General Indications

• Clinically or biochemically apparent adrenal hormonal hyperfunction.
  
• Possible or certain malignant adrenal mass.
  
• Adrenal mass of uncertain significance.

Specific Conditions and Disease States

• Primary hyperaldosteronism.
  
  
  
  • Unilateral cortical adenoma causing Conn’s syndrome.
    
  • Bilateral hyperplasia with unilateral dominance (established by adrenal vein sampling).
  
  
• Hypercortisolism.
  
  
  
  • Unilateral cortical adenoma.
    
  • Refractory Cushing’s syndrome (from Cushing’s disease, primary adrenal hyperplasia, or ectopic adrenocorticotropic hormone [ACTH] syndrome).
  
  
• Pheochromocytoma.
  
• Unilateral cortical adenoma causing virilization.
  
• Myelolipoma (in selected situations).
  
• Adrenal cyst (if refractory or symptomatic).
  
• Adrenocortical carcinoma.
  
• Incidentaloma with indeterminate or concerning imaging characteristics.
  
• Adrenal metastases of other primary cancers (in selected situations).

Laparoscopic Adrenalectomy

Absolute

• Adrenocortical carcinoma (certain or likely).
  
• Refractory coagulopathy.
  
• Comorbidities precluding safe general anesthesia.

Relative

• Previous ipsilateral partial adrenal resection.
  
• Previous extensive upper abdominal or retroperitoneal surgery.
  
• Very large adrenal tumors (> 6–8 cm).
  
• Suboptimal medical preparation for pheochromocytoma resection.

Open Adrenalectomy