Endocrine Abstracts

Unsuspected adrenal masses, or incidentalomas, are increasingly found with the widespread use of thoracic and abdominal imaging. These masses may be hormonally active or nonfunctional and benign or malignant. Clinicians must determine the nature of the mass to decide what treatment, if any, is needed.

In our 17 year experience, we observed 232 patients (158 females, 74 males aged 22-91, mean age 69) affected with monolateral incidentaloma. 58 of them (25%) underwent adrenal surgery and pathology revealed: 40 cortical adenomas, 12 pheocromocitomas, and 6 primary or metastatic carcinoma. In patients with cortical adenoma, 20 patients presented hormonal findings consistents with Cushing disease, 10 with Conn disease, and 10 presented no hormonal alterations with a size mass >4 cm. In patients with feocromocitoma, only 6 patients presented elevations of cathecolamines/metanephrines. In patients with neoplastic disease, the size of the mass was, in our experience, predictive for malignancy.

Among the patients under clinical follow up, 15 of them presented biochemical findings suggestive for subclinical cortisol hypersecretion, but they do not still meet the criteria for surgery, and only 7 patients switched from a silent/subclinical to a hyperfunctional hormonal condition, and/or showed a significant increase of the mass, that required surgery. In 6 of them pathology revealed a cortical adenoma, and in 1 metastasis of an occult lung carcinoma.

Our data suggest that the management of incidental adrenal masses is hampered by the limited studies of their natural history. The low prevalence of adrenal cortical carcinomas and the relatively low incidence of progression to hyperfunction call into question the advisability of current practice of intense, long-term clinical follow-up.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.