Abstract
BackgroundAdrenal incidentalomas are adrenal masses that are discovered by imaging tests performed for other reasons.AimsIn this retrospective study, we analysed 229 Turkish patients with adrenal masses and who presented with or without complaints.Study designDescriptive retrospective study and review of the literatureMethodsThis study conducted a retrospective review of 229 patients with adrenal incidentalomas that were referred to Cukurova University Hospital's endocrinological department between 2009 and 2014. We reviewed detailed patient histories, physical examination findings, and symptoms and signs related to hormonal hypersecretion or malignant neoplasm and recorded clinical indications for performing diagnostic radiological imaging. The statistical analysis of data was performed using SPSS‐19 software.ResultsOf the 229 patients reviewed, 195 (85.2%) had non‐functional, benign adrenal adenomas, and 34 (14.8%) had functional lesions. Among those with functional lesions, 8 (3.5%) had lesions that secreted excess cortisol, 11 (4.8%) had lesions that secreted aldosterone, and 15 (6.6%) had lesions that secreted catecholamines. Eighty‐four patients included in the study (36.8%) underwent adrenalectomy; in 14 of these cases, the adrenalectomy was performed before surgical treatment criteria occurred. The most frequent pathologic diagnosis was adrenal cortical neoplasia (n = 38); 32 of these patients had adenomas (Weiss <4 criteria), and 6 had carcinomas (Weiss >4 criteria). Other patient diagnoses included benign pheochromocytoma (n = 13), pseudocyst (n = 12), metastasis (n = 10), haemorrhage (n = 3), necrosis (n = 1), hyperplasia (n = 2), and other (n = 5).ConclusionsDetailed endocrinological and radiological assessments of the mass nature and hormone status are necessary in cases of adrenal incidentaloma. Appropriate surgical treatment or periodic follow‐up must be determined based on the assessment results.
Highlights
The management of adrenal diseases has recently undergone major development as a result of rapid advances in laboratory and, in particular, imaging techniques
Eighty‐four patients included in the study (36.8%) underwent adrenalectomy; in 14 of these cases, the adrenalectomy was performed before surgical treatment criteria occurred
Detailed endocrinological and radiological assessments of the mass nature and hormone status are necessary in cases of adrenal incidentaloma
Summary
The management of adrenal diseases has recently undergone major development as a result of rapid advances in laboratory and, in particular, imaging techniques. If adrenal disease is suspected based on clinical findings, the diagnostic algorithm initially involves hormone tests to detect adrenal hyperfunction. These are followed by imaging studies addressing the morphological presentation of adrenal pathology, including evaluation of adjacent structures. Guidelines for the evaluation of adrenal incidentaloma have recently been published by the European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumours.[4] The first stage that must be assessed after diagnosing adrenal incidentaloma is an examination of the mass in terms of hormonal status and malignancy.[5]. Adrenal incidentalomas are adrenal masses that are discovered by imaging tests performed for other reasons
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