Endocrine Abstracts

JOINT205

Purpose: Adrenal incidentalomas refer to adrenal masses, at least 1 cm in diameter, discovered incidentally through imaging conducted for non-adrenal-related reasons. The widespread use and advances in imaging technology have significantly increased the frequency of adrenal incidentaloma detection. The challenge in evaluating these lesions lies in balancing the potential benefits of early treatment for malignant or secreting tumors with the risks and costs of unnecessary treatments. The lack of studies integrating radiological findings with epidemiological and clinico-biological data, particularly at the continental and national levels, presents significant diagnostic and therapeutic challenges for clinicians. This study aims to investigate the epidemiological and clinico-biological characteristics of adrenal incidentalomas, evaluate radiological criteria indicative of malignancy, and identify markers that predict hormonal secretion, especially cortisol production.

Methods: A retrospective study was carried out on 153 patients referred to the endocrinology department at Farhat Hached Hospital for the assessment of an adrenal incidentaloma between January 2015 and December 2023.

Results: The average age of the patients was 55.76±13.36 years, with non-secreting adenomas being the most observed lesion in 94 patients (61,44%). In our series, autonomous cortisol secretion (ACS) was the most frequent hormonal abnormality, accounting for 17% of cases. Pheochromocytoma was diagnosed in 6 patients (3.92%), and primary hyperaldosteronism was found in 8 patients (5.2%). Secreting adenomas were significantly larger than non-secreting adenomas (27.55±11.7 mm vs 20.5±9.3 mm). The attenuation value was also higher in secreting adenomas with ACS. Moreover, contralateral adrenal atrophy, hepatic steatosis, and bone demineralization were more common in adenomas with ACS than in non-secreting ones. Our series included 6 cases of adrenocortical carcinoma (ACC). The average size of ACC (61±27.07 mm) was significantly larger than that of lipid-poor adenomas. Only one ACC measured less than 4 cm, and the mean non-contrast density for ACCs was 29.7 UH. None of the pheochromocytomas had a non-contrast density below 10 UH. Of the 5 pheochromocytomas in our series, only one exhibited the typical "light bulb sign" with a homogeneous hyperintense lesion.

Conclusion: Imaging is crucial for characterizing adrenal incidentalomas and for the early detection of malignant lesions. It also plays a key role in the presumptive diagnosis of ACS.

Limitations: Our study primarily focused on the initial management of adrenal incidentalomas. Future studies will be needed to establish a follow-up protocol for benign lesions that are not surgically treated.