The supracostal approach to the kidney and adrenal.

Our experience with 67 supracostal approaches to the kidney or adrenal gland demonstrates that 1) the exposure was uniformly superb,2) diaphragm reapproximation was unnecessary, 3) a single pericostal suture soundly closed the intercostal space, 4) no complications could be attributed to inadequate exposure and 5) pleural entry was the most common complication. We have found the supracostal approach to the kidney and adrenal to be staisfactory and recommend it to others.     

Tumors of the adrenal cortex

Three cases of adrenal cortical disease have been presented. These three demonstrate every variety of symptom complex which has sometimes been called the adreno-syndrome with the last case falling into the category of Cushing's syndrome.     

Physiology of the adrenal cortex

Knowledge of the functional morphology and physiology of the adrenal cortex and of the regulation of its secretory products is essential to understanding the meaning of the results of various tests in the diagnosis of adrenocortical disease and to providing the postoperative care necessary to correct this condition. Removal of a cortisol-producing adenoma will necessitate replacement of glucocorticoids only, whereas after resection of an aldosterone-producing adenoma, no steroid replacement will be required.     

Non-functioning tumours of the adrenal cortex

Twelve cases of non-functioning adrenal tumours are presented. All were discovered incidentally during radiological investigation of abdominal conditions or staging of known malignancies. Adrenal tumours in patients with known malignancies are not necessarily metastases. Size remains the most important factor in determining their management and tumours larger than 3.5 cm should be operated on because of the possibility of malignancy. Smaller tumours should be assessed by computed tomography (CT) every 3 months for 1 year. Any change in contour, margin, density or hormone function during the follow-up period indicates the need for surgery.