Endocrine Abstracts

The adrenal incidentalomas have become a common clinical problem. In the vast majority of cases these masses are non- secreting adrenocrotical adenomas. However, some may show minor endocrine abnormalities with a subclinical hyperfunction or represent malignancies.

Objectives: The aim of the study was to analyze and follow-up of incidentalomas and to establish the risk factors for mass enlargement and/or hormonal disturbances.

Material and methods: One hundred and sixty-six patients, mean age 56, with adrenal incidentalomas were investigated in our Department in 1995–2006 years. Endocrine evaluation consisted of serum cortisol profile, ACTH, DHEA-S, aldosterone and plasma renin activity as well as 24 h urinary free cortisol, aldosterone and metanefrines excretion.

The adrenal tumors were revealed by ultrasound scan, MRI or CT scan of the abdomen performed for unrelated reasons. Body mass index and blood pressure were investigated. The follow-up period was in range of 1–10 years.

Results: Unilateral adrenal masses were found in 147 patients (right – 89, left – 58), while bilateral masses were present in 19 patients. Mean diameter of the adrenal mass was 3.6 cm (range 0.5–9). Ninety-four patients were overweight/obese (BMI>25), 99 patients had hypertension.

In 133 patients the endocrine function was normal initially. Thirty-five persons demonstrated hormonal disturbances without clinical symptoms: 26 persons developed subclinical hypercortisolism, 5 showed increased 24 h urinary level of metanefrines and 2 exhibited hyperaldosteronism.

In 21 patients we observed enlargement of adrenal masses during follow-up.

The operation because of tumor size or hormonal function was performed in 83 patients. The adrenal cancer was diagnosed in 3 patients and bilateral metastases into adrenals in 3 persons.

Conclusions: A careful biochemical and imaging follow-up is advisable in all patients with adrenal incidentaloma because in some of them the hormonal hyperfunction or malignancy development is likely.