Positional statement of the European Society of Endocrine Surgeons (ESES) on malignant adrenal tumors

Malignant adrenal tumors are very rare, and in addition, the criteria determining whether an adrenal neoplasm is benign or malignant are not precise. This explains that it is difficult to give clear recommendations, and in many cases, it is easier to recommend what should not be done than to recommend what should be done. The European Society of Endocrine Surgeons organized in Lyon (May 13–14, 2011) a workshop on malignant or potentially malignant adrenal tumors. In the year prior to the workshop, three working groups reviewed the available literature on pheochromocytomas (PCCs)/paragangliomas (PGLs), adrenocortical carcinomas, and metastases, respectively. In their respective field, these three working groups tried to grade the evidence for recommendations in accordance with accepted international standards. Results of their extensive update were presented during this workshop, and recommendations were discussed in three plenary sessions with input from all the participants. Articles were amended on the basis of the discussion at the workshop. Adrenocortical carcinomas