.3 percent were found in the study of abdominal pain. Surgical indications were: size ≥ 4 cm, enlarged in controls, atypical features in the abdominal and pelvic CT and/or functionality. 54.2 percent were ≥ 4 cm, 16.7 percent increase in size in controls, 45.8 percent had atypical features in the abdominal and pelvic CT and 33.3 percent were functioning, being the most frequent hypercortisolism. In 87.5 percent of patients the approach was laparoscopically. The morbidity was 12.6 percent (pneumonia, wound infection and stroke) and perioperative mortality was 0 percent. Discussion: The adrenal incidentaloma is a rare indication for surgery of adrenal tumors. Before the intervention should be studies in order to evaluate functionality and suspicion of malignancy. Functionating tumors and suspicious of malignancy should be resected, being the laparoscopic approach the election, likely in most cases.

Introducción: El incidentaloma suprarrenal es aquella lesión encontrada como hallazgo en estudios imagenológicos para el diagnóstico de desórdenes no suprarrenales. La gran mayoría de esos pacientes no son de resorte quirúrgico. Nuestro objetivo es describir las características clínicas y resultados del manejo quirúrgico de los incidentalomas suprarrenales operados en el Hospital Clínico de la Universidad de Chile. Material y Método: Estudio descriptivo-retrospectivo. Período 2000-2009. Se obtuvo información de fichas clínicas y registro de biopsias de los pacientes operados por incidentaloma suprarrenal. Resultados: Se evaluaron 24 pacientes intervenidos quirúrgicamente, el 66,7 por ciento sexo femenino, el 58,3 por ciento entre los 41 y los 70 años. El 58,3 por ciento se pesquisaron durante el estudio de dolor abdominal. Las indicaciones quirúrgicas fueron: tamaño ≥ 4 cm, aumento de tamaño en controles, características atípicas en la TC abdomino-pelviana y/o la funcionalidad. El 54,2 por ciento fueron ≥ de 4 cm, 16,7 por ciento aumento de tamaño en controles, 45,8 por ciento tenía características atípicas en la TC abdomino-pelviana y 33,3 por ciento fueron funcionantes, siendo lo más frecuente el hipercortisolismo. El 87,5 por ciento de los pacientes se abordaron por vía laparoscópica. La morbilidad fue de 12,6 por ciento (neumonía, infección de herida operatoria y AVE) y la mortalidad peri operatoria fue de 0 por ciento. Discusión: El incidentaloma suprarrenal es una indicación infrecuente de cirugía de tumores suprarrenales. Antes de la intervención deben estudiarse con el propósito de evaluar funcionalidad y sospecha de malignidad. Los tumores funcionantes y sospechosos de malignidad deben ser resecados, siendo la vía laparoscópica la de elección, factible en la gran mayoría de los casos.

Bilateral adrenal tumors from different tissues: 1case report and literature review / 中华内分泌外科杂志

Objective To improve the recognization of bilateral adrenal tumors from different tissues and to discuss the treatment.Methods One case of bilateral adrenal tumors from different tissues:pheochromocytoma in one side and adrenocortical adenoma in the other side was reported and the data of syptoms,physical features,auxillary examination,diagnosis and treatment were retrospectively reviewed.Results The patient was diagnosed as adrenocorticotropic hormone (ACTH) -independent Cushing's syndrome in other hospital and received laparoscopic adrenalectomy for right adrenal tumor.During the operation the blood pressure fluctuated seriously and was even more than 200 mm Hg.The pathological report showed the mass was pheochromocytoma.After the operation,the patient's clinical manifcstation was not changed.Half a year later the lab test showed blood ACTH was still less than 5 pg/ml,24 h urinary-free cortisol (UFC) was 571.32 μg,and 24 h urinary catecholamines (U CA) was:noradrenalin (NE) 22.80 μg,epinephrine (E) 2.55 μg,dopamine (DA) 92.92 μg.CT detected a mass in left adrenal gland.The patient received laparoscopic adrenalectomy for left adrenal tumor after being transferred to Peking Union Medical College Hospital.The tumor was proved as adrenocortical adenoma by postoperational pathology.One week after the operation,the 24 h UFC was 56.2 μg.Conclusions Bilateral adrenal tumors from different tissues are very rare in clinic.Adrenalectomy for tumors from both sides and remaining the normal adrenal glands are recommended.

A case with 21-hydroxylase deficiency combined with adrenal adenoma and testicular adrenal rest tumors / 中华内分泌代谢杂志

Objective To investigate the clinical and genetic characteristics in a male patient with 21hydroxylase deficiency combined with adrenal and testicular tumors.Methods Clinical features and laboratory data were collected from the patient.Testicular biopsy was performed.The CYP21 gene was sequenced for mutations.Results The patient presented left adrenal and testicular enlargements.The laboratory examinations showed that plasma ACTH,androstenedione,testosterone,progesterone,and 17-hydroxyprogesterone were markedly elevated.CT scan revealed that the right adrenal gland being resected and the left adrenal with nodular enlargement.Furthermore,testicular biopsy showed a prominent peritubular fibrosis with increased number of peritubular fibroblasts,tubular hyalinisation,and calcification.Sequencing analysis showed a A>G homozygous mutation at intron 2.Conclusion Patients with untreated 21-hydroxylage deficiency may.have adrenal adenomas and(or)testicular adrenal rest tumor simultaneously.

Carcinoma suprarrenal: [revisión] / Adrenocortical carcinoma: [review]

El carcinoma suprarrenal es una patología poco frecuente, con una incidencia anual estimada en 1-2 casos por millón de habitantes. Si bien se presenta a cualquier edad tiene una distribución bimodal, presentándose con mayor frecuencia antes de los 5 años y durante la cuarta y quinta décadas de vida. Tiene una leve tendencia a ser más frecuente en mujeres. Cerca del 60 por ciento de los casos se presentan como un tumor funcional asociado a un síndrome clínico reconocible. De estos los más frecuentes son el síndrome de Cushing y la virilización. El hiperaldosteronismo y la feminización son infrecuentes. Los pacientes con tumores no funcionales presentan un cuadro clínico producto del efecto de masa tumoral. Los estudios hormonales e imagenológicos son de vital importancia al momento de evaluar un paciente con sospecha de carcinoma suprarrenal. La adrenalectomía quirúrgica permanece como la única alternativa potencialmente curativa mientras que el Mitotano es el fármaco de elección en pacientes con tumores irresecables o enfermedad metastásica. El pronóstico del Carcinoma suprarrenal es malo, con una tasa de recurrencia de hasta el 80 por ciento y un promedio de sobrevida de 2 años.

Adrenocortical Carcinoma is an uncommon disease with an estimated incidence of 1-2 cases permillion people. Although it can occur at any age, it has a bimodal distribution, appearing more frequentlyin the first five years and during the fourth and fifth decades of life. It has a slight tendency to be more frequent in women. About 60 percent of cases are presented as a functional tumor associated with a recognizable clinical syndrome. Of these the most common are Cushing syndrome and virilization. The feminization and hyperaldosteronism are rare. Patients with a non-functional tumor present symptoms due to the tomoural mass effect. Hormonal and imaging studies are essential when assessing a patient with suspected adrenal carcinoma. Adrenalectomy remains as the only potentially curative treatment, whereas Mitotane is the drug of choice in patients with unresectable tumors or metastatic disease. The prognosis of adrenal carcinoma is poor, its rate of recurrence reaches 80 percent with an average survival of 2 years.

A Comparative Study of Three Kinds of Procedures for Adrenal Tumors / 中国微创外科杂志

0.05;q=8.055,P0.05;q=9.163,P

Percutaneous computed tomography-guided ethanol injection in adrenal benign functioning tumors / 中华放射学杂志

Objective To evaluate the effects of percutaneous computed tomography-guided ethanol injection (PEI-CT) in adrenal benign functioning tumors. Methods Twenty cases of adrenal benign functioning tumors were treated by the therapy of PEI-CT. Among them, 5 cases were pheochromocytomas, and 15 cases were aldosteronomas. After the treatment, the change of blood pressure, aldosterone plasma levels, potassium plasma levels, and catecholamines urine levels was investigated. Both plain and enhanced CT scans were performed before and after the treatment to evaluate the changes of the size and necrosis in the tumors. Results Normalization of blood pressure and catecholamines urine levels was observed in 5 cases of pheochromocytoma during 6-19 months′ follow up after the treatment. In the 15 cases of aldosteronoma, aldosterone plasma levels reduced with potassium plasma levels increasing to the normal range within 5-7 days after the treatment. Aldosterone plasma levels increased with potassium plasma levels reduced again in 7 months after the treatment in one case, aldosterone plasma levels and potassium plasma levels returned to the normal range after the second treatment. Hypertension returned to normal in 13 cases of aldosteronoma, and one case maintained normal blood pressure (BP) only under the condition of taking lower dosage of spironolactone within 7-15 days after the treatment, and one month later, the blood pressure of the case become normal without taking any antihypertensive drugs. The other case maintained normal blood pressure in the need of taking lower dosage of antihypertensives after the treatment. CT scan showed total necrosis of tumors in 15 cases and majority necrosis in 5 case within 7-15 days after the treatment. Conclusion The therapy of percutaneous computed tomography-guided ethanol injection in adrenal benign functioning tumors shows satisfactory effects with the advantages of easy manipulation, safety, less injury and cost.

Primary Aldosteronism Due to Aldosterone Producing Adenama in the Presence of Contralateral Nonfunctioning Adenama / 대한내분비학회지

Primary aldosteronism is in most cases due either to a unilateral adrenal adenama or to a bilateral hyperplasia of the adrenal cortex. But, a few of bilateral adrena1 tumors in primary aldosteronism also have been reported. In these cases, it is important to differentiate the bilateral aldosterone producing adenomas from the unilateral aldosteronoma in the presence of a contralateral nonhmctioning adenoma for marking a treatment plan. We report a case of primary aldosteronism due to a unilateral aldosteronoma in the presence of a contralateral nonfunctioning adenoma. Abdominal CT sean revealed bilateral adrenal tumors, of which the functioning one was successfully localized using adrenal scintigraphy and selective adrenal venous sampling.

Clinical Experiences of Adrenal Tumors: Studies on the Localization of Adrenal Tumors / 대한비뇨기과학회지

Diagnostic accuracy in localizing tumors by means of computed tomography (CT), adrenal scintigraphy, ultrasonography (US) and IVP was compared in 12 cases of adrenal tumors which were experienced during last 6 years. The following results were obtained : 1. The patient group consists of 8 pheochromocytomas, 3 primary aldosteronism, and 1 Cushing syndrome. 2. For the initial diagnosis of adrenal cortical tumor (primary aldosteronism, Cushing syndrome) CT and adrenal scintigraphy are reliable and noninvasive modalities with high diagnostic accuracy, whereas in pheochromocytoma, US, CT and adrenal scintigraphy was useful. 3. Invasive diagnostic modalities such as aortography, venous sampling of adrenal gland and venography should be restricted to localizing adrenal tumors cannot be diagnosed by previous non -invasive diagnostic modalities.