Endocrine Abstracts

Introduction: Adrenal incidentalomas (AI) are tumours revealed during radiological procedures in patients without previous suspicion for adrenal disease. This study was conducted to determine the frequency of functional AI.

Patients and methods: Thirty-eight patients with AI were included in the study. The following parameters were considered: patient age, gender, size and location of the tumour, and radiological characteristics of adrenal masses. In order to determine hormonal activity of incidentalomas the following tests were done: basal cortisol values and day-night rhythm, adrenocorticotropic hormone (ACTH) overnight dexamethasone suppression test, vanillymandelic acid (VMA) in 24 h urine, electrolytes, haematocrit (HCT), acid-base status, oral glucose tolerance test (OGTT) and chromogranin A (CgA).

Results: Patients consisted of 22 females (57.89%) and 16 males (42.1%) aged between 23 and 78. The highest incidence was in sixth decade (34.21%). Regarding the tumour localisation, 60.53% were found in the left ad-renal gland, 34.21% were visualised in the right, and 5.26% of the patients had bilaterally AI. The majority of analysed lesions were 1–4 cm in size (86.84%). Based on CT scans features, only two patients were highly suspicious of malignant AI. Hormonal evaluation showed that 32 patients (84.21%) had non-functional adrenal lesions. Among 6 patients with verified AI functional activity, 3 had pheochromocytomas, 2 were diagnosed as Cushing’s syndrome and one patient had aldosterone-producing adenoma. Adrenalectomy was performed in 9 patients. Histopathological examination confirmed suspected hormonal activity in 6 patients, adrenocortical carcinoma in one patient and secondary deposits due to bronchial carcinoma in one patient.

Conclusion: Along with technology advances detection of AI is significantly increased. Two crucial tasks for physician are: 1. to distinguish functional from nonfunctional adrenal tumour and 2. to conclude whether it is benign or malignant one. Even though the frequency of functional AI is low and malignant AI even lower, thorough diagnostic procedures should be conducted in order to triage patients for surgical treatment.