Endocrine Abstracts

Introduction: Adrenal masses (AM) are being increasingly diagnosed but only a small portion will need surgical treatment.

Methods: We retrospectively reviewed patients referred to the Endocrinology Clinic that underwent adrenalectomy between 1996 and 2023.

Results: We included 57 patients. Most AM were diagnosed incidentally (53%) and had a median size of 32 (25) mm. Forty (70%) patients had hormonal hypersecretion (HH): pheocromocytoma (PC) (15; 37%), primary hyperaldosteronism (PHA) (15; 37%), ACTH independent Cushing’s syndrome (CS) (6; 15%), mild autonomous cortisol secretion (MACS) (3; 8%) and cortisol and androgens co-secretion (1; 3%). Patients with PC were initially referred to our clinic for incidentaloma (10; 71%), hypertension (HT) (3; 22%) or as a part of screening for a genetic syndrome (1; 7%). Patients with PHA had HT with (7; 54%) or without (6; 46%) hypokalemia. Patients with CS presented with an incidentaloma (4; 67%) or features of hypercortisolism (2; 33%). Reasons for surgery included HH (39; 68%), imaging features not suggestive of benign adenoma (NB) (9; 16%) and others (9; 16%). All masses described as adenoma (23; 40%) on imaging exams had a benign diagnosis after surgery. AM described as NB (21; 37%) were later diagnosed as PC (8; 40%), cortical adenoma (CA) (2; 10%), ganglioneuroma (2; 10%), oncocytic CA (1; 5%), tumor of uncertain malignant potential (1; 5%), myelolipoma (1; 5%), nodular hyperplasia (1; 5%), black adenoma (1; 5%) and infarcted adrenal neoplasia (1; 5%). Two patients (10%) had AM with features suggestive of adrenal carcinoma: 1 was diagnosed with an infarcted cavernous hemangioma, and 1, deemed irresectable. AM with a diagnosis of PC after surgery and an accessible imaging exam (12; 26%) were initially described as NB (8; 67%), PC (3; 25%) or myelolipoma (1; 8%). All patients with PC and CS were biochemically cured after surgery. Of the 15 patients with PHA, 13 (87%) were biochemically cured, with resolution of HT and hypokalemia, when present. Of the remaining 2 (13%), 1 (50%) had an imaging exam describing an adenoma and bilateral hyperplasia, and 1 (50%) had a diagnosis of nodular hyperplasia after surgery.

Conclusions: Imaging exams were accurate in detecting benign lesions. All patients with PHA had relevant clinical manifestations of HH while most patients with PC and CS presented with an incidentaloma. Surgery was effective in most cases and the patients who were not cured likely had bilateral HH.