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Experience in surgical treatment of pediatric patients with adrenal tumors (monocenter study)

Objective — to determine and analyze the structure of adrenal pathology in pediatric patients operated at the Center in the years 2009 to 2020 (retrospective analysis). 
Materials and methods. A retrospective study was carried out. The analysis and investigation involved following data of 24 pediatric patients with adrenal neoplasms: age, gender, anamnesis, clinical features, preliminary diagnosis, diagnostic methods, hormonal background, radiological characteristics of tumors, surgical method of treatment, pathomorphological signs of tumors. The observation period was 2 to 11 years, on average 3 to 5 years. 
Results. A total, 980 operations in patients with the pathology of the adrenal glands were performed, from them 24 interventions (2.4 %) were carried out in pediatric patients of age group 5 to 17 years, the age 12.2 years. The proportion of boys was 8 (33.3 %), girls — 16 (66.7 %). The duration of the disease was 1 to 97 months, 13.2 months at average. The following main complaints were determined: weight gain, increased blood pressure, increased body hair, impaired puberty, pain in the abdominal cavity. Malignant tumors included adrenocortical cancer — 12.5 %, ganglioneuroblastoma — 12.5 % and pheochromoblastoma — 1 case, in total — 29.1 %. Tumors of the adrenal cortex 25 %, the adrenal medulla 12.6 %, other types of tumors amounted to 33.3 %. The long-term results of malignant neoplasms of the adrenal glands were determined. In six cases (follow-up period was up to 10 years) there was no recurrence of the disease. Additional treatment in the form of radiation and chemotherapy was not carried out. 79.1 % were operated laparoscopically, 20.9 % had lumbotomy with adrenalectomy. There were large sized malignant tumors of 4 — 17 cm, on average 8 cm. Benign tumors were between 1 — 11 cm, on average 4.3 cm. 58 % of cases were not hormonally active. In the post-operative phase, attention was paid to the prevention of adrenal insufficiency. Blood cortisol was determined on the 3rd-5th day after the operation. 29 % of patients needed hormonal substitution therapy. Two clinical cases in children of the same biological family are considered separately. 
Conclusions. Neoplasms of the adrenal glands in children, in the structure of operations performed for the pathology of the adrenal gland constituted 2.4 % of the total number of patients, the proportion of malignant neoplasms in children, according to our data was 29.1 % among pediatric patients. Malignant tumors of the adrenal glands do not have a clear age correlation. The presence of clinical manifestations associated with hormonal activity makes it possible to suspect a tumor. Hormonal activity was confirmed in 42 % of cases. At the same time, the absence of these changes does not exclude the possibility of a tumor. The disease had no clinical manifestations in 25 % of the investigated subjects.