The Medical Assessment and Surgical Management of Adrenal Masses for the Practicing Urologist

Wesley A. Mayer, MD, presented “The Medical Assessment and Surgical Management of Adrenal Masses for the Practicing Urologist​” during the 25th Annual Innovations in Urologic Practice on September 26th, 2021, in Santa Fe, New Mexico.

How to cite: Mayer, Wesley A. “The Medical Assessment and Surgical Management of Adrenal Masses for the Practicing Urologist.” September 26th, 2021. Accessed Jul 2024. https://grandroundsinurology.com/the-medical-assessment-and-surgical-management-of-adrenal-masses-for-the-practicing-urologist/

Decisional Tools to Determine Need for Biopsy and Re-Biopsy in Men with Elevated PSAs – Summary

Wesley A. Mayer, MD, Associate Professor of Medicine at Baylor College of Medicine in Houston, Texas, discusses how urologists should medically assess and surgically manage adrenal masses. He begins by briefly going over his sources, including the 2016 European Society of Endocrinology Clinical Practice Guideline, the 2011 Canadian Urology Association Guidelines, the 2009 American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons Guidelines, material from UpToDate, and the work of Alexander Kutikov, MD, FACS. He highlights the fact that there is no AUA guideline on adrenal masses, as well as very little new guidance in this space. Dr. Mayer suggests that urologists should be more involved in managing adrenal masses since they are surgical experts of the retroperitoneum, familiar with the anatomy and pathophysiology of the kidneys and adrenal gland, and experts at minimally invasive surgery. He then defines the adrenal mass as a >1 cm lesion that can arise from the medulla or cortex. He explains that the majority are discovered incidentally and are called “adrenal incidentaloma,” and advances in modern imaging technology have significantly increased their prevalence. Most adrenal masses are benign lesions but some are not, and Dr. Mayer lists three important questions a urologist should ask to determine risk when confronted with a mass, including whether there are characteristics suggestive of a malignancy, whether the mass is hormonally active, and whether the patient has a history of malignancy. He then summarizes key points in how to evaluate adrenal masses radiologically and metabolically, and discusses when biopsy is necessary. Dr. Mayer follows this with an overview of surgical management, noting that laparoscopic adrenalectomy is standard of care for most masses and open adrenalectomy should be performed if adrenal cortical carcinoma is suspected. He also shows a video of an adrenalectomy for pheochromocytoma. Dr. Mayer concludes by explaining that follow-up is important since some masses will convert to being hormonally active and/or will have concerning growth characteristics.  

About The 25th Annual Innovations in Urologic Practice:

Presented by co-chairs Mohit Khera, MD, MBA, MPH, and Michael Coburn, MD, FACS, the Innovations in Urologic Practice conference provides a detailed review and commentary on multiple genitourinary and urologic diseases. Among the featured oncological topics are bladder cancer and immunotherapies, as well as upper tract cancer management, prostate cancer, including state-of-the-art imaging, focal therapy, and MRI. Experts also discuss new tools and techniques for nephrectomy and treating advanced renal cell carcinoma. In terms of general urological approaches, the conference also includes pelvic reconstruction and trauma, men’s health topics like male infertility and sexual dysfunction, and ways to diagnose and treat infections in the urology patient. Dr. Mayer presented this talk at the 2021 conference.

For further educational activities from this conference, visit our collection page.