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Incidentally discovered adrenal mass (incidentaloma): investigation and management of 208 patients
Abstract
OBJECTIVE: Incidentally discovered adrenal masses are fairly common, although there are some controversies concerning the results of hormonal investigation (especially DHEAS values) and the methods of management. We summarize our experience in diagnosis, pathological findings and treatment of a large group of patients with incidentally found adrenal tumours. DESIGN AND PATIENTS: Our study included patients referred to the Department of Endocrinology of the Centre of Post-graduate Medical Education (Warsaw, Poland) during the last 10 years because of an adrenal tumour incidentally found on ultrasound scan. In all cases this was confirmed by computed tomography. There were 208 patients (148 female and 60 male), 14-76 years old. Unilateral adrenal masses were found in 172 patients (right 106, left 66), while bilateral masses were demonstrated in 36 patients. The size of the tumours ranged between 0.8 and 21.0 cm. The most common clinical abnormalities were hypertension (36 cases), obesity (23 cases), diabetes (8 cases), Addison's disease (6 cases). MEASUREMENTS: Endocrine tests evaluating pituitary-adrenal function (urinary excretion of 17-hydroxycorticosteroids, 17-ketosteroids and catecholamines, plasma concentrations of ACTH, cortisol, DHEAS, androstendione and testosterone, dexamethasone suppression test and corticotrophin-releasing hormone stimulation test). RESULTS: Cortisol hypersecretion was noted in two patients with coexisting Cushing's disease and high normal 17-OHCS values with lack of dexamethasone suppressibility were found in six other patients with pre-clinical Cushing's syndrome. More common were subtle hormonal abnormalities: low ACTH levels (in 33 out of 98 investigated patients), diminished dexamethasone suppressibility and lack of ACTH response in the CRH test (in two out of 12 patients). Urinary catecholamine excretion was elevated in nine patients. In the group of 85 patients treated by surgery the most frequent pathological findings were: adrenocortical adenoma (21), carcinoma (17), phaeochromocytoma (13), metastatic masses (12) and myelolipoma (10). The size of carcinomas ranged from 3.2 to 20.0 cm, while the size of non-malignant tumours ranged from 1.5 to 21.0 cm. CONCLUSIONS: Every patient with an incidentally discovered adrenal mass has to be investigated to detect malignancy and subtle hormonal overproduction, to select the cases for surgical treatment. Most of the adrenocortical carcinomas were > 7.0 cm in diameter. For prophylactic purposes, adrenal incidentalomas > 4.0 cm should be treated by surgery, while the smaller ones could be followed-up (with special care for those between 3.0 and 4.0 cm).
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“Similarly, LDDST has been used to diagnose SH (18,40,41,55) without advantages, with the exception of patients affected with alcoholism, psychiatric disorders, and diabetes in whom this test may be more accurate (1,14,66).”
From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [40]
In the citing paper
“Low serum ACTH levels are frequently found in AI patients (19,21,32,36,40,43,44,48,49,56,60,61).”
From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [40]
In the citing paper
“some authors have proposed higher (3 or 8 mg) dexamethasone doses (40,46,54,56), which however did not show a better performance (14,23,66).”
From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [40]
In the citing paper
“To simplify the diagnostic workout, other authors used the concomitant presence of at least two altered parameters of HPA axis activity for SH diagnosis (9, 18, 19, 21, 32, 37, 39, 40, 42, 47, 49, 52-54, 56, 60, 61).”
From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [40]
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BackgroundCongenital Adrenal Hyperplasia
Mallappa, A., & Merke, D. P. (2017) · Management of Adrenal Masses in Children and Adults · doi:10.1007/978-3-319-44136-8_11 · Cited by 8
Słapa, R. Z., Kasperlik-Zaluska, A. A., Migda, B., et al. (2014) · Endokrynologia Polska · doi:10.5603/ep.2014.0017 · Cited by 9
“For 20 years, we have observed a significantly increased number of such tumours [14–18], as a result of wider access to diagnostic imaging modalities, and have tried to differentiate benign masses from malignant ones.”
BackgroundSelf-citationSubclinical Cushing's syndrome in adrenal incidentalomas--possible metabolic consequences.
Bohdanowicz-Pawlak, A., Szymczak, J., Waszczuk, E., Bolanowski, M., & Bednarek-Tupikowska, G. (2013) · PubMed · Cited by 9
Solitary Adrenal Metastasis in a Patient with Sigmoid Colon Cancer; Report of a Case
Shoji, Y., Dohke, M., Masuda, T., Nakamura, F., Yano, T., NIIZEKI, H., Kashimura, N., & MATSUNAMI, O. (2007) · International Journal of Gastrointestinal Cancer · doi:10.1007/s12029-007-9001-z · Cited by 9
Kapetanakis, S., Drygiannakis, I., Tzortzinis, A., et al. (2011) · Journal of Medical Case Reports · doi:10.1186/1752-1947-5-136 · Cited by 9
“The presence of lipoblasts is the histological hallmark of liposarcoma [2, 4 ].”
BackgroundInfluentialPrimary Adrenal Lymphoma Presenting with Adrenal Failure: A Case Report and Review of the Literature
Karimi, F. (2017) · Intern J Endocrinol Metab · doi:10.5812/ijem.12014 · Cited by 9
“For example, in one reported series of 208 adrenal incidentalomas, 53% of the cases with proved adrenal metastases had bilateral disease (9).”
BackgroundSoon, P. S. H., & Sidhu, S. B. (2009) · Cancer treatment and research · doi:10.1007/978-1-4419-0857-5_11 · Cited by 9
Minowada, S., Enomoto, Y., Korenaga, T., et al. (2000) · Endocrine Journal · doi:10.1507/endocrj.47.185 · Cited by 9
Genetic and Molecular Biomarkers in Aggressive Pheochromocytomas and Paragangliomas
Torresan, F., Iacobone, C., Giorgino, F., & Iacobone, M. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms25137142 · Cited by 9
“PPGLs are extremely rare tumors, with an incidence of about 2–8 cases per million people per year; they are found in about 4% as incidentalomas [3], but autopsy series have revealed a much higher prevalence [4].”
BackgroundIncidentalomas suprarrenales: experiencia clínica en los hospitales de Castilla-La Mancha
Lamas, C., Palma, M., Martín, D., de Frutos, V. Á., López, M., & Marco, A. (2009) · Endocrinología y Nutrición · doi:10.1016/s1575-0922(09)72708-1 · Cited by 8
Pereira, M. A. A., Ferraz‐de‐Souza, B., Freire, D. S., & Lucón, A. M. (2004) · Arquivos Brasileiros de Endocrinologia & Metabologia · doi:10.1590/s0004-27302004000500022 · Cited by 8
Indications and Results of Surgery for Incidentally Found Adrenal Tumors
Meyer, A. A., & Behrend, M. (2006) · Urologia Internationalis · doi:10.1159/000093915 · Cited by 8
Treatment of adrenocortical carcinoma: Contemporary outcomes
Chen, D. Y. T., Sosa, R. E., & Scