Endocrine Abstracts

Introduction: Adrenal surgical series are scarce in the literature. We aim to present a single institution consecutive case series and to establish a radiologic-pathological correlation.

Material and methods: A retrospective, observational and descriptive study was conducted by searching the Pathology database for surgically removed adrenal lesions. Cases were matched with the Imagiology database. Ultrasound, CT and MRI images were then reviewed by the same experienced radiologist in order to determine any possible correlation with the pathological findings.

Results: A total of 35 patients, 18 males (51.4%) and 17 females (48.6%) were evaluated. Benign lesions: 18 (51.4%); malignant lesions: 17 (48,6%). Primary adrenal lesions: 22 (62.9%); benign: 18 (81.8%); malignant: 4 (18.2%); pheochromocytomas: 6 (27.3%). Secondary adrenal lesions: 13 (37.1%), pulmonary neoplasia metastasis: 8 (61.5%); metastasis from other origins: 5 (38.5%). Malignant adrenal lesions: primary adrenal: 4 (23.5%); secondary adrenal: 13 (76.5%). Benign lesion average features: US - average diameter 56.2 mm; right-sided, nodular shape, regular edges, solid/ cystic structure, homogeneous, hypoechogenic, without calcifications; CT - average diameter 40,7 mm, right-sided, nodular shape, regular edges, well defined boundaries, solid structure, homogeneous, average density 15.9 HU, high contrast uptake, without calcifications; MRI - average diameter 50.8 mm; right-sided, nodular shape, regular edges, well defined boundaries, solid structure, heterogeneous, hipointense in T1-weighted images, hiperintense in T2-weighted images, heterogenous contrast uptake. Malignant lesion average features: US - average diameter 85.2 mm; right-sided, nodular shape, lobulated edges, solid structure, heterogeneous, hypoechogenic, without calcifications; CT - average diameter 53.9 mm, right-sided/ bilateral, nodular shape, irregular edges, well defined boundaries, solid structure, heterogeneous, average density 28.8 HU, high contrast uptake, without calcifications; MRI - average diameter 34 mm; right-sided, nodular shape, lobulated edges, well defined boundaries, solid structure, heterogeneous, hipointense in T1-weighted images, hiperintense in T2-weighted images, heterogeneous contrast uptake. No distinctive findings were specific for pheochromoctytoma.

Conclusions: Adrenal lesions diagnosis and management can be challenging. Radiological features assessment is valuable but is not pathognomonic. Ultrasound is also a reliable method in identifying suspicious lesions.