Endocrine Abstracts

Introduction: Adrenal incidentaloma is a problem with increasing importance. There are CT-density and washout criteria for distinction between adrenal adenoma and other tumours, there are well established protocol of screening for malignancy and/or hormonal dysfunction. But there remains small portion of atypical adenoma where detailed diagnostic is needed. One relatively new option is endosonography-guided fine-needle aspiration biopsy.

Aim: To assess validity, complications and diagnostic contribution of endosonography-guided fine-needle aspiration biopsy in patients with atypical adrenal tumour.

Methods: Pilot study – 14 patients with atypical adrenal mass were selected for the study. In all patients was performed common screening for malignancy and/or hormonal dysfunction. Excluding criteria was typical adrenal adenoma and functional adrenal tumour. In all patients were examined plasmatic metanephrines and was excluded feochromocytoma before biopsy. All patients were admitted after endosnographic biopsy to clinical department and were observed till next day.

Results: 14 patients, 6 men and 8 women were included in the study. In all patients were not observed any complication of biopsy. In 5 cases there were bilateral tumours, in 3 cases right adrenal tumours and in 6 cases left adrenal tumour. 3 tumours were bigger than 4 cm; others were smaller than 4 cm. In one case of unilateral tumour no biopsy was performed – adrenal gland was too small for secure biopsy; in one case of bilateral tumour was performed only one sample from anatomical reasons. In other cases totally 17 samples were taken; 2 were marginally sufficient, 15 were sufficient. In 9 cases, two bilateral and 7 unilateral, were biopsies benign and patients were observed. In 5 cases was indicated unilateral adrenalectomy. One feochromocytoma, one metastasis of ovarian carcinoid tumour, two adenocarcinoma and one adrenal cortex tumour (borderline characteristic between carcinoma and adenoma).

Conclusion: Endosonography-guided fine-needle aspiration biopsy seems to be useful and safe method of differential diagnosis of atypical adrenal tumours. It can reveal any primary or secondary malignancy in early stage, with good possibility of surgical treatment.