Journal of Endocrinological Investigation

, Volume 29, Issue 4, pp 298–302 | Cite as

Prevalence of adrenal incidentaloma in a contemporary computerized tomography series

  • S. Bovio
  • A. Cataldi
  • G. Reimondo
  • P. Sperone
  • S. Novello
  • A. Berruti
  • P. Borasio
  • C. Fava
  • L. Dogliotti
  • G. V. Scagliotti
  • A. Angeli
  • M. Terzolo
Original Articles


Adrenal incidentalomas, defined as masses discovered incidentally during imaging investigation of non-adrenal disorders, have become a rather common finding in clinical practice. The prevalence is not well characterized and varies among studies. The aim of the present study was to perform a prospective evaluation of the prevalence of adrenal incidentalomas among subjects undergoing computerized tomography (CT) scan of the chest in a screening program of lung cancer (Tic TAC study) in Piedmont, a region of Northwestern Italy. This evaluation included 520 subjects (382 males and 138 females, aged between 55–82 yr), referred to our hospital from April to December 2001. Twenty-three patients with adrenal masses were identified: 21 adrenal adenomas, 1 myelolipoma, and 1 metastasis of lung cancer. Therefore, the overall prevalence of adrenal lesions was 4.4%, and that of benign adrenal masses was 4.2%. This prevalence is higher than those found in previous CT scan series reported in the literature, probably because of the use of high-resolution CT scanning technology. Another factor that influenced our results is that subject age is skewed towards the decades characterized by a greater occurrence of adrenal masses. The outcome of this study confirms that we are presently able to identify incidentally discovered adrenal masses more often than in early years and that the prevalence of adrenal incidentalomas on CT images is approaching that of autopsy series. The present study provides a reliable estimate of the prevalence of adrenal incidentaloma with currently used CT scanners. Notwithstanding that our subjects were at increased risk of lung cancer, the rate of adrenal metastases was low. We think that the present results can be generalized even if we may disclose the lack of histological diagnosis.

Key Words

Adrenal incidentaloma adrenal metastasis computerized tomography cortical adenoma 


