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Clinical analysis of the etiological spectrum of bilateral adrenal lesions: A large retrospective, single-center study

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Abstract

Purpose

To investigate the clinical characteristics, endocrinological function, and etiology of bilateral adrenal lesions in hospitalized patients.

Methods

A retrospective study of 777 patients with bilateral adrenal lesions was conducted at the Chinese People’s Liberation Army General Hospital between January 2013 and January 2018. Patients’ demographic features, hormonal profiles, imaging findings, and histopathological findings were reviewed from database records.

Results

Of the 777 patients with bilateral adrenal lesions, 495 were men. The mean age at diagnosis was 52.0 ± 13.0 years. Overall, 511 (65.8%) cases were benign, followed by adrenal metastases (n = 224, 28.8%), pheochromocytoma (n = 26, 3.3%), adrenal lymphoma (n = 9, 1.2%), and adrenal corticocarcinoma (ACC; n = 7, 0.9%). Hormonal evaluation revealed that 34.3% of bilateral adrenal lesions were functional. The primary etiologies of functional lesions were primary aldosteronism (16.6%, 129/777), and primary bilateral macronodular adrenocortical hyperplasia (PBMAH; 8.8%, 68/777). Patients with lymphoma and metastases were significantly older than those with benign nonfunctional lesions (60.4 ± 11.0 years vs. 54.5 ± 10.4 years and 57.9 ± 10.8 years vs. 54.5 ± 10.4 years, respectively; both P < 0.001). Lesions in patients with adrenal lymphoma, ACC, pheochromocytoma, metastases, congenital adrenal hyperplasia, tuberculosis, and Cushing’s syndrome were significantly larger than benign nonfunctional lesions (all P < 0.001).

Conclusion

Benign adrenal lesions and metastases from the lungs are the most common causes of bilateral adrenal lesions. Primary aldosteronism and PBMAH are the most prevalent functional lesions. Moreover, patients with lymphoma or metastases are older and their masses are larger.

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Acknowledgements

We would like to thank all the patient, doctors, nurses, and technicians involved at two centers for their dedication to the study.

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Author notes

  1. These authors contributed equally: Jinyang Zeng, Fangfang Yan

Authors and Affiliations

  1. Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China

    Fangfang Yan & Jinyang Zeng

  2. Department of Endocrinology, Chinese People’s Liberation Army General Hospital, Beijing, China

    Fangfang Yan, Jinyang Zeng, Yulong Chen, Yu Cheng, Yu Pei, Li Zang, Kang Chen, Weijun Gu, Jin Du, Qinghua Guo, Xianling Wang, Jianming Ba, Zhaohui Lyu, Jingtao Dou & Yiming Mu

  3. Department of Endocrinology, Hainan Branch of Chinese People’s Liberation Army General Hospital, Sanya, Hainan, China

    Guoqing Yang

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Contributions

F.Y. and J.Z.: collected data and wrote the manuscript draft. Y.C., Y.C., Y.P., L.Z., K.C., W.G., J.D., Q.G., X.W., J.B., Z.L., J.D.: contributed to discussion and revision. G.Y. and Y.M.: designed the study and revised the submission. All authors contributed to the discussion and approved the final manuscript for the version to be submitted.

Corresponding authors

Correspondence to Guoqing Yang or Yiming Mu.

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The authors declare no competing interests.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and was approved by the Ethics Committee (No. 2019-229).

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Yan, F., Zeng, J., Chen, Y. et al. Clinical analysis of the etiological spectrum of bilateral adrenal lesions: A large retrospective, single-center study. Endocrine 77, 372–379 (2022). https://doi.org/10.1007/s12020-022-03077-w

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