ECE2014 Poster Presentations Adrenal cortex (56 abstracts)
Introduction: While, both quality and accessibility to novel imaging technics rises, we observe a surge in detection of adrenal masses. Those tumors are accidentally found in ~ 0.4% of ultrasonographies and in 4% of computed tomography scans (CT) conducted due to other indications. In spite of high prevalence of those lesions approach to their diagnosis, follow-up and treatment is still controversial. High financial costs and possible adverse effect on health connected with their management are a matter of debate. Taking into account those arguments, we aimed at assessing the morphology and hormonal function of incidentalomas.
Patients and methods: The study was conducted on 619 patients, diagnosed in Department of Endocrinology, Metabolism and Internal Medicine in Poznań between 2004 and 2013. Group consisted of 396 women and 223 men, aged from 19 to 88 years (mean age 59.7). CT scan was performed in each case. We assed hormonal function of hypothalamuspituitaryadrenal gland axis. Daily urine metoxycatecholamines and electrolytes excretion as well as serum aldosterone, serum renin activity and DHEA-S were measured.
Results: Hormonal activity was disclosed in 84 cases (13.6%). Among those tumors 21 (25%) secreted excessively mineralocorticoids, while 46 (54.8%) glucocorticoids. Metoxycatecholamines production was raised in 19% (16), DHEA-S in 1.2% (1). Patients with increased glucocorticoids secretion were diagnosed with: symptomatic (14) or subclinical Cushings syndrome (32). Nodules were bilateral in 19.4% cases. We disclosed that 89.3% lesions were smaller than 4 cm, whereas only 2.7% exceeded 6 cm in maximal diameter. Hormonally active tumors were larger than inactive ones (30.9 vs 24.3. mm; P=0.0004).
Conclusions: Despite majority of adrenal tumors was inactive, noticeable amount posed a risk of hormonal overproduction. Cushings and Conns syndrome were most common diagnosis. The preponderant size of tumor was under 4 cm. Whereas activity was diagnosed more often in larger lesions, difference between the maximal diameter in hormonally active and non-secreting lesions was quite small, but significant. To sum up, every incidentaloma require comprehensive diagnostics in order to avoid the omission of hormonally active ones.