Adrenal incidentalomas accompanying malignant tumours: clinical study of 1888 patients
Anna A Kasperlik-Zaluska1, Jadwiga Slowinska-Srzednicka1, Elzbieta Roslonowska1, Wojciech Jeske1, Andrzej Cichocki2, Maciej Otto3 & Wojciech Zgliczynski1
Diagnostic procedures reveal that majority of incidentally found adrenal tumours (adrenal incidentalomas, AI) appear to be benign adenomas. However, AI accompanying malignant tumours must be diagnosed very carefully to take a proper decision concerning their management. In the registry of the Department of Endocrinology in Warsaw, there are 1888 patients (1388 women, 500 men, F/M ratio 2.8) with AI, 1087 years old. Primary malignant tumours were diagnosed in 155 patients (adrenal cancer in 141 cases). Metastatic infiltrations in the adrenals were detected in 53 patients (3%), with F/M ratio 0.8, originating the most frequently from renal (19) or pulmonary (17) carcinoma, next from the colon (6), stomach (4) and mammary carcinoma (3). All metastatic tumours were characterized by high density in CT >20 HU (1st phase), their size ranged 3.018.0 cm. In 27 patients bilateral adrenal metastases were found, in 16 of them resulting in Addisons disease and in 11 cases in preclinical Addisons disease. In two women endometrial carcinoma was followed by adrenal cancer. In two other women pulmonary carcinoma was associated with adrenal cancer. In 84 patients (4%) detection of AI was preceded by surgery for a malignant tumour, the most frequently pulmonary (21), renal (20), mammary (19) or colorectal cancer (8). The density of these tumours did not exceed 15 HU, and their size ranged 1.84.5 cm. A careful observation with imaging investigations has been conducted in this group of patients. Eight patients were treated by surgery because of a slow enlargement of the tumour or density exceeding 10 HU, and an adenoma was diagnosed microscopically. Almost all patients with metastatic infiltrations of the adrenal glands were treated by open surgery, however prognosis in this group was poor. In summary, metastatic tumours were characterized by higher density, frequent bilateral localization with tendency to adrenal hypofunction and majority of them exceeded 5.0 cm in size.
This work was supported by a 501-1-1-07-16/06 CMKP Grant.