Background: The purpose of this study is to evaluate the impact of modern imaging techniques in respect to indication for operation, surgical approach and resectional management of diseases of the adrenal glands. Methods: 278 patients operated on for primary and secondary tumors of the adrenals from 1975 to 1996 were investigated in this study. Results: Imaging techniques improved the choice of surgical approach to the adrenals and the planning of surgical procedure. Additionally, the indication for operation of adrenal incidentaloma, primary aldosteronism, adrenomedullary hyperfunction and Cushing's syndrome have been completed. Conclusions: The improvement of imaging techniques in the diagnosis of adrenal processes did contribute substantially to the reduction of surgical morbidity of adrenal resections by the preferential use of less traumatic surgical techniques (extraperitoneal incisions and endoscopic approach, subtotal adrenalectomy).