Endocrine Abstracts

Background and Aims: The incidence of adrenal incidentaloma(AI) has been rising sharply due to the increased use of radiologic imaging. It shows evident variation with age, with the majority of the cases presenting in the 5th to 7th decade of life. This study aims to assess the prevalence of AI and its radiological features and hormonal profiles in the geriatric population.

Patients and Method: We conducted a retrospective descriptive study including 177 patients diagnosed with AI, referred to the Endocrinology Department of Hedi Chaker University Hospital, Sfax, Tunisia during 2011–2020. All patients have undergone clinical examination, adrenal CT, and biochemical workup for hormonal secretion.

Results: Among the 177 patients diagnosed with AI, 38.9% were 65 years and older. We focused our investigation on the geriatric population sample(n=69). The mean age at diagnosis was 71.4±4.2 years, with a female predominance(57.5%). At the time of diagnosis, older adults reported various unspecific “aging-related symptoms” such as asthenia(50%), weight loss(40%), and paresthesia(37.5%). Hypertension(67.5%), diabetes(42.5%), and dyslipidemia(30%) were the leading comorbidities in geriatric patients bearing AI. Ninety-five percent of AI were detected on CT scans performed mainly for nephritic colitis(42.5%) or abdominal pain(17.5%). Complementary centered adrenal CT featured adrenal adenomas in 90%, less frequently bilateral adrenal hyperplasia (7.5%), and macronodular adrenal hyperplasia(2.5%). AI was unilateral in 61%, mainly left-sided(54.5%), and bilateral in 39%. The mean size of AI was 24.1±12.8 mm. 10% of aged patients were harboring AI larger than 40 mm. Non-contrast CT density was < 10UH in 82.5%. As for the remaining patients(17.5%), enhanced CT showed an absolute washout > 60% in 42.9% of cases. Based on the hormonal workup, 70% of elderly patients had non-secreting lesions. The functioning incidentalomas displayed autonomous cortisol secretion(32.5%), primary hyperaldosteronism(25%), or secondary hyperaldosteronism(21.8%). Only one senior had a secreting pheochromocytoma. AI with mixed hormonal secretion was recorded in 12.5%.

Conclusion: AI often affects the geriatric population, with an incidence reaching 10% after 70 years compared to 1–4% in younger adults. The vast majority of the AIs are non-functioning adenomas. Less common, some hormonal secretions, especially autonomous cortisol secretion and primary hyperaldosteronism, may be individualized in elderly patients bearing AI, although the hormonal excess often remains subclinical. Due to frailty and comorbidities frequently associated with advanced age, surgical management should be discussed on a case by case basis and proposed for seniors harboring lesions suspected of malignancy or overt hormonal secreting tumors: pheochromocytoma, cortisol secreting adenoma, etc