ECE2017 Guided Posters Endocrine Tumours (13 abstracts)
The natural history of adrenal incidentaloma – results from the international prospective multi-centre EURINE-ACT study
Irina Bancos 1, , Vasileios Chortis 2 , Katharina Lang 2 , Alessandro Prete 2 , Massimo Terzolo 3 , Martin Fassnacht 5 , Marcus Quinkler 8 , Darko Kastelan 9 , Dimitra Vassiliadi 7 , Felix Beuschlein 5 , Urszula Ambroziak 4 , Alice Sitch 10 , Jonathan Deeks 10 & Wiebke Arlt 2
1Mayo Clinic, Rochester, MN, USA; 2Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; 3University of Turin, Turin, Italy; 4Warszawski Uniwersytet Medyczny, Warszawa, Poland; 5Universitätsklinikum Würzburg, Würzburg, Germany; 6Klinikum der Ludwig-Maximilian-Universität München, München, Germany; 7Attiko University Hospital, Athens, Greece; 8Charité Universitätsmedizin Berlin, Berlin, Germany; 9University Hospital Zagreb, Zagreb, Croatia; 10Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Background: Adrenal masses are discovered in 5% of abdominal imaging scans. Work-up aims at exclusion of malignancy and hormone excess. However, estimates of these risks derive from retrospective studies only, mostly small and with significant selection bias.
Methods: Prospective multi-centre study (2011–2016) in 14 centres (11 countries) of the European Network for the Study of Adrenal Tumours (ENSAT) with prospective consecutive enrolment of patients with newly diagnosed adrenal mass. Extra-adrenal malignancy and phaeochromocytoma were exclusion criteria. Diagnosis was confirmed by histology or imaging follow-up.
Results: We enrolled 1994 patients, 1746 (87.6%) with a benign adrenocortical adenoma (ACA), 83 (4%) with other benign masses (e.g. adrenomyelolipoma, cyst), 106 (5.3%) with adrenocortical carcinoma (ACC) and 59 (3%) with other malignant masses (e.g. metastases, sarcoma). Risk of ACC was highest in young patients (<40yrs:13%; 40–60yrs:6%;>60yrs:3%, P<0.0001) and in large masses (>4 cm:21%, <4 cm:0.4%, P<0.0001). Of 1746 patients with ACA, imaging for exclusion of malignancy included unenhanced CT in 1301 patients, with tumour density <10HU indicative of a benign tumour in 69%, with 16% borderline (10–20HU) and 15% suspicious (>20HU) results. MRI with chemical shift results in 271 ACA patients were indicative of a benign lesion in 79%. In 829/1746 (47%) ACA patients, two or more imaging studies were performed; 19% underwent three or more. Upon re-imaging after ≥6 months, the adrenal mass appeared stable in size 601 of 629 ACA patients (96%). Mild autonomous cortisol excess (MACE) was detected in 547/1316 (42%) patients with ACA. Adrenalectomy was performed in 21% (370/1746) of ACA patients. Of those, 222 (60%) had overt hormone excess and 64 (17%) had MACE (70; 18%); the remaining 84 patients (23%) had non-functioning ACA.
Conclusions: Overall risk of ACC is 5.3% and is highest in young patients with adrenal mass size >4 cm. ACAs are frequently misclassified as malignant by routine imaging, resulting in a high rate of interval imaging and unnecessary adrenalectomies.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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