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Incidentalomas of the adrenal gland: 36 Operated patients and review of literature

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Abstract

Incidental discovery of an adrenal mass during radiologic-examinations is common. Several recommendations have been made for the management of so-called incidentalomas. It has become clear that not all incidentalomas should be operated, but the criteria for nonoperative treatment have been under continuous debate. In this study 36 operated incidentalomas are presented, and the indications for operative treatment are discussed with a review of the recent literature on the subject. Four pheochromocytomas and three hormonally active cortical adenomas, two producing cortisol and one androgens, were found. In this series there were no malignancies. The operation could have been avoided in most cases, and patients could have been followed up with repeated radiologic-examinations. It is suggested that masses smaller than 6 cm in diameter be followed radiologically after 3, 9, and 18 months. Masses between 3 and 6 cm could be further examined using magnetic resonance imaging and fine needle aspiration and then operated if features suggestive of malignancy are found. Masses larger than 6 cm in diameter should be treated operatively.

Résumé

La découverte fortuite d'une masse de la surrénale par un examen radiologique est fréquente. Ces dernières années, on a essayé d'affiner les indications thérapeutiques. Il est clair qu'il ne faut pas opérer toutes les masses de la surrénale, mais il n'existe pas encore de consensus permettant de décider de ne pas le faire. Dans cette étude, on analyse 36 cas de telles tumeurs, opérées, et les indications ont été comparées aux données de la littérature. Parmi ces tumeurs, il y avait quatre phéochromocytomes, trois adénomes sécrétant de la corticosurrénale, un produisant des androgènes, et deux du cortisol. Il n'y avait aucune tumeur maligne dans cette série. L'opération aurait pu être évitée dans bon nombre de cas, la surveillance étant assurée par la simple radiologie. On suggère que les masses dont le diamètre est inférieur à six centimètres soient suivies radiologiquement 3, 9 et 18 mois après leur découverte. Celles sont le diamètre est entre 3 et 6 cm pourraient être l'objet d'un examen par IRM et une biopsie percutanée si l'on soupçonne une tumeur maligne. Par contre, les masses dont le diamètre dépasse 6 cm devraient être opérées.

Resumen

El descubrimiento incidental de una masa suprarrenal en exámenes radiológicos es común, por lo cual en los últimos años se han planteado recomendaciones para el manejo de tales incidentalomas. Ya es claro que no todos los incidentalomas deben ser operados, pero el criterio para el manejo no operatorio es motivo de continuado debate. En el presente estudio se presentan 36 incidentalomas operados, se discute el tratamiento operatorio y se hace una revisión de la literatura reciente. El grupo incluye cuatro feocromocitomas y tres adenomas corticales hormonalmente activos, dos productores de cortisol y uno de andrógenos; no se hallaron tumores malignos. La operación pudo haberse evitado en la mayoría de los casos y los pacientes hubieran podido ser seguidos con exámenes radiológicos repetidos. Se sugiere que las masas menores de seis centimetres de diámetro sean seguidas radiológicamente a los tres, nueve y 18 meses. Las masas de tamano entre tres y seis centímetros pueden ser valoradas además con resonancia magnética y aspiration con aguja y operadas si se encuentran características sugestivas de malignidad. Masas mayores de seis centímetros de diámetro deben ser operados de inmediato.

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Authors and Affiliations

  1. Second Department of Surgery, Helsinki University Central Hospital, Haartmaninkatu 4, SF-00290, Helsinki, Finland

    Jukka E. Sirén M.D., Reijo K. Haapiainen M.D., Kauko T. Huikuri M.D. & Arto H. Sivula M.D.

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  1. Jukka E. Sirén M.D.
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Sirén, J.E., Haapiainen, R.K., Huikuri, K.T. et al. Incidentalomas of the adrenal gland: 36 Operated patients and review of literature. World J. Surg. 17, 634–639 (1993). https://doi.org/10.1007/BF01659129

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