Background: Incidental discovery of an adrenal mass (AM) presents a common finding in patients with a history of extraadrenal malignant tumour. Discerning malignancy in AM is based on radiology (Rx) and scintigraphic (Sx) criteria, and finally fine-needle aspiration biopsy (FNA) of the tissue.
Objective: Determine the concordance of Rx and Sx techniques in patients with an AM and previous oncologic history.
Materials and methods: We carry out a retrospective study. We select 10 patients with AM discovered during the study of the primary tumour. To rule out functionality of AM, we perform an initial hormonal study. The lesions were discovered with abdominal computerized tomography and then we realized Sx study with 131I cholesterol (except one case in which we used 75Selenium). FNA was not realized in any case.
Results: Functionality of AM was ruled out in all cases. In 60% of cases existed concordance between Rx and Sx studies, and both techniques argued for benign nature (adenoma/hyperplasia). In 2 cases, the AM showed Rx signs (heterogeneous and >15 Hounsfield units) suggestive of malignant process. In opposition, the Sx showed bilateral uptake, indicative of benign disease. In one case, follow up of the patient during 7 years supported de benign nature of the AM, that remains stable in size and nonfunctional. In the second case the patient died because of causes related with the primary tumour. Death occurred after 2 years of follow up, and during this period, growth of the mass was not evidenced. In the last 2 cases, Rx characteristics were compatible with adenoma but the Sx features could not rule out metastasis because adrenal glands did not showed uptake. In one case the small size of the AM (1.5 cm) could explain the lack of uptake. In the last case, there was no explaining reason for no up take of the adrenal gland. However, the support of benign process by Rx and clinical signs and the difficult access by FNA, lead us to decide to wait and follow up. At the moment, stability of the AM indicates its benign nature.
Conclusions: In spite of progressive development of diagnostic tools, safety distinction between benign and metastasic ethiology of AM is in most cases extremely difficult. Establishing dignity in AM requires consensus and close collaboration of endocrinologists, radiologists, oncologists, and nuclear doctors to structure evaluation protocols to obtain maximum information from available diagnostic tools. Perhaps, near follow up of the patients will allow us to define nature of AM with enough certainty.
03 - 07 May 2008
European Society of Endocrinology