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  1. 1.
    Kloos RT, Gross MD, Francis IR, Korobkin M, Shapiro B. Incidentally discovered adrenal masses. Endocr Rev 1995, 16: 460–84.PubMedGoogle Scholar
  2. 2.
    Grumbach MM, Biller BMK, Braunstein GD, et al. Management of the clinically inapparent adrenal mass (“incidentaloma”). Ann Intern Med 2003, 138: 424–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Commons RR, Callaway CP. Adenomas of the adrenal cortex. Arch Intern Med 1948, 81: 37–41.CrossRefGoogle Scholar
  4. 4.
    Kokko JP, Brown TC, Berman MM. Adrenal adenoma and hypertension. Lancet 1967, i: 468–70.CrossRefGoogle Scholar
  5. 5.
    Hedeland H, Ostberg G, Hokfelt B. On the prevalence of adrenocortical adenomas in an autopsy material in relation to hypertension and diabetes. Acta Med Scand 1968, 184: 211–4.PubMedCrossRefGoogle Scholar
  6. 6.
    Granger P, Genest J. Autopsy study of adrenal in unselected normotensive and hypertensive patients. Can Med Assoc J 1970, 103: 34–6.PubMedCentralPubMedGoogle Scholar
  7. 7.
    Russell RP, Masi AT, Ritcher ED. Adrenal cortical adenomas and hypertension. A clinical pathologic analysis of 690 cases with matched controls and a review of the literature. Medicine 1972, 51: 211–25.PubMedCrossRefGoogle Scholar
  8. 8.
    Abecassis M, McLoughlin MJ, Langer B, Kudlow JE. Serendipitous adrenal masses: prevalence, significance, and management. Am J Surg 1985, 149: 783–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Meagher AP, Hugh TB, Casey JH, Chisholm DJ, Farrell JC, Yates M. Primary adrenal tumor ten years experience. Aust NZJ Surg 1988, 58: 457–62.CrossRefGoogle Scholar
  10. 10.
    Reinhard C, Saeger W, Schubert B. Adrenocortical nodules in post-mortem series. Development, functional significance, and differentiation from adenomas. Gen Diagn Pathol 1996, 141: 203–8.PubMedGoogle Scholar
  11. 11.
    Aso Y, Homma Y. A survey on incidental adrenal tumors in Japan. J Urol 1992, 147: 1478–81.PubMedGoogle Scholar
  12. 12.
    Herrera MF, Grant CS, van Heerden JA, Sheedy PF, Ilstrup DM. Incidentally discovered adrenal tumors: an institutional perspective. Surgery 1991, 110: 1014–21.PubMedGoogle Scholar
  13. 13.
    Caplan RH, Strutt PJ, Wickus GG. Subclinical hormone secretion by incidentally discovered adrenal masses. Arch Surg 1994, 129: 291–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Ambrosi B, Peverelli S, Passini E, et al. Abnormalities of endocrine function in patients with clinically “silent” adrenal masses. Eur J Endocrinol 1995, 132: 422–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Barzon L, Fallo F, Sonino N, Boscaro M. Development of overt Cushing’s sindrome in patients with adrenal incidentalomas. Eur J Endocrinol 2002, 146: 61–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Bastounis EA, Karayiannakis AJ, Anapliotou ML, Nakopoulou L, Makri GG, Papalambros EL. Incidentalomas of the adrenal gland: diagnostic and therapeutic implications. Am Surg 1997, 63: 356–60.PubMedGoogle Scholar
  17. 17.
    Bencsik Z, Szabolcs I, Kovacs Z, et al. Low dehydroepian-drosterone sulfate (DHEA-S) level is nota good predictor of hormonal activity in nonselected patients with incidentally detected adrenal tumors. J Clin Endocrinol Metab 1996, 81: 1726–9.PubMedGoogle Scholar
  18. 18.
    Favia G, Lumachi F, Basso S, D’Amico DF. Management of incidentally discovered adrenal masses and risk of malignancy. Surgery 2000, 128: 918–24.PubMedCrossRefGoogle Scholar
  19. 19.
    Mantero F, Arnaldi G. Management approaches to adrenal incidentalomas: a view from Ancona, Italy. Endocrinol Metab Clin North Am 2000, 29: 107–11.PubMedCrossRefGoogle Scholar
  20. 20.
    Osella G, Terzolo M, Borretta G, et al. Endocrine evaluation of incidentally discovered adreanl masses. J Clin Endocrinol Metab 1994, 79: 1532–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Mantero F, Terzolo M, Arnaldi G, et al. A survey on adrenal incidentaloma in Italy. J Clin Endocrinol Metab 2000, 85: 637–44.PubMedGoogle Scholar
  22. 22.
    Reincke M, Nieke J, Krestin GP, Saeger W, Allolio B, Winkelman W. Preclinical Cushing’s syndrome in adrenal “incidentalomas”: comparison with adrenal Cushing’s syndrome. J Clin Endocrinol Metab 1992, 75: 826–32.PubMedGoogle Scholar
  23. 23.
    Barzon L, Sonino N, Fallo F, Palù G, Boscaro M. Prevalence and natural history of adrenal incidentalomas. Eur J Endocrinol 2003, 149: 273–85.PubMedCrossRefGoogle Scholar
  24. 24.
    Glazer HS, Weyman PJ, Sagel SS, Levitt RG, McClennan BL. Nonfunctioning adrenal masses: incidental discovery on computed tomography. AJR Am J Roentgenol 1982, 139: 81–5.PubMedCrossRefGoogle Scholar
  25. 25.
    Novello S, Fava C, Borasio P, et al. Three-yearfindings of an early lung cancer detection feasibility study with low-dose spiral computed tomography in heavy smokers. Ann Oncol 2005, 16: 1662–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Chidiac RM, Aron DC. Incidentalomas. A disease of modern technology. Endocrinol Metab Clin North Am 1997, 26: 233–53.PubMedCrossRefGoogle Scholar
  27. 27.
    Griffing G. A-I-D-S: The new endocrine epidemic. J Clin Endocrinol Metab 1994, 79: 1530–1.PubMedGoogle Scholar
  28. 28.
    Gross MD, Shapiro B. Clinically silent adrenal masses. J Clin Endocrinol Metab 1993, 77: 885–8.PubMedGoogle Scholar
  29. 29.
    Korobkin M, Brodeur FJ, Yutzy GG, et al. Differentiation of adrenal adenomas from nonadenomas using CT attenuation values. AJR Am J Roengtenol 1996, 166: 531–6.CrossRefGoogle Scholar
  30. 30.
    Korobkin M, Brodeur FJ, Francis IR, Quint LE, Dunnick NR, Goodsitt M. Delayed enhanced CT for differentiation of benign from malignant adrenal masses. Radiology 1996, 200: 737–42.PubMedGoogle Scholar
  31. 31.
    Hamrahian AH, Ioachimescu AG, Remer EM, et al. Clinical utility of noncontrast computed tomography attenuation value (hounsfield units) to differentiate adrenal adenomas/hyperplasias from nonadenomas: Cleveland Clinic experience. J Clin Endocrinol Metab 2005, 90: 871–7.PubMedCrossRefGoogle Scholar
  32. 32.
    Guidelines Committee European Society of Hypertension — European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003, 21: 1011–53.CrossRefGoogle Scholar
  33. 33.
    The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1997, 20: 1183–97.Google Scholar
  34. 34.
    Bray GA. An approach to the classification and evaluation of obesity. In: Björntorp P, Brodoff BN eds. Obesity. Philadelphia: Lippincott. 1992, 294–308.Google Scholar
  35. 35.
    Rao P, Kenney PJ, Wagner BJ, Davidson AJ. Imaging and pathologic features of myelolipoma. Radiographics 1997, 17: 1373–85.PubMedCrossRefGoogle Scholar
  36. 36.
    Cyran KM, Kenney PJ, Memel DS, Yacoub I. Adrenal myelolipoma. AJR Am J Roentgenol 1996, 166: 395–400.PubMedCrossRefGoogle Scholar
  37. 37.
    Young WF. Management approaches to adrenal incidentalomas: a view from Rochester, Minnesota. Endocrinol Metab Clin North Am 2000, 29: 159–85.PubMedCrossRefGoogle Scholar
  38. 38.
    Terzolo M, Osella G, Alì A, Angeli A. Adrenal incidentalomas. In: De Herder WW ed. Functional and morphological imaging of the endocrine system. Endocrine Updates. Vol. 7. Boston: Kluwer Academic Publishers. 2000, 191–211.CrossRefGoogle Scholar
  39. 39.
    Lam KY, Lo CY. Metastatic tumors of the adrenal glands: a 30 years experience in a teaching hospital. Clin Endocrinol (Oxf) 2002, 56: 95–101.CrossRefGoogle Scholar
  40. 40.
    Mansmann G, Lau J, Balk E, Rothberg M, Miyachi Y, Bornstein SR. The clinically inapparent adrenal mass: update in diagnosis and management. Endocr Rev 2004, 25: 309–340.PubMedCrossRefGoogle Scholar
  41. 41.
    Belldegrun A, Hussain S, Seltzer SE, Loughlin KR, Gittes RF, Richie JP. Incidentally discovered mass of the adrenal gland. Surg Gynecol Obstet 1986, 163: 203–8.PubMedGoogle Scholar
  42. 42.
    Gillams A, Roberts CM, Shaw P, Spiro SG, Goldstraw P. The value of CT scanning and percutaneous fine needle aspiration of adrenal masses in biopsy-proven lung cancer. Clin Radiol 1992, 46: 18–22.PubMedCrossRefGoogle Scholar
  43. 43.
    Lenert JT, Barnett Jr CC, Kudelka AP, etal. Evaluation and surgical resection of adrenal masses in patients with a history of extra-adrenal malignancy. Surgery 2001, 130: 1060–7.PubMedCrossRefGoogle Scholar
  44. 44.
    Oliver TW Jr. Isolated adrenal masses in non small-cell bron-chogenic carcinoma. Radiology 1984, 153: 217–8.PubMedGoogle Scholar
  45. 45.
    Katz RL. Fine needle aspiration cytology of the adrenal gland. Acta Cytol 1984, 28: 269–82.PubMedGoogle Scholar
  46. 46.
    Aron DC. Adrenal incidentalomas and glucocorticoid autonomy. Clin Endocrinol (Oxf) 1998, 49: 157–8.CrossRefGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2006

Authors and Affiliations

  • S. Bovio
    • 1
  • A. Cataldi
    • 2
  • G. Reimondo
    • 1
  • P. Sperone
    • 3
  • S. Novello
    • 4
  • A. Berruti
    • 3
  • P. Borasio
    • 5
  • C. Fava
    • 2
  • L. Dogliotti
    • 3
  • G. V. Scagliotti
    • 4
  • A. Angeli
    • 1
  • M. Terzolo
    • 1
  1. 1.Department of Biological and Clinical SciencesInternal Medicine IItaly
  2. 2.RadiologyItaly
  3. 3.Medical OncologyItaly
  4. 4.Department Unit of Pulmonary OncologyItaly
  5. 5.Thoracic Surgery, ASO San LuigiUniversity of TurinTurinItaly

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