Indications for surgical adrenalectomy include:

A. An adrenal mass larger than 6 cm.

C. Cushing's syndrome secondary to adrenal neoplasms or to persistent ectopic ACTH syndrome when the primary tumor is inoperable.

D. Pheochromocytoma in adults and children

DISCUSSION: Adrenalectomy is indicated for the management of adrenal masses larger than 6 cm. on CT since tumors of this size harbor carcinoma in more than 90% of cases. Surgical adrenalectomy is also the treatment of choice for primary adrenal causes of Cushing's syndrome. Surgical adrenalectomy may be considered as an alternative to medical adrenalectomy with metyrapone, aminoglutethimide, or mitotane in patients with ectopic ACTH syndrome when treatment of the primary tumor is unsuccessful. Patients with aldosteronism that is ACTH sensitive and posture insensitive likely have an adrenal adenoma that is curable by adrenalectomy. Aldosteronism that is ACTH insensitive and posture sensitive is likely caused by idiopathic adrenal hyperplasia, which is best managed medically with spironolactone, triamterene, amiloride, or nifedipine. Adrenalectomy following preoperative alpha-adrenergic blockade, with or without beta-adrenergic blockade, and hydration is the treatment of choice of all pheochromocytomas. Adrenalectomy is not indicated in the management of any of the congenital adrenal hyperplasias.