Differences between bilateral adrenal incidentalomas and unilateral lesions
Open accessAbstract
IMPORTANCE: Adrenal incidentalomas are found in 1% to 5% of abdominal cross-sectional imaging studies. Although the workup and management of unilateral lesions are well established, limited information exists for bilateral incidentalomas. OBJECTIVE: To compare the natural history of patients having bilateral incidentalomas with those having unilateral incidentalomas. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of a prospective database of consecutive patients referred to an academic multidisciplinary adrenal conference. The setting was a tertiary care university hospital among a cohort of 500 patients with adrenal lesions between July 1, 2009, and July 1, 2014. MAIN OUTCOMES AND MEASURES: Prevalence, age, imaging characteristics, biochemical workup, any intervention, and final diagnosis. RESULTS: Twenty-three patients with bilateral incidentalomas and 112 patients with unilateral incidentalomas were identified. The mean age at diagnosis of bilateral lesions was 58.7 years. The mean lesion size was 2.4 cm on the right side and 2.8 cm on the left side. Bilateral incidentalomas were associated with a significantly higher prevalence of subclinical Cushing syndrome (21.7% [5 of 23] vs 6.2% [7 of 112]) (P = .009) and a significantly lower prevalence of pheochromocytoma (4.3% [1 of 23] vs 19.6% [22 of 112]) (P = .003) compared with unilateral lesions, while rates of hyperaldosteronism were similar in both groups (4.3% [1 of 23] vs 5.4% [6 of 112]) (P > .99). Only one patient with bilateral incidentalomas underwent unilateral resection. The mean follow-up was 4 years (range, 1.2-13.0 years). There were no occult adrenocortical carcinomas. CONCLUSIONS AND RELEVANCE: Bilateral incidentalomas are more likely to be associated with subclinical Cushing syndrome and less likely to be pheochromocytomas. Although patients with bilateral incidentalomas undergo a workup similar to that in patients with unilateral lesions, differences in their natural history warrant a greater index of suspicion for subclinical Cushing syndrome.
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In a surgical series of 112 unilateral AI and 23 bilateral AI, mild cortisol excess was present in 21.7% bilateral vs 6.2% unilateral.
“a more recent surgical series including 112 unilateral AI and 23 bilateral AI, where mild cortisol excess was present in 21.7% bilateral AI versus 6.2% of unilateral AI (321).”
From Adrenal incidentaloma (2020) · cites this paper as [321]
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References 26 · Cited by 50
Research works printed but not linked: 2
- Vassilatou E, Vryonidou A, Ioannidis D, Paschou SA, Panagou M, Tzavara I. Bilateral adrenal incidentalomas differ from unilateral adrenal incidentalomas in subclinical cortisol hypersecretion but not in potential clinical implications. Eur J Endocrinol. 2014;171(1):37-45.
- Iacobone M, Citton M, Scarpa M, Viel G, Boscaro M, Nitti D. Systematic review of surgical treatment of subclinical Cushing's syndrome. Br J Surg. 2015; 102(4):318-330.
- Authors
- Pasternak, J. D., Seib, C. D., Seiser, N., Tyrell, J. B., Liu, C., Cisco, R. M., Gosnell, J. E., Shen, W. T., Suh, I., & Duh, Q.-Y.
- Affiliations
- University of California, San Francisco (US)
- Division of Endocrinology, Department of Medicine, University of California, San Francisco
- Good Samaritan Hospital (US)
- Corresponding author
- Duh, Quan-Yang
- ORCID
- Venue
- JAMA Surgery
- Publisher
- American Medical Association (AMA)
- Published
- 2015-10-01
- Volume
- 150
- Issue
- 10
- Pages
- 974
- ISSN
- 2168-6254 (ISSN-L)
- OpenAlex
- W1573372138
- Cited by
- 50
- References
- 26
- Citations by year
- 2026: 7 · 2025: 4 · 2024: 4 · 2023: 5 · 2022: 4 · 2021: 6 · 2020: 4 · 2019: 5 · 2018: 5 · 2017: 5
- FWCI
- 3.34
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Surgery (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Keywords
- subclinical Cushing's syndrome, pheochromocytoma, hyperaldosteronism, adrenocortical carcinoma, adrenalectomy
- MeSH terms
- Adrenal Gland Neoplasms, Cushing Syndrome, Female, Humans, Male, Middle Aged, Pheochromocytoma, Retrospective Studies, Incidental Findings
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