Adrenal Incidentaloma Needs thorough Biochemical Evaluation – An Institutional Experience

Abstract

Context: Adrenal incidentalomas (AIs) are seen in around 2% of apparently healthy individuals. These require careful evaluation for the hormone excess state and the presence of malignancy prior to intervention. Aims: To study the clinical, biochemical, and imaging characteristics of the patients with AI and correlate the diagnosis with the histopathology findings in patients undergoing surgery. Settings and Design: Retrospective observational study. Methods and Material: Patients with adrenal incidentaloma presenting between January 2017 and January 2021 were evaluated as per guidelines provided by the European Society of Endocrinology and the European Network for the Study of Adrenal Tumors. Patients were given final diagnosis on the basis of imaging impression, hormonal activity, and biopsy results (when applicable). Results: Forty-eight patients were evaluated, with 25 being male, the mean age being 40.9 years (8–71), and the mean size of the mass being 6.21 (1.4–13.7) cm. Thirty-five (72.9%) of them underwent surgical excision. The most common diagnosis was myelolipoma (16), followed by pheochromocytoma (10) and adenoma (9). Nineteen patients were found to have hormone-secreting masses. Two patients with pheochromocytoma were normotensive. There was discordance between imaging diagnosis and hormonal status in two patients, with final diagnosis of pheochromocytoma. One patient with extramedullary erythropoiesis of the adrenal gland was subsequently diagnosed with sickle cell anemia and adrenal insufficiency. Conclusions: The study highlights the rare possibility of discrepancy between non-contrast CT diagnosis and functional status of AI. There is also a rare possibility of extramedullary erythropoiesis presenting as AI with adrenal insufficiency. Specific evaluation for such rare possibilities should be considered in AI cases as per clinical scenario.

Incidentaloma suprarrenal. Reporte de caso.

“…Por otra parte, las pruebas bioquímicas son igual de importantes para valorar si la masa suprarrenal es funcionante o no, incluso en pacientes asintomáticos. En este contexto, Akash et al, (2) en su estudio realizado en el Hospital de Gauhati en India observaron que el 39,5% de tumores suprarrenales diagnosticados eran lesiones funcionantes. Por lo tanto, en la evaluación bioquímica resulta esencial descartar el exceso de cortisol con el test de supresión con dexametasona y el exceso de catecolaminas a través de la medición de metanefrinas (6).…”

“…Una masa suprarrenal clínicamente insidiosa que mide más de 1 cm de diámetro, diagnosticada durante estudios de imagen que se realizan por razones distintas a la sospecha de una patología suprarrenal se denominan incidentalomas (2). El 85% de tumores suprarrenales son benignos y corresponden a los adenomas de la corteza suprarrenal (10).…”

“…La mayoría de masas suprarrenales se diagnostican durante estudios de imagen realizados por razones distintas a la sospecha de una patología suprarrenal, frente a esto Geelhoed y Druy en 1982 introducen el término de incidentaloma que define una masa adrenal que mide más de 1 cm de diámetro, asintomática que es detectada de manera fortuita, pero que técnicamente se conocen como adenomas a las lesiones benignas descubiertas(1). En este grupo se excluye aquellas lesiones descubiertas durante la valoración de pacientes con síndromes hereditarios o tumores extraadrenales (2). La prevalencia es variable a nivel mundial y oscila entre el 1% y 8,7% en series de autopsias informadas y entre el 4% y 10% en estudios radiológicos (3).…”