The aim of study was to make a retrospective audit of diagnostic approach of symptomatic and asymptomatic patients with adrenal tumours diagnosed at VUHSK from 2010 to 2013.
Methods: Cases coded as D35.0; D44.1; E27.0; E27.5; E27.8; E27.9 according to ICD-10 classification were retrieved from database. Electronic data capture system was used to collect information.
Results: There were 527 (123 men, 404 women) patients, age 62.5±11 years, diagnosed with adrenal tumours from 2010 to 2013: 281 patient had symptoms: hypertension 91.1%, episodic elevations of blood pressure 34.5%, hypokalaemia 18.1%, 246 patients had no symptoms. There were 71.5 and 94.7% of tumours found incidentally in symptomatic and asymptomatic groups respectively. Suspicion of hormonal hypersecretion and proper diagnostic approach was used only in 80 (28.5%) of symptomatic patients. Symptomatic patients were assessed for hormonal activity as compared to asymptomatic: aldosterone 64.8 vs 43.9%, renin 54.4 vs 30.1%, metanephrine/normetanephrine or adrenaline/noradrenaline 61.2 vs 22.0% (P<0.001 for all), cortisol 39.2% in both groups, comprehensive analysis 14.6 vs 6.5% (P=0.003). Computed tomography confirmed diagnosis in 93% of cases in both groups; with larger tumors in asymptomatic compared to symptomatic patients (24.7±14.0 vs 22.5±14.4 mm, P=0.02).
Non-secreting tumours were diagnosed in 81.4 vs 94.8%, aldosteroma in 10.3% vs 1.2%, phaeochromocytoma in 6.8 vs 0.8% (P<0.001 for all), carcinoma in 1.1 vs 0.4%, P=0.378 comparing symptomatic and asymptomatic groups respectively. There were 45% of secreting tumours in symptomatic patients for whom proper diagnostic approach was used based on symptoms.
Conclusions: The proportion of patients having adrenal tumours with and without symptoms is similar. Although hormonal assessment should be performed in all patients, clinical symptoms should urge the doctor for comprehensive assessment as the prevalence of secreting tumours is the highest in symptomatic patients for whom proper diagnostic approach was used to clarify the diagnosis.
16 - 20 May 2015
European Society of Endocrinology