Endocrine Abstracts

This study reviewed 322 adrenalectomies performed between April 2010 and April 2023 at a tertiary centre with specialist services, which excluded six due to incomplete records. The analysis focused on surgical indication, against the post-adrenalectomy histological results. Of the 322 cases, 182 (57%) were for functional adrenal diseases, and 140 (43%) were for malignancy associated reasoning. The most common single indication was carcinoma related (n = 80), confirmed subsequently as malignant in 86% of cases. For indications specific to an adrenal lesion ≥4 cm (n = 41); average size 6.2 cm, incidentally revealed in 70%; 93% were benign; all <9`cm size (n = 37), whereas 3 of the 4 >9 cm showed malignant histological features (MHF) (based on histopathological scoring systems). Functional disease indications included pheochromocytomas (n = 70), with 40% showing MHF; MACS or Subclinical Cushing’s (n = 44, 4.5% MHF), adrenal Cushing’s syndrome (n = 18, 28% MHF), Cushing’s disease (n = 13, 0% MHF), and Conn’s syndrome (n = 32, 0% MHF). Histological reporting of prominent zona fasciculata occurred in 23% with MACS, 28% with adrenal Cushing’s syndrome, and 16% with Conn’s syndrome, none of which had MHF (n = 27). Six patients had confirmed genetic susceptibility factors, (4 x pheochromocytoma, 1 x large adenoma, 1 x Cushing’s disease). This study data revealed an adrenal lesion size cutoff of 9 cms for size only concerns, predicted MHF with 75% sensitivity and 100% specificity, whereas below this threshold all were benign, suggesting an amended threshold for adrenalectomy would be appropriate. An unexpected 28% incidence of MHF in adrenal Cushing’s syndrome specimens, and 40% in Phaeochromocytomas suggests concerns beyond functional disease impact in these patient groups warranting greater study. Overall, a low concordance (55% ) between preoperative expectations of malignancy and actual MHF was revealed. A poor correlation between histological findings in the Cushing’s groups was revealed, although when present was indicative of benign histology.