Pitfalls of adrenal tumors’ management in real-life medicine: a cases series

Abstract

The genetic of adrenal tumors represents a complex, yet incompletely described field, involving either benign or malign neoplasia, secretor or not, unior bilateral, hereditary or non-hereditary, underlying germline or somatic mutations; isolated or in combination with a multitude of endocrine and nonendocrine conditions. Our purpose is to introduce clinical aspects based on reallife medicine experience concerning adrenal tumors with unexpected or partially explained aspects, as well as limits of daily practice, like the decision of bilateral adrenal removal in pheochromocytoma without clinical evidence of an underlying genetic condition; the association of pheochromocytoma with lichen planus lesions; the co-presence of adrenal tumors with thyroid cancer (an apparently non -MEN syndrome combination); the decision of adrenalectomy in primary hyperaldosteronism where the patient delays the intervention. This is a cases series of patients who were followed at different medical and surgical centers. Even though our females’cases phenotype does not entirely fit any of the classical genetic syndromes, genetic testing, for a wider range of genetic anomalies, might be useful in order to identify a possible genetic link. While multiple gene studies are related to adrenal tumors, real-life medicine data are no conclusive in many cases which are not the typical scenario of MEN syndrome. This is a topic of further advance for the purpose of clinical benefit in the multidisciplinary management of these cases.