Endocrine Abstracts

Background: The adrenal incidentalomas (AI), adrenal masses ≥10 mm in diameter incidentally detected, have increased their prevalence due to technological advances in imaging. The adrenalectomy is indicated in functioning adrenal tumors and in cases suspected of malignancy.

Objectives: To analyze the characteristics of patients with AI and to evaluate the clinical outcome, in terms of evolution toward hypersecretion and significant growth, during follow-up over 5 years.

Methods: Observational, descriptive and retrospective study of patients with AI observed in our Department between January and October 2013.

Results: Among the 64 included patients, 57.8% were female and the mean age of diagnosis was 58.6±11.8 years. The median diameter of AI was 25 mm (range 10–85 mm). The most of AI (76.6%) had a diameter ≤30 mm and six AI had a diameter ≥40 mm. Of these six, two showed imaging features of adrenal myelolipomas (40–50 mm) and of the remaining four (diameter>50 mm) three were pheochromocytomas and the last one was a probable metastatic disease. The functionality evaluation revealed that 50 (78.1%) patients had non-functional masses, the subclinical Cushing’s syndrome (SCS) was diagnosed in three (4.7%), pheochromocytoma in another three, and primary hyperaldosteronism in one case (1.6%). The median time of follow-up was 19 months, range 4–109 months. After 3 years of follow-up, one patient had a significant growth of AI (10 mm) and two acquired autonomous cortisol secretion (SCS). Eight patients (12.5%) were oriented to surgical treatment, namely due to functionality (n=5), structural changes (n=2) and significant growth (n=1).

Conclusion: Excluding myelolipomas, the AI ≥4 cm in diameter corresponded to hormonally active or malignant lesions, so adrenalectomy in these tumors seems undeniable. The percentage of AI which grew significantly and became active was low, therefore it’s surely questionable the relevance of the long term follow-up of these patients.