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adrenal cysts are usually unilateral lesions discovered incidentally during imaging procedures or surgery and at autopsy
. endothelial or lymphangiomatous cysts account for nearly 45% of these lesions and are usually small , measuring 0.1 to 1.5 cm in diameter . adrenal pseudocysts that lack an epithelial lining are the next most common variety ( 39% ) and most likely represent encapsulated residual of previous adrenal haemorrhages
. pseudocysts may become massive and may cause symptoms because of the compression of adjacent structures .
the acute haemorrhage is readily distinguished by magnetic resonance imaging ( mri ) . traumatic rupture of adrenal cysts has also been reported .
parasitic cysts due to echinococcal disease ( 7% ) and true epithelial cysts ( 9% ) account for the remainder of adrenal cysts .
most cystic adrenal lesions are found incidentally and can be observed ; symptomatic cysts can be percutaneously drained or laparoscopically decorticated .
we retrospectively reviewed the case records of patients presenting with adrenal lesions and managed at our centre during the period april 2000 to december 2010 .
age , gender , presenting symptoms , physical examination findings , laboratory investigations and imaging records were all noted and analysed .
during the 10-year study period , 14 patients , with a mean age of 41.36  5.57 years , were diagnosed to have adrenal cysts .
the pain was acute and associated with vomiting and fever . in these two patients , a vague abdominal mass was felt . in the remaining 10 , the pain was mild , and positional . at times
computerized tomography ( ct ) was done in all to determine the nature of the cyst and its relation to the surrounding structures .
transperitoneal laparoscopic excision of cysts was done in three and laparoscopic adrenalectomy in the remaining eleven .
the mean operating time was 76.43  11.05 min , and the mean blood loss was 27.43  3.98 cm .
no major intra- or post - operative complications were noted in any of the patients .
nine of these cysts were endothelial cysts , whereas the remaining five were adrenal pseudocysts .
cysts of the adrenal gland are rare , but today , with the wider application of sonography and computed tomography more and more adrenal cysts are being detected incidentally .
the reported incidence in clinical series is of 5.4% . in the autopsy series , they count less than 0.064 - 0.18% .
adrenal cysts are usually asymptomatic , and most of them are diagnosed incidentally during ultrasound or ct examination .
some of these patients present with acute abdominal pain and can rarely mimic an acute abdomen whenever bleeding occurs into the cyst .
there are also a small number of cases in the literature in which the adrenal cysts were hormonally active ( cushing 's syndrome , pheochromocytoma ) .
most commonly these cysts either present or are diagnosed in the fourth / fifth decade of life .
reported of an adrenal cyst being diagnosed in a female infant of 1 month and a 1-year - old male child .
reported a case of an antenatally diagnosed cystic abdominal mass in a fetus , which on exploration after birth turned out to be an adrenal cyst [ figures 1 and 2 ] .
pushing left kidney inferiorly axial section cd abdomen showing a huge left - sided adrenal cyst with well defined the rubric of adrenal cysts comprises a broad differential diagnosis , rendering definitive diagnosis and subsequent management difficult .
these cysts are categorized into four subtypes : endothelial , pseudocyst , epithelial , and parasitic .
radiologic differentiation is helpful ; however , imaging characteristics , such as haemorrhage in a pseudocyst , can confound identification of benign versus malignant lesions .
any functional lesion , potentially malignant lesion , or benign lesion more than 5 cm in diameter deserves surgical treatment .
cyst aspiration has been one of the options for smaller cysts ; however , recurrence is a possibility .
open surgical excision of cysts has been described by several authors . since the introduction of laparoscopy
, it has become a popular and procedure of choice , whenever dealing with small adrenal masses or cysts .
several studies have demonstrated a clear advantage of laparoscopic surgery over open surgery in terms of analgesia , hospital stay , blood loss , and complication rate [ figures 3 and 4 ] . left adrenal cyst
reported on the feasibility and safety of laparoscopic management of symptomatic and large adrenal cysts . during the period june 1993 to april 2004 they performed 149 laparoscopic adrenalectomies ; out of which , 8 patients with symptomatic adrenal cysts or pseudocysts were treated laparoscopically .
six patients underwent laparoscopic adrenal cyst decortication and marsupialization , one underwent laparoscopic partial adrenalectomy , and one underwent laparoscopic adrenalectomy .
mean hospital stay was 1.7 days . at a mean follow - up of 18.5 months , all patients were asymptomatic and without radiographic evidence of cyst recurrence [ figure 5 ]
. left adrenal cyst excised during the period april 2000 to december 2010 , 62 patients underwent laparoscopic adrenalectomy which included 11 large pheochromocytomas and 18 children .
the mean operating time of laparoscopic adrenalectomy was significantly less when the lesion was a cyst as compared to solid lesions in our experience .
there were no cases of conversion to open irrespective of the lesion being solid / cystic .
assessed the safety and efficacy of different surgical procedures used for managing benign adrenal cysts .
90 months follow - up , there were no recurrences in both the groups . in our series ,
all the 14 patients were symptomatic and were referred to our centre for further management .
it was possible to treat all these cystic lesions laparoscopically with minimal invasion , decreased blood loss , and shorter hospitalization .
the mean size of the cyst was 9.57  1.55 cm , which might have been the reason that these lesions were symptomatic in our series .
voluminous cysts have also been reported , which can rupture and lead to massive bleed in the retroperitoneum .
very rarely have functional rests , or have malignant potential ; however , one always need to look out for them especially when dealing with complex cysts .
adrenal cysts are rare , but with the use of ultrasonography and other imaging techniques many of these are being diagnosed incidentally .
laparoscopic adrenalectomy is a safe and effective treatment for symptomatic and large benign adrenal cysts .
it has the advantages of a shorter hospital stay , less blood loss and enhanced cosmesis .
introduction : cystic lesions of the adrenals are rare with an incidence of 0.06% in autopsies , and the most frequently found are either the endothelial cysts or the pseudocysts . 
 we report our series of patients presenting with adrenal cysts.materials and methods : the case records of patients presenting with adrenal cysts were reviewed and analyzed . 
 age , gender , presenting symptoms , physical examination findings , laboratory investigations and imaging records were all noted and analysed.results:during the 10-year study period , 14 patients , with a mean age of 41.36  5.57 years , were diagnosed to have adrenal cysts . 
 laparoscopic excision of cysts was performed in three and laparoscopic adrenalectomy in the remaining eleven.conclusions:adrenal cysts are rare , and intervention is indicated whenever they are large ( > 5 cm ) , symptomatic , functional , and potentially malignant . 
 laparoscopic management of these cysts in the form of either decortication / excision is safe , effective , minimally invasive , with minimal blood loss and shorter duration of hospitalization .