The paper analyzes the results of examination and treatment of 145 patients. They divided into 2 groups: I (n = 71) - patients after adrenalectomies, II (n = 74) – after adrenal resections. In each of the groups, subgroups were identified, while I A (n = 49) and II A (n = 42) included patients who underwent intervention for the period up to and including 2016, I B and II B – patients whose neoplasms were treated according to the developed algorithm. Patients from these groups were comparable by gender and age. The average age of patients was 56.9 ± 1.6 years, 93 (64.1 %) of whom were of working age.
The results of hardware research methods using ROC analysis are analyzed. The accuracy of ultrasound examination (USD) in the case of adenomas was 0.72 (0.63 – 0.81), for pheochromocytes – 0.88 (0.62 – 0.98), for fluid structures – 0.77 (0.42 – 0.96). The use of computer (CT) and magnetic resonance imaging (MRI) showed unambiguous accuracy indicators, namely for adenomas 0.91 (0.83-0.96) and 0.93 (0.71 – 1.00), for pheochromocytomas – 0.96 (0.72 – 1.00) and 0.99 (0.85 – 1.00), for liquid structures – 0.94 (0.64 – 0.99) and 0.99 (0.74 – 1.00).
CT and MRI of the abdominal organs with intravenous contrast showed the greatest informative value in the diagnosis of adrenal tumors.
According to the results of laboratory diagnostics, the hyperproduction of specific hormones was revealed in 25 (86.2 %) patients with corticosteromas, in 14(77.8 %) patients with aldosteromas, and in 11 (68.8 %) patients with pheochromocytomas. In addition, 4 (22.2 %) patients with aldosteromas had a blood cortisol-free response. In 4 (13.8 %) patients with corticosteroids, aldosterone increase was found. In 3 (18,8 %) patients with pheochromocytomas and total metanephrines, the blood cortisol was shown to be increased, in 1 (6,3 %) - dihydrotestosterone (1982,3 pg / ml) and in 1 (6.3 %) – the increase of DHEA-s was found (689.2 mcg / dl).
The results of using various accesses (HALS, laparotomy, and laparoscopy) for single - and bilateral adrenal tumor lesions were analyzed. Using the HALS method, difficulties in identifying and isolating tumors and eliminating complications that occurred during surgery were eliminated. The use of minimally invasive techniques made it possible to achieve a satisfactory result of operations in 120 (82.8 %) cases.
118 (81.4%) patients had an intraoperative need for glucocorticosteroids to stabilize hemodynamic parameters. On Day 10 after organ-preserving operations, hypocorticism persisted in 5 (31.3 %) patients with corticosteroids and in 10 (76.9 %) after adrenalectomies. Similar phenomena occurred in 1 patient after adrenalectomy for pheochromocytoma and in 1 - after resection of aldosteroma.
According to changes in hormone levels after total removal of tumors, patients were 14.2 % (p = 0.040) more likely to experience palpitations within 6 months, 16.6 % (p = 0.020) more likely to experience anxiety and poor sleep, and 14.2 % (p = 0.040) more likely to experience body temperature increase.
After 12 months, signs of arterial hypertension after adrenalectomies disappeared in 14 (58.3 %) patients with hormonally active tumors, after resections – in 13 (52.0%), (p = 0.440). Adrenal insufficiency was persistent in 8 (19.0%) patients after adrenalectomies and in 2 (4.8%) - after organ-preserving operations, p = 0.040.
CT scans revealed contralateral adrenal tumors in 2 (4.8%) patients after adrenalectomies and in 2 (4.8%) patients after resections. Relapse of the neoplasm occurred in 3 (3.6%) patients after organ-preserving operations. Hypertrophy of the contralateral adrenal gland after unilateral adrenalectomy was observed in 19 (45.2 %) patients, after resections – in 10 (23.8 %), p = 0.040.
According to the results of the study, which showed the advantages of performing organ-preserving interventions for corticosteromas, pheochromocytomas and insidentalomas, a therapeutic algorithm was developed and implemented, which proposed an assessment of the structure of neoplasms based on the results of laboratory, hardware and hormonal studies. Depending on the degree of damage to the adrenal glands, the location of the neoplasm and the production of corresponding hormones by the tumor, a differentiated approach was taken to choose the optimal treatment method.
At the stage of planning surgical interventions, we managed to increase the number of organ-preserving interventions by expanding the indications of neoplasms more than 40.0 mm, so the number of organ-preserving interventions increased from 4.8% to 31.4%, p = 0.0001. as a result, there was a tendency to reduce the number of adrenalectomies by 18.7 % (p = 0.150) in this category of patients.
When comparing the results of surgical treatment according to the developed algorithm, after 6 months, a decrease in the frequency of hypocorticism was obtained by 5.8 % (p = 0.028) in treated patients.
