Clinical Characteristics and Follow-Up Results of Adrenal Incidentaloma

Abstract

It is recommended that adrenal incidentaloma patients should be monitored for radiological changes, increase in size and new functionality that may occur in the future, even if they are benign and nonfunctional at the initial evaluation. Our aim is to evaluate the key clinical characteristics of adrenal incidentaloma patients focusing on changes during follow-up and associated clinical outcomes. A total of 755 patients (median age: 56 years), with an adrenal incidentaloma > 1 cm and underwent functionality tests, were included in the study. Clinical characteristics, functionality status and follow-up durations were recorded. During the course of follow-up, any changes in size and development of new functionality, and clinical consequences thereof were evaluated. In 71.8% of patients, incidentalomas were non-functional. Most frequent functionality (15.8%, n=119) was subclinical hypercortisolemia (SH) [10.9% (n=82) possible autonomous cortisol secretion (PACS) and 4.9% (n=37) autonomous cortisol secretion (ACS)] of all incidentalomas. Frequencies of Cushing’s syndrome (CS), pheochromacytoma and primary hyperaldosteronism were 4.9% (n=37), 3.8% (n=29) and 3.7% (n=28), respectively. Adrenocortical carcinoma frequency was 1.5% (n=11). Of 755 patients, 43% (n=325) were followed up regularly more than 6 months. Median follow-up duration was 24 months (6–120). A total of 17 (5.2%) patients, which had non-functional incidentalomas at baseline had developed new functionality during follow-up, of which 15 (4.6%) were SH [13 patients (4%) PACS and 2 patients (0.6%) ACS] and 2 (0.6%) were CS. During follow-up, 24% (n=78) of the patients had an increase in mass size between 5–9 mm, while 11.7% (n=38) of the patients had an increase of ≥10 mm. During follow-up, 4% (n=13) of the patients developed a new lesion with a diameter ≥10 mm on the opposite side. In patients with a follow-up duration of more than 2 years, frequencies of size increase and new lesion emerging at the opposite adrenal gland were higher. 14 patients (4.3% of the patients with regular follow-up) underwent surgery due to increase in size or development of new functionality during follow-up. Our study demonstrated that a necessity for surgery may arise due to increase in size and development of functionality during follow-up period in adrenal incidentaloma patients, and thus continuing patient follow-up, even with wider intervals, will be appropriate.

Natural history of nonfunctioning adrenal incidentalomas: a 10-year longitudinal follow-up study

“…Only 0.9% of adenomas grew by at least 10 mm when the mean follow-up was shorter than 24 months, compared with 2.9% of adrenal tumors followed for at least 24 months ( 2 ). However, in a recent study, 11.7% of the patients had an increase ≥10 mm at 24 month follow-up ( 21 ) that was similar to our cohort, where tumor enlargement (≥10 mm) occurred in 8.9% of patients. Some previous observations proposed that adenomas with a baseline size of at least 25 mm were less likely to grow than smaller adenomas (< 25 mm) suggesting that patients with larger tumors were involved later in their course of natural history ( 2 ); however, we did not observe such differences.…”

“…We collected data about additional CT findings at the follow-up CT scan. At follow-up, 37.9% of patients had additional CT changes in kidneys, 21 We observed atherosclerotic changes and dilatation of aorta (N=1 in BMI < 25 kg/m 2 , N=3 in BMI 25-30 kg/m 2 and N=2 in BMI < 30 kg/m 2 ). In BMI group 25-30 kg/m 2 we observed one patient with lung nodules, one with Bochdalek's hernia and one with fracture of eleventh thoracic vertebra.…”

Adrenocortical Carcinoma: Updates of Clinical and Pathological Features after Renewed World Health Organisation Classification and Pathology Staging

“…Functioning tumours traditionally will be managed by surgical approach. On the other hand, non-functional adrenal incidentalomas with no radiological features of malignancy and of small size will normally be monitored by radiological examination and functionally to see if there are any clinical progression [191]. An increase in size and development of functionality during follow-up in patients with adrenal incidentalomas will normally lead to biopsy and surgical resection.…”

Predictors of Tumour Growth and Autonomous Cortisol Secretion Development during Follow-Up in Non-Functioning Adrenal Incidentalomas

“…However, this is probably a consequence of several factors: (1) a type 2 error, due to low rates of ACS and cardiometabolic comorbidities development; and (2) short follow-up period, as the development of comorbidities is likely directly associated not only with the serum cortisol post-DST level but also with the time of exposure. Several previous studies, however, have observed an increased cardiometabolic risk in patients with AIs and ACS [ 22 , 23 ]. Our data support this association as, despite the lack of statistically significant differences, a higher proportion of new comorbidities in patients who progressed to ACS than in patients who remained suppressible after DST was also observed ( Table A1 ).…”