Presentation and outcome of patients with an adrenal mass: A retrospective observational study

Abstract

Background: Adrenal masses are uncommon, often present with a wide spectrum of manifestations, ranging from silent, benign incidentaloma to functional and rarely highly malignant neoplasm. The study aimed to evaluate the characteristics and outcomes of patients with an adrenal mass. Materials and Methods: This was a single-center, retrospective, observational study on 42 patients diagnosed with an adrenal mass, between August 2010 and August 2019 at our institute. They were studied for clinical, laboratory, radiological, and surgical outcome. All the patients were subjected to computed tomography adrenal protocol and hormonal evaluation (overnight 1 mg dexamethasone suppression test [ONDST] and urinary metanephrine/normetanephrine in all; plasma aldosterone/renin activity ratio [ARR] in patients with hypertension/hypokalemia). Results: The mean age of the study sample was 45.2 ± 12.4 years, with female (69%) predominance. Symptomatic adrenal mass (52.4%) was the most common presentation. Abdominal pain (61.9%) and hypertension (54.8%) were the most common presenting symptoms. Obesity and dyslipidemia were present in half of the patients and hyperglycemia in 23.8%. The majority of tumors were benign (90.5%). Most of the adrenals lesions were nonfunctional (47.6%), followed by pheochromocytoma (26.2%), primary hyperaldosteronism (7.1%), and adrenal Cushing's syndrome (7.1%). Most of the lesions were large, i.e., >4 cm (42.8%). The surgical cure was achieved in 74.1% of patients, with good outcome in nonfunctional adrenal adenoma and myelolipoma. Age ≤40 years was associated with functional adrenal mass. Conclusions: A higher proportion of patients have functional tumors, with pheochromocytomas comprising 26.3%. Majority of patients achieved surgical cure. Age ≤40 years predicted functionality of adrenal mass.