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Tumour size in adrenal tumours: its importance in the indication of adrenalectomy and in surgical outcomes—a single-centre experience

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Abstract

Objective

To evaluate the relevance of tumour size in adrenal tumours in the estimation of malignancy risk and in the outcomes of adrenalectomy.

Methods

We evaluate the histological results and surgical outcomes (intraoperative and postsurgical complications) in a retrospective single-centre cohort of patients without history of active extraadrenal malignancy with adrenal tumours consecutively operated in our centre during January 2010 and December 2020. We compared these results in lesions smaller and larger than 40, 50, and 60 mm.

Results

Of 131 patients with adrenal tumours who underwent adrenalectomy, 76 (58.0%) had adrenal masses measuring ≥ 40 mm; 47 were > 50 mm and 28 > 60 mm. The final diagnosis was adrenocortical carcinoma (ACC) in 7 patients, pheochromocytoma in 35, and benign lesions in the remaining. All patients with ACC had adrenal masses > 50 mm, with Hounsfield units > 40 and low lipidic content in the CT. The risk of ACC and pheochromocytoma increased as tumour size did. The diagnostic accuracy of tumour size was quite good for the prediction of ACC (AUC-ROC 0.883). Nevertheless, when only adrenal tumours with HU < 40 were considered, the risk of ACC was 0% independent of tumour size. For pheochromocytomas, the risk was of 8.6% independent of tumour size for lesions with < 20HU. The risk of intraoperative and postoperative complications was independent of tumour size.

Conclusion

Risk of malignancy and of pheochromocytoma increased as tumour size increased, but, in the presurgical estimation of malignancy risk and of pheochromocytoma, not only tumour size, also lipidic content and other radiological features, should be considered. The risk of complications was independent of tumour size, but hospital stay was longer in patients with complication or open approach.

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Funding

SENDIMAD: BECA SENDIMAD de Ayuda a la Investigación en Endocrinología, Nutrición y Diabetes 2019. IRYCIS: Convocatoria intramural de ayudas a proyectos de investigación de investigadores noveles, investigadores clínicos asociados y/o grupos emergentes del Hospital Universitario Ramón y Cajal 2019.

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Authors and Affiliations

  1. Urology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain

    C. Mínguez Ojeda, V. Gómez Dos Santos, J. Álvaro Lorca & F. J. Burgos Revilla

  2. Pathology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain

    I. Ruz-Caracuel & H. Pian

  3. General Surgery Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain

    A. Sanjuanbenito Dehesa

  4. Endocrinology and Nutrition Department, Hospital Universitario Ramón y Cajal, IRYCIS, Colmenar Viejo Street, km. 9, 100, 28034, Madrid, Spain

    M. Araujo-Castro

Authors
  1. C. Mínguez Ojeda
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  4. I. Ruz-Caracuel
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  7. F. J. Burgos Revilla
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  8. M. Araujo-Castro
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Correspondence to M. Araujo-Castro.

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The authors have no conflict of interest.

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All procedures performed in the participants of the study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Patient consent was waived due to the retrospective nature of the study. Only for patients who continued follow-up or prospectively included the informed consent was requested.

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Mínguez Ojeda, C., Gómez Dos Santos, V., Álvaro Lorca, J. et al. Tumour size in adrenal tumours: its importance in the indication of adrenalectomy and in surgical outcomes—a single-centre experience. J Endocrinol Invest 45, 1999–2006 (2022). https://doi.org/10.1007/s40618-022-01836-0

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