Endocrine Abstracts

In the last 18 years 1710 patients with incidentally found adrenal tumours=adrenal incidentalomas (AI), 1300 women (F/M=2.8), aged 10–87 years, were registered at our department. In 338 of them (20%) bilateral tumours were detected. This study aimed at analyzing character of bilateral tumours and defining methods of their management. The size: 1.0–13 cm (in the group of 1710 patients: 1.0–23 cm) most of them up to 3.5 cm. Hormonal and imaging studies were performed in all the patients. High density of the tumour in the native phase of CT with delayed washout and the size >4.0 cm were considered as important indications for surgery. Of 66 patients with bilateral AI were treated by surgery for oncological or endocrinological purposes (mainly pre-Cushing’s syndrome). In case of malignancy bilateral operations were performed, in other cases unilateral adrenalectomy was usually done, basing on individual indications (choosing the tumour greater in diameter or with a more evident progression or presenting higher density on CT).

Pathomorphology: The most frequent malignant tumours were metastases and lymphomas, more rare was cancer (four patients); non-malignant tumours – adenomas, adrenal hyperplasia and pheochromocytomas. Pre-Cushing’s syndrome was diagnosed the most frequently in adrenal hyperplasia; sometimes both hyperplastic adrenals presented subclinical cortisol hypersecretion. Following removal of an adrenal adenoma causing subclinical Cushing’s syndrome secondary insufficiency of the remaining adrenal was observed. Replacement therapy with hydrocortisone in gradually reduced doses was withdrawn within 3–6 months in a majority of these patients.

The remaining patients, not qualified for surgery, have been carefully observed (imaging and hormonal examinations have been performed).

Conclusions: Endocrinological or oncological indications for surgery were recommended in 20% of patients with bilateral AI; the most frequent causes were adenomas, adrenal hyperplasia, pheochromocytomas, metastases and lymphomas.

Supported by a 501-1-1-07-16/06 CMKP Grant.