The functional assessment and growth rates of adrenal incidentalomas: a single center experience

S. Avci; S. Zuhur; B. Oguz; S Ucak Basat; Y. Altuntas

Purpose: The aim of this study was to evaluate the functional status and growth rates of adrenal incidentalomas, diagnosed at our center between 2005 through 2010.

Methods: The computer and archive records of 113 patients, diagnosed as adrenal incidentalomas and followed-up at our center, were retrospectively analysed.

Results: A total of 113 patients (133 tumors, 80 women (%70.8) and 33 men (% 29.2), ranged in age between 27 and 77 years old) were included in the study. All patients were evaluated and followed-up by magnetic resonace imaging (MRI) at 6-month intervals. Hormonal evaluation including urinary metanephrine, normetanephrine, free cortisole and serum cortisole (basal and after low dose dexamethasone supression) in all patients, ACTH (in patients with Cushing’s sendrome) and plasma renin activity and aldosteron levels (in patients with hypertension) were performed at baseline and then at 6–12-month intervals. According to MRI results, the tumors were located in the right adrenal in 36 (31.8%), in the left adrenal in 57 (50.4%) and in bilateral adrenals in 20 patients (17.7%). A tru-cut biyopsi was performed in 8 patients with suspected tumor appearance on MRI. The clinical diagnosis of patients were presented in Table 1. All patients were followed-up for 15.6±15.4 months (min. 6, max. 60 months). During follow up, none of the patients with non-functional adrenal incidentaloma developed hormonal hyperfunction. However, tumor enlargement was determined in ten patients (%7.5), (<1 cm in four tumors (%40), between 1 and 2 cm in three tumors (%30) and >2 cm in 3 tumors (%30) respectively.

Conclusion: Tumor enlargement may occur in a substantial number of adrenal incidentalomas during follow-up. Since the mass enlargement may be a sign of malignancy, long-term follow-up of these patients with imaging techniques is essential.

Table 1
Diagnoses	Patients (n=113) no (%)
Non-functional Adenoma Cushing’s syndrome Pheochromocytoma Conn’s syndrome Congenital Adrenal Hyperplasia Metastasis Malignancy^a Primary adrenal tuberculosis Adrenomiyelolipoma	71 (63) 21 (19) 8 (7) 5 (4) 2 (2) 2 (2) 2 (2) 1 (1) 1 (1)
^aOne non-hodgkin lymphoma and one primary adrenal carcinoma.

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.

Endocrine Abstracts

P104