Cortical sparing adrenalectomy in sporadic and bilateral tumors

Complete removal of the adrenal gland has been the standard approach in the surgical treatment of tumors for decades. There, however, is bigger role emerging for organ sparing adrenalectomy especially in the era of minimal invasive surgery. Initially proposed for bilateral tumors in hereditary diseases and in tumors in a solitary gland, partial adrenalectomy gained also popularity in the treatment of spontaneous unilateral small masses. Various surgical techniques have been described so far with promising surgical and functional outcomes with increased quality of life compared to total adrenalectomy. Steroid replacement can be avoided in most cases even in bilateral disease and successful normalization of pathological preoperative endocrine levels were reported in various kinds of adenoma. Therefore, minimal invasive partial adrenalectomy, which seems to be still underused, is a valid treatment option for small hormonal active adrenal tumors whenever surgically possible.