Objective: Incidentally found adrenal tumour (adrenal incidentaloma = AI) is the most frequent adrenal disorder. Every patient with AI has to be evaluated carefully to choose the best method of management. We present our experience with a group of 1300 patients with AI, registered at our department.
Material and methods: Material consisted of 1300 patients (female/male ratio 2.6, age 1087 years) with AI ranging in size from 0.8 to 23.0 cm. Methods: clinical examination, biochemical assays, hormonal determinations (cortisol, androgens, ACTH, aldosterone, metanephrines), imaging studies (ultrasound scans, CT, MRI), histological/ immunocytochemical investigations in 420 patients treated by surgery.
Results: Basing on these examinations we diagnosed in our material 116 patients with adrenal cancer, 14 with other primary malignant adrenal tumours, 48 with metastatic tumours and 1122 with probably benign tumours. The most important criteria for surgery were imaging phenotype (mainly high density, over 20 HU in the I phase of CT), size (≧5 cm) rapid growth of the tumour and suspicion of a clinically silent chromaffin tumour (for fear of an unexpected metanephrines crisis). In some cases of adrenal cancer elevated levels of androgens have been noted. The most frequent form of subclinical hyperactivity has been pre-Cushings syndrome (6.5%).
Conclusions: 1/Malignant adrenal tumours were found in 178 patients (14%), in this number adrenal cancer in 9%. 2/ The oncological criteria for surgery were of primary importance in our material, with the elevated density in CT (I phase) as the main single indication.