Tratamiento laparoscópico de incidentaloma suprarrenal derecho. Informe de caso

Abstract

The adrenal incidentalomas are silent adrenal masses. Its prevalence is 1 - 2% in occasional abdominal TC scans. A directly proportional increase in relation to the age is evident. Approximately 80% are nonfunctioning adenomas, in a lower percentage, they produce subclinical Cushing's syndrome, Pheochromocytoma, and Aldosterone among others and this is closely related to the clinical manifestations presented by the patient. In a tomographic study, suggestive data of malignancy can be evidenced such as: a diameter greater than 4cm, higher density 10HU, and high degree of heterogeneity, calcifications, jagged edges and areas of necrosis. It is important to differentiate between a benign or malignant lesion, hormonally functioning or not, since this depends on the medical action. Patient Information: Female, 29 years old, with no personal pathological history, presented with right hypochondrium pain, nausea, vomiting, chills, generalized pallor, visceromegaly at the right hypochondrium level, laboratory tests, and tumor markers: negative, negative catecholamines, Cortisol negative; Contrast Abdominal-Pelvic TC: hypodense mass with 11.5 x 9.5 cm, regular borders, liquid density, peripheral calcification. A presumptive diagnosis of a tumor dependent on the right adrenal gland versus hepatic tumor is established. Treatment: A diagnostic laparoscopy is performed, showing a giant right adrenal gland tumor of 15 cm in diameter, adhered to the lower face of the liver, completely freed, completely dry, and removed through a laparoscopic umbilical port without complications. Favorable postoperative evolution, medical discharge at 24 hours, stable and asymptomatic. Anatomopathological diagnosis : Adrenal cortical adenoma with hemorrhagic cystic degeneration Conclusions: Adrenal incidentaloma is a pathology of low prevalence, variable clinical and insidious presentation. The importance of its diagnosis lies in the possibility of differentiating between a benign lesion and a malignant and determining its hormonal potential on the host. The laparoscopic treatment has limited indications, but it is an effective and safe strategy.