Incidentally Discovered Adrenal Tumors: A Lesson from Observation of 1444 Patients

Abstract

This study was aimed at summarizing our experience in the management of 1 444 patients with incidentally found adrenal tumors observed at a single endocrinological centre. Hormonal determinations were performed in all patients at the beginning of the observation period to detect subclinical adrenal hyperfunction. The imaging phenotype on CT and MRI was analyzed for defining the malignant potential of the tumors. Based on the results of these examinations we diagnosed among our cohort probably benign masses in 87%, malignant tumors in 10% (adrenal carcinoma - 9%), and metastases in 3%. Subclinical hyperfunction was diagnosed in 8%; the most frequent was the pre-Cushing's syndrome. A subgroup of 480 patients (33%) was submitted to surgery because of oncological or endocrinological indications. The patients not qualified for surgery were carefully controlled by imaging and hormonal examinations. Malignancy is the most serious risk in the group of patients with incidentally discovered adrenal tumors.

Key words

adrenal carcinoma - adrenal adenoma - pheochromocytoma - chromaffin tumor - adrenal incidentaloma

References

• 1 Kloos RT, Gross MD, Francis IR, Korobkin M, Shapiro B. Incidentally discovered adrenal masses.  Endocr Rev. 1995;  16 460-484
• 2 Young Jr WF. The incidentally discovered adrenal mass.  N Engl J Med. 2007;  356 601-610
• 3 Kasperlik-Załuska AA, Rosłonowska E, SłowinŽ ska-Srzednicka J, Migdalska B, Jeske W, Makowska A, Snochowska H. Incidentally discovered adrenal mass (incidentaloma): investigation and management of 208 patients.  Clin Endocrinol. 1997;  46 29-37
• 4 Kasperlik-Zaluska AA, Roslonowska E, Slowinska-Srzednicka J, Otto M, Cichocki A, Cwikla J, Slapa R, Eisenhofer G. 1 111 patients with adrenal incidentalomas observed at a single endocrinological center Incidence of chromaffin tumors.  Ann NY Acad Sci. 2006;  1073 38-46
• 5 Mantero F, Arnaldi G. Investigation protocol: adrenal enlargement.  Clin Endocrinol. 1999;  50 141-146
• 6 Mantero F, Terzolo M, Arnaldi G, Osella G, Masini AM, Ali A, Giovanetti M, Opocher G, Angeli A. A survey on adrenal incidentaloma in Italy.  J Clin Endocrinol Metab. 2000;  85 637-644
• 7 MacFarlane DA. Cancer of the adrenal cortex: the natural history, prognosis and treatment in a study of fifty-five cases.  Ann Roy Coll Surg Engl. 1958;  23 155-186
• 8 Kasperlik-Zaluska AA. Clinical results of the use of mitotane for adrenocortical carcinoma.  Braz J Med Biol Res. 2000;  33 1191-1196
• 9 Kasperlik-Zaluska AA, Cichocki A. Clinical role of determination of plasma mitotane and its metabolites levels in patients with adrenal cancer: Results of a long-term follow-up.  J Exp Ther Oncol. 2005;  5 125-132
• 10 Schteingart DE, Doherty GM, Gauger PG, Giordano TJ, Hammer GD, Korobkin M, Worden FP. Management of patients with adrenal cancer: recommendations of an international consensus conference.  Endocr Relat Cancer. 2005;  12 667-680
• 11 Brown H, Goldberg PA, Selter JG, Cabin HS, Marieb NJ, Udelsman R, Setaro JF. Hemorrhagic pheochromocytoma associated with systemic corticosteroid therapy and presenting as myocardial infarction with severe hypertension.  J Clin Endocrinol Metab. 2005;  90 563-569
• 12 Moran ME, Rosenberg DJ, Zornow DH. Pheochromocytoma multisystem crisis.  Urology. 2006;  67 846.e19-846.e20
• 13 Stratakis CA. Adrenocortical tumors, primary pigmented adrenocortical disease (PPNAD)/Carney complex, and other bilateral hyperplasias: The NIH studies.  Horm Metab Res. 2007;  39 467-473

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