Conservative and surgical management of incidentally discovered adrenal tumors (incidentalomas)

Jockenhövel, F.; Kuck, W.; Hauffa, Berthold P.; Reinhardt, Walter; Benker, G.; Lederbogen, S; Olbricht, Th.; Reinwein, D.

doi:10.1007/bf03348745

Cited by 62 publications

(35 citation statements)

References 29 publications

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“…Barzon et al (1999), in the most comprehensive study to date, reported that though the risk of malignancy was very low even in the case of an increment in mass size, the large incidentalomas should be carefully followed-up due to the elevated probability of hyperfunction which, in their study, occurred in two out of 75 patients studied. Other authors have similarly reported the development of overt hypersecretion of the mass over time and even occasional malignant transformation of adrenal incidentalomas (Hensen et al, 1990;Jockenhovel et al, 1992). In contrast, no shift toward malignancy or functional hyperactivity was observed in several other studies (Osella et al, 1994;Barry et al, 1998;Terzolo et al, 1998;Rossi et al, 2000;Siren et al, 2000;Grossrubatscher et al, 2001).…”

Section: Discussionmentioning

confidence: 90%

“…While several concordant diagnostic and therapeutic algorithms have been proposed for management of patients with adrenal incidentalomas, follow-up studies are scanty and those reported in the literature are not univocal, probably on account of different duration of observation, number of patients studied and methodological approaches adopted (Jockenhovel et al, 1992;Barzon et al, 1999;Siren et al, 2000). Barzon et al (1999), in the most comprehensive study to date, reported that though the risk of malignancy was very low even in the case of an increment in mass size, the large incidentalomas should be carefully followed-up due to the elevated probability of hyperfunction which, in their study, occurred in two out of 75 patients studied.…”

Section: Discussionmentioning

confidence: 99%

“…The majority, but not all, recommend a conservative approach, except for masses suspected for malignancy and/or clearly hyperfunctioning which need surgical treatment (Jockenhovel et al, 1992;Ambrosi et al, 1997;Barzon et al, 1998;Barzon and Boscaro, 2000;Brunt and Moley, 2001; Thompson and Young, 2003;Mansmann et al, 2004). However, the follow-up of these apparently benign and nonfunctioning masses is arbitrary, reflecting the clinical experience of the individual Unit rather than deriving from clinical studies planned to evaluate this aspect.…”

mentioning

confidence: 99%

“…The main problem is that the natural course of adrenal incidentalomas has not yet been fully clarified. Prespecified protocols that have prospectively investigated the evolution of these masses are scanty and those reported in the literature have given inconsistent results on the basis of different duration of observation, number of patients studied and methodological approaches adopted (Jockenhovel et al, 1992;Terzolo et al, 1998;Barzon and Boscaro, 2000;Siren et al, 2000). In particular, it is not known if these masses may increase in size and, above all, whether this is a marker of malignant transformation or whether malignancy may also occur without size variation.…”

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confidence: 99%

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Long-term morphological and hormonal follow-up in a single unit on 115 patients with adrenal incidentalomas

et al. 2005

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We investigated the natural course of adrenal incidentalomas in 115 patients by means of a long-term endocrine and morphological (CT) follow-up protocol (median 4 year, range 1 -7 year). At entry, we observed 61 subclinical hormonal alterations in 43 patients (mainly concerning the ACTH -cortisol axis), but confirmatory tests always excluded specific endocrine diseases. In all cases radiologic signs of benignity were present. Mean values of the hormones examined at last follow-up did not differ from those recorded at entry. However in individual patients several variations were observed. In particular, 57 endocrine alterations found in 43 patients (37.2%) were no longer confirmed at follow-up, while 35 new alterations in 31 patients (26.9%) appeared de novo. Only four alterations in three patients (2.6%) persisted. Confirmatory tests were always negative for specific endocrine diseases. No variation in mean mass size was found between values at entry (25.470.9 mm) and at follow-up (25.770.9 mm), although in 32 patients (27.8%) mass size actually increased, while in 24 patients (20.8%) it decreased. In no case were the variations in mass dimension associated with the appearance of radiological criteria of malignancy. Kaplan -Meier curves indicated that the cumulative risk for mass enlargement (65%) and for developing endocrine abnormalities (57%) over time was progressive up to 80 months and independent of haemodynamic and humoral basal characteristics. In conclusion, mass enlargement and the presence or occurrence over time of subclinical endocrine alterations are frequent and not correlated, can appear at any time, are not associated with any basal predictor and, finally, are not necessarily indicative of malignant transformation or of progression toward overt disease.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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Long-term morphological and hormonal follow-up in a single unit on 115 patients with adrenal incidentalomas

et al. 2005

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“…Out of these patients, 13 (0.65%) developed subclinical hypercortisolism, six (0.3%) overt Cushing's syndrome, and one (0.05%) catecholamine hypersecretion (53,62,104). In our recent follow-up study of 130 patients with adrenal incidentalomas, the estimated cumulative risk to develop either subclinical or overt glucocorticoid hypersecretion was 3.8% after 1 year and 6.6% after 5 years (53).…”

Section: Hormone Productionmentioning

confidence: 89%

Prevalence and natural history of adrenal incidentalomas

Barzon

Sonino

Fallo

et al. 2003

European Journal of Endocrinology

559

414

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Clinically silent adrenal masses discovered by imaging studies performed for unrelated reasons, i.e. adrenal incidentalomas, have become a rather common finding in clinical practice. However, only limited studies of incidence, prevalence, and natural history of adrenal incidentalomas are available. A comprehensive review of the literature shows the prevalence of adrenal incidentalomas to be 2.3% at autopsy and 0.5 -2% at abdominal computed tomography scan. Most lesions are adrenocortical adenomas at histology, whereas the prevalence of adrenocortical carcinomas is relatively low. The risk of malignancy over time for masses defined as benign at diagnosis is estimated at about 1/1000, even though 5-25% of masses increase in size during follow-up. Hyperfunction develops in about 1.7% of cases and the risk is higher in patients with lesions larger than 3 cm. Cortisol hypersecretion is the most likely disorder that may ensue, and it remains subclinical in about two-thirds of cases. The lack of controlled studies precludes making specific management recommendations. Large perspective controlled studies to define the epidemiology, natural history, and possible associated morbidity of adrenal incidentalomas and their impact on the quality of life of patients are needed.

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