Undetermined masses in adrenal topography: experience of a compound by a tertiary health center

kuhn Aliny Weber; Victor Srougi; Vania Brondani; Fabio Tanno; Freitas Ricardo de; Fernando Coelho; Maria Pereira; Madson Almeida; Latronico Ana Claudia; Jose Chambo; Berenice Mendonca; Barisson Villares Fragoso Maria Candida

doi:10.1530/endoabs.99.EP186

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Endocrine Abstracts (2024) 99 EP186 | DOI: 10.1530/endoabs.99.EP186

ECE2024 Eposter Presentations Adrenal and Cardiovascular Endocrinology (155 abstracts)

Undetermined masses in adrenal topography: experience of a compound by a tertiary health center

Aliny Weber kuhn ¹ , Victor Srougi ² , Vânia Brondani ¹ , Fabio Tanno ² , Ricardo de Freitas ^3,4 , Fernando Coelho ^3,4 , Maria Pereira ¹ , Madson Almeida ^1,5,6 , Ana Claudia Latronico ^1,5 , Jose Chambô ² , Berenice Mendonca ^1,5 & Maria Candida Barisson Villares Fragoso ^1,5,6

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¹Hospital das Clínicas, University of São Paulo School of Medicine, Division of Endocrinology, São Paulo, Brazil; ²Hospital das Clínicas, University of São Paulo School of Medicine, Division of Urology, São Paulo, Brazil; ³Cancer Institute of São Paulo State (ICESP), Interventional Radiology, São Paulo, Brazil; ⁴Hospital das Clínicas, University of São Paulo School of Medicine, Radiology Institute (InRad), São Paulo, Brazil; ⁵Hospital das Clínicas, University of São Paulo School of Medicine, Laboratory of Hormones and Molecular Genetics LIM/42, Division of Endocrinology and Metabolism, São Paulo, Brazil; ⁶Cancer Institute of São Paulo State (ICESP), University of Sao Paulo Medical School, Division of Endocrine Oncology, São Paulo, Brazil

Introduction: Masses in adrenal topography have been diagnosed frequently due to more available access to radiological imaging. Adrenal incidentalomas occur around 5% to 7% of patients undergoing abdominal imaging mainly over 50 years of age. The HCFMUSP is a complex tertiary center, a national reference to adrenal disorders and since 2006 around 300 adrenalectomies were performed; 8% of them corresponded to undetermined masses in adrenal topography.

Objective: We retrospectively analyzed imaging features and the definitive diagnosis of undetermined masses located in adrenal gland topography identified by abdominal CT or MRI from 2006 to 2023 (n= 49).

Methods: All patients were undergoing an extensive hormonal evaluation, according to the European and American Society of Endocrinology guidelines. Two expert radiologists reviewed all images. Forty-nine patients were included and underwent unilateral adrenalectomy, to elucidate the etiology of the lesion on adrenal topography. Masses diagnosed as adrenocortical carcinoma were excluded from this analysis.

Results: Thirty-four (69.3%) were female. The general mean age was 48.3 years old (range 18-82yo). Abdominal or lumbar pain was the leading cause for the imaging study (42.8%), and 34.6% were identified as adrenal incidentalomas during the approach to urinary tract infection, nephrolithiasis, or pulmonary disease. None of these patients had any clinical signs of adrenal hormonal hyperfunction, neither abnormal hormonal secretion. Twenty-five patients (51%) presented a mass on the left side, and only two cases presented bilateral adrenal masses. The mean size was 8.54 cm (1.3-18 cm), with non-adrenal-neoplasia standing out for a larger average size of 11 cm (7.2-15 cm). The mean Hounsfield Units (HU) on non-contrasted CT scans were 25 HU (0-50 HU). There was no significant difference in HU concerning the size of the lesion, although non-adrenal neoplasias showed a slightly higher average, reaching 30.4 HU (3-48 HU). The etiologies were: non-adrenal cancer (15 cases) (30.6%), ganglioneuroma (9 cases) (18.3%), adrenal cysts (6 cases) (12.2%), adrenal hemorrhage (4 cases) (8.1%), infectious disease (4 cases) (8.1%), schwannoma (3cases) (6.1%), lymphangioma (2 cases) (4%), pseudocyst (2 cases) (4%), prostate cancer metastasis (1 case) (2%), arteriovenous malformation (1 case) (2%), myelolipoma (1 case) (2%), acute splenitis (1 case) (2%).

Conclusion: In this large cohort, undetermined masses in adrenal topography were more prevalent in females, with non-adrenal cancer being the most frequent cause, particularly highlighting leiomyosarcoma. Ganglioneuroma was the most frequently diagnosed benign tumor.