Endocrine Abstracts

Background: Adrenal incidentalomas are defined as clinically silent adrenal masses >1 cm in size and are detected in up to 10% of patients during imaging procedures performed for unrelated conditions. 17% and 23% of incidentally detected adrenal lesions were reported to be bilateral. The bilateral adrenal tumors include metastasis, lymphoma, neuroblastoma, pheochromocytoma, adenoma and myelolipoma. Non-neoplastic bilateral adrenal masses include infectious processes and hematomas.

Methods and Design: A retrospective review of all patients with bilateral adrenal masses who are detected in Ondokuz Mayıs University Endocrinology Clinic from 2008 to 2022 was performed. Gender, patient and diagnosis age, diameter and HU of each masses, follow- up time, imaging type, basal cortisole, ACTH, DHEAS and 17-OH Progesterone level, 1-mg dexametahasone supression test (DST) and 2-day-2 mg DST, DHEAS, 17-OH Progesteron, plasma Aldosteron(PA), plazma Renin activity(PRA), PA/PRA ratio, Saline Infusion Test, adrenal venous sampling, 24-hour-urine catecholamines and if operated, type and localization is reported.

Results: In this study, 222 patients was involved. The median age of all patients was 62.22 (range 51-72 years) and median diagnosis age was 57.58 (47-67 years). 50.2% (n=127) was women and 42.8% (n=95) was men. 120 patients (54.1%) had non-functional adenomas while 10 (4.5%) had cushing, 4 (1.8%) had pheochromacytoma, 8 patients (3.6%) had primary hyperaldosteronism, 1 (0.5%) had myelolipoma, 7 (3.2%) had other metastatic malignancies, 17 had mild autonomous cortisol secretion (MACS) and 55 (24.8%) was not properly followed. 191 patients (89.3%) didn’t have any operation, while 10 (4.7%) underwent right, 9 (4.2%) left and 4 (1.9%) bilateral adrenalectomy. The operation types were 18 (78.3%) laparoscopic and 5 (21.7%) open. 23 patients that underwent adrenalectomy had a follow up of median 16 (0-187) months, while the remaining 191 (0-122) patients had a follow-up of median 5 months (P: 0.031). Diameter of right adrenal was 40 mm for the operated (P<0.001). Left adrenal diameter was 22 mm for the operated group(P: 0.032). 208 patients who had 24-hour-urine catecholamines sample, 4 (17.4%) were elevated in the operated group and 3 (1.6%) were elevated in the non-operated (P: 0.003). The diagnosis for the masses were also statistically significant in the operated group (P<0.001).

Conclusion: Most of the bilateral masses were non-functional. Cortisol and aldosterone secretion are the main causes of functional adenomas. No cases of primary adrenal malignancy were diagnosed besides that metastatic malignancies. Mass diameter for both sides and follow up time were increased in the operation group.