Limited significance of repeated long-term radiological and hormonal examination in nonfunctioning adrenal incidentalomas

Abstract

Purpose:The purposes of the present study were to evaluate growth rate of nonfunctioning adrenal incidentalomas (AIs) and their development to hormonal hypersecretion on follow-up.Materials and methods:A retrospective study was conducted from the electronic medical records. A total of 314 patients were diagnosed with adrenal tumors between 2000 and 2016. After excluding patients who had overt adrenal endocrine disorders or whose adrenal tumors were clinically diagnosed as metastatic malignancies, we investigated 108 patients with nonfunctioning AIs including characteristics, the treatment, the way of follow-up and pathology.Results:Fifteen patients received immediate adrenalectomy because of the initial tumor size or patient's preference. Pathological examination revealed malignancy in 2 patients. In the remaining 93 patients, radiological examinations were performed periodically. Tumor enlargement of ≥ 1.0cm was observed in 8.6% of the patients who were followed up as nonfunctioning AIs with a median follow-up period of 61.5 months (range: 4-192). Eleven patients underwent adrenalectomy. On the pathological examinations, all of the tumors, which showed a size increase, were diagnosed as benign tumors. Regarding the followed up patients without adrenalectomy, only 2.4% of the patients had tumor enlargement during the prolonged follow-up. Furthermore, none of the patients developed hormonal hypersecretion or clinical signs such as obesity, glucose intolerance or poorly controlled hypertension.Conclusions:Tumor enlargement of AIs did not correlate with malignancy. The value of repeat radiological and hormonal examinations may be limited in the long-term follow-up of patients whose AIs are not enlarged.

Is Follow-up of Adrenal Incidentalomas Always Mandatory?

“…to the assessment of baseline imaging characteristics in the identification of suspicious adrenal masses [25]. This concept is confirmed in a recent, small, retrospective study reporting a tumor growth ≥1.0 cm in almost 9% of patients, even if none of them was found to be malignant [27]. Despite growing evidence is supporting the strategy suggested by the ESE/ENSAT guidelines, prospective studies are still lacking to definitively validate this approach.…”

Discrepancies in the Recommended Management of Adrenal Incidentalomas by Various Guidelines

“…30 In a large retrospective study Tasaki et al reported that only 8.6% of their patients had mass growth increases greater than 1.0 cm during followup and, despite this growth, these masses were confirmed as benign on pathology. 31 The only malignancies in their study were discovered on initial imaging and subsequently resected.…”

Enhancement patterns of adrenal nodules on magnetic resonance imaging

“…Another important point of this study, despite not being the primary objective, was to observe differences in size, oncologic history, and signal on T2-weighted imaging had all statistical differences among groups, and these variables should be considered when an adrenal lesion is diagnosed in clinical practice. Increasing size in follow-up exams is not always related to malignancies (21) and a misdiagnosis of a benign lesion can be emotionally and financially harmful.…”