Abstract
Background: Because of the increased use of imaging interventions, more subjects have been diagnosed with adrenal incidentaloma in recent years. Aim: To evaluate the risk of mass enlargement, hormone hypersecretion and development of adrenal carcinomas during short-term followup. Subjects and methods: There were 317 subjects with incidentally discovered adrenal tumors in the registry. Forty subjects were excluded because of clinically overt hormone secretion at diagnosis and subjects with complete data were included in radiological (no.=150) and hormonal (no.=150) follow-up. Radiological evaluation was performed with computed tomography (CT) and/or magnetic resonance imaging (MRI). There were 143 subjects with adrenal adenomas and 7 subjects with other tumor types (cyst or myelolipoma). Median follow-up duration was 24 months. Results: Increase in tumor size was detected in 25 subjects (17.4%) with adenomas and 1 subject with adrenal myelolipoma (14.3%). Decrease in tumor size was found in 7 subjects (4.8%) with adrenal adenomas. One patient was diagnosed with adrenocortical carcinoma during follow-up. In subjects with non-functioning adrenal adenoma (NFA, no.=120) or subclinical Cushing syndrome (sCS) (no.=30), no subject developed clinically overt hormone hypersecretion, while 8 (6%) subjects in the NFA group developed sCS. Tumor diameter and follow-up duration were significantly higher in subjects who developed sCS. Conclusion: In conclusion, we demonstrated that, despite being infrequent, adrenal tumors may increase in size, develop overt or subclinical hormone secretion or feature malignant transformation. Therefore, radiological and hormonal follow-up should be recommended to the patients. More investigations are needed for the establishment of long-term follow-up protocols.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Barzon L, Sonino N, Fallo F, Palu G, Boscaro M. Prevalence and natural history of adrenal incidentalomas. Eur J Endocrinol 2003, 149: 273–85.
Barry MK, van Heerden JA, Farley DR, et al. Can adrenal incidentalomas be safely observed? World J Surg 1998, 22: 599–603; discussion -4.
Barzon L, Fallo F, Sonino N, Boscaro M. Development of overt Cushing’s syndrome in patients with adrenal incidentaloma. Eur J Endocrinol 2002, 146: 61–6.
Bastounis EA, Karayiannakis AJ, Anapliotou ML, et al. Incidentalomas of the adrenal gland: diagnostic and therapeutic implications. Am Surg 1997, 63: 356–60.
Bencsik Z, Szabolcs I, Goth M, et al. Incidentally detected adrenal tumours (incidentalomas): histological heterogeneity and differentiated therapeutic approach. J Intern Med 1995, 237: 585–9.
Bondanelli M, Campo M, Trasforini G, et al. Evaluation of hormonal function in a series of incidentally discovered adrenal masses. Metabolism 1997, 46: 107–13.
Bulow B, Jansson S, Juhlin C, et al. Adrenal incidentaloma — follow-up results from a Swedish prospective study. Eur J Endocrinol 2006, 154: 419–23.
Courtade A, Carnaille B, Ernst O, et al. Outcome of incidental adrenal masses not operated on: 44 cases over 7 years. Eur J Surg 1997, 163: 315.
Herrera MF, Grant CS, van Heerden JA, Sheedy PF, Ilstrup DM. Incidentally discovered adrenal tumors: an institutional perspective. Surgery 1991, 110: 1014–21.
Jockenhovel F, Kuck W, Hauffa B, et al. Conservative and surgical management of incidentally discovered adrenal tumors (incidentalomas). J Endocrinol Invest 1992, 15: 331–7.
Libe R, Dall’Asta C, Barbetta L, et al. Long-term follow-up study of patients with adrenal incidentalomas. Eur J Endocrinol 2002, 147: 489–94.
Mantero F, Arnaldi G. Management approaches to adrenal incidentalomas. A view from Ancona, Italy. Endocrinol Metab Clin North Am 2000, 29: 107–25, ix.
Osella G, Terzolo M, Borretta G, et al. Endocrine evaluation of incidentally discovered adrenal masses (incidentalomas). J Clin Endocrinol Metab 1994, 79: 1532–9.
Rossi R, Tauchmanova L, Luciano A, et al. Subclinical Cushing’s syndrome in patients with adrenal incidentaloma: clinical and biochemical features. J Clin Endocrinol Metab 2000, 85: 1440–8.
Siren J, Tervahartiala P, Sivula A, Haapiainen R. Natural course of adrenal incidentalomas: seven-year follow-up study. World J Surg 2000, 24: 579–82.
Terzolo M, Ali A, Osella G, Mazza E. Prevalence of adrenal carcinoma among incidentally discovered adrenal masses. A retrospective study from 1989 to 1994. Gruppo Piemontese Incidentalomi Surrenalici. Arch Surg 1997, 132: 914–9.
Virkkala A, Valimaki M, Pelkonen R, et al. Endocrine abnormalities in patients with adrenal tumours incidentally discovered on computed tomography. Acta Endocrinol (Copenh) 1989, 121: 67–72.
Commons RR, Callaway CP. Adenomas of the adrenal cortex. Arch Med Interna 1948, 81: 37–41.
Dobbie JW. Adrenocortical nodular hyperplasia: the ageing adrenal. J Pathol 1969, 99: 1–18.
Mantero F, Terzolo M, Arnaldi G, et al. A survey on adrenal incidentaloma in Italy. Study Group on Adrenal Tumors of the Italian Society of Endocrinology. J Clin Endocrinol Metab 2000, 85: 637–44.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Yener, S., Ertilav, S., Secil, M. et al. Prospective evaluation of tumor size and hormonal status in adrenal incidentalomas. J Endocrinol Invest 33, 32–36 (2010). https://doi.org/10.1007/BF03346546
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03346546