Malignant adrenal incidentaloma
N. Kesri1, A. Boudiba2 & F. Chentli1
With the development of medical imaging, many malignant lesions of the adrenal lodge are incidentally discovered. In this prospective monocentric study we are looking for factors of presumption of malignancy in the preoperative stage on a non-oncological series of 91 IS.
Monocentric prospective study, AI revealed by TDM±echo supplemented by a clinic/hormonal adrenal exploration ±isotopic. In the absence of against indications, the indication of the adrenalectomy has been systematic for histological typing. The diagnosis of malignancy is retained for 26 IS on Weiss criteria ≥3 for 17 unilateral AI removed /22 (10 adrenal cortical carcinoma ACC, 2 malignant PH and 5 non-glandular MAI) and 9 MAI having benefited from palliative treatments: 4 bilateral metastatic AI and 5 secretant expansive ACC.
Results: Prevalence of MAI is 28.5%, 10F/16 M, median 45.6 years. The average axis =10.2±5 cm, median 10 cm (3.420 cm). Clinically rare co-morbidities, toxic habits 34.6%, rapid deterioration of general condition 53.8%, painful abdominal syndrome 80.8%, prescription of major analgesics 19.2%, severe general signs 42.3%, weight loose 23.1%, HTA 7.7%, an endocrine syndrome is noted in 19.3% (virilization two cases, moderate Cushing one case, atypical adrenergic syndrome two cases). AI were apparently clinically benign in 34.6%. Biologically: high prevalence of night hypercortisolism (83.3%) in the MAI glandular, freinable in 28.6%. Secretion of androgen precursors or metanephrines is noted only in glandular MAI. Isotopic profile of nine MAI shows lack of fixation in five MIBG and discordant fixation in four norcholesterol scinti scans.
Conclusion: In addition of classical suspicious TDM signs, male sex, age <45ans, rapid physical deterioration, mixed hypercortisolism and the lack or discordant scintigraphic fixation are suggestive of MAI; lesions >3 cm must be removed.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.