Outcome in patients with adrenal incidentaloma selected for surgery: an analysis of 88 cases investigated in a single clinical center

Abstract

Objective: The study was designed to evaluate the clinical, endocrinological and radiological parameters used to investigate adrenal incidentalomas and select patients for surgery. Design and Methods: An analysis of 88 consecutive patients with adrenal incidentaloma selected for surgery and investigated in a single clinical center was performed. Results: Mean (6 S.D.) age of the patients was 53614 years. Fourteen (16%) of the adrenal incidentalomas were malignant tumors (2 adrenocortical carcinomas, 3 metastases, 4 adenocarcinomas, 4 sarcomas and 1 mesenchymoma), 10 (11%) were pheochromocytomas, 32 (36%) were non-secretory benign adrenal adenomas and the remaining were benign adrenal (n 8; 9%) or extraadrenal (n 24; 27%) masses. Endocrinological investigations revealed 1 Conn adenoma, 4 tumors responsible for Cushing's syndrome or silent hypercortisolism and 1 androgen secreting tumor. Abnormalities of endocrine evaluations were observed in the 2 malignant adrenocortical carcinomas. Elevated 24-h urinary metanephrine levels were observed in the 9 pheochromocytomas tested. Complications of surgery occurred in 14% of the cases. Regardless of the endocrine status, parameters associated with malignant tumors were: older age (mean age of patients harboring malignant tumors vs patients with benign incidentalomas: 62 6 17 years vs 52 6 13 years, P 0.005), weight loss (39% vs 7%, P 0.005), and mass diameter greater than 60 mm (69% vs 15%, P < 0.001). By multiple logistic regression analysis malignant tumors were associated with increased age, diameter greater than 60 mm and bilateral masses. Conclusion: This study points to a high rate of pheochromocytomas and malignant tumors in patients selected for surgery. This high rate differs from some previous reports and might be explained by the criteria used to select patients for surgery. Among these two groups of tumors, careful systematic endocrinological investigations allow the detection of altered secretion in the vast majority ± if not all ± malignant tumors of adrenal origin and pheochromocytomas. Only 5% of the incidentalomas below 30 mm selected for surgery in this study were malignant, in keeping with the use of this criteria as an important parameter to select patients with normal hormonal investigations for careful follow-up.

Aberrant cortisol regulations in bilateral macronodular adrenal hyperplasia: a frequent finding in a prospective study of 32 patients with overt or subclinical Cushing's syndrome

“…administration of 1 mg/kg ovine CRH (oCRH). Assays were performed as previously reported (17)(18)(19).…”

Adrenocortical cancer: pathophysiology and clinical management

“…Although ACC are rare among incidentalomas, the diagnosis of ACC is nowadays more often made during the diagnostic work-up of an adrenal incidentaloma (Luton et al 2000). This circumstance is important since it might be a way to diagnose an ACC at an earlier stage and to improve the prognosis (Abiven et al 2006).…”

“…By contrast, adrenocortical cancer (ACC) is rare, with an estimated prevalence between 4 and 12 per million in adults (Grumbach et al 2003). Despite this rarity, malignancy is always feared because of its poor prognosis when investigating an adrenocortical mass (Luton et al 2000). The diagnosis of malignancy of adrenocortical tumors relies on careful investigations of clinical, biological and imaging features before surgery and pathological examination after tumor removal.…”

Expression of progesterone and estradiol receptors in normal adrenal cortex, adrenocortical tumors, and primary pigmented nodular adrenocortical disease

“…The hormonal investigations were performed as described elsewhere (Luton et al 2000. For patient PPNAD 5, whose disease was discovered during pregnancy, paradoxical responses to LH and other hormones were sought 1 month after delivery.…”