Important Advances in Adrenal Pathologic Classification, Imaging Analysis, and Systemic Therapy: What the Contemporary Endocrine Surgeon should Know

This review highlights recent advances in adrenal endocrine surgery and oncology, emphasizing progress in pathology, imaging, perioperative planning, and systemic therapy. In pathology, the World Health Organization recently refined the classifications of adrenocortical lesions as well as pheochromocytomas and paragangliomas. In radiology, new molecular imaging tracers and theranostics have advanced adrenal functional imaging. Novel applications of artificial intelligence and 3D anatomical modeling have also aided tumor diagnosis and adrenal surgery preoperative planning. In endocrine oncology, the expansion of tumor molecular profiling and the application of new targeted therapies has improved progression-free survival in patients with advanced pheochromocytomas and paragangliomas. Dual immunotherapy has modestly improved progression-free survival in patients with adrenocortical carcinoma. Recent changes in pathologic classification, imaging analysis, and novel applications of targeted systemic therapies have transformed care of patients with adrenal tumors, shepherding surgical and endocrine oncology into an era of precision medicine.