Abstract
BackgroundThe prevailing view that advocates long-term hormonal follow-up of adrenal incidentalomas is currently under debate. The purpose of the present study was to examine all adrenal incidentalomas presented during five years to a single centre. We hypothesized that 24-month biochemical follow-up in patients with an initial normal screening would fail to increase the sensitivity in finding hormone producing tumours.MethodsThe present study is a retrospective register based cohort study of 194 patients referred to the Department of Endocrinology at Södersjukhuset between the years 2006–2010. Computerized medical records were used to find and extract information on patients with newly discovered adrenal incidentalomas. The sensitivity, specificity, positive predictive value and negative predictive value were calculated to evaluate the validity of an initial normal screening when used to identify individuals with hormone producing tumours.ResultsOf the incidentalomas 94% consisted of benign, non-functioning tumours. Three patients were diagnosed with cortisol hypersecretion and one with pheochromocytoma. The sensitivity, specificity, positive predictive value and negative predictive value of an initial complete negative screening to predict a hormone producing tumour were 100%, 63%, 12% and 100%, respectively.ConclusionPatients with an initially normal hormonal screening may not need further biochemical follow-up.
Highlights
The prevailing view that advocates long-term hormonal follow-up of adrenal incidentalomas is currently under debate
The present study examined all adrenal incidentalomas presented to a single centre between 2006 and 2010
Individuals who presented with a first time diagnosis of adrenal incidentaloma were considered eligible for inclusion in the study (n = 255)
Summary
The prevailing view that advocates long-term hormonal follow-up of adrenal incidentalomas is currently under debate. We hypothesized that 24-month biochemical follow-up in patients with an initial normal screening would fail to increase the sensitivity in finding hormone producing tumours. An adrenal incidentaloma is a tumour in the adrenal gland accidentally discovered when a patient undergoes radiological investigation for other reasons than suspected adrenal disease [1]. The mean prevalence is 2.3% and increases with age to 6.9% in patients above 70 years [2]. The prevalent occurrence together with the increased use of radiological investigation has resulted in the frequent incidental discovery of asymptomatic adrenal masses. Even though the majority of incidentalomas are benign and non-hyperfunctioning, careful radiological and hormonal investigations are needed in order to identify malignant and hormone producing tumours [3].
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