Preoperatively asymptomatic adrenal incidentaloma

Since the introduction of new, very sensitive imaging procedures (ultrasonography, CT, MRI) the incidence of incidentally discovered, asymptomatic adrenal masses has clearly increased. These tumours are a new challenge to develop therapy and preoperative evaluation strategies, as the following case report shows. In a 29-year-old asymptomatic female patient a large adrenal tumour on the left side was discovered on abdominal ultrasonography during pregnancy. The further endocrinological examinations were normal. The patient was operated on post partum. During intraoperative manipulation of the tumour we observed an excessive increase in blood-pressure and heart rate. Shortly after removal of the tumour and immediate sympatholytic treatment the situation was under control. The intraoperative clinical situation and histological work-up of the tumour led to the diagnosis of phaeochromocytoma. The problem of adrenal incidentalomas is discussed on the basis of the current literature and an algorithm for preoperative evaluation is presented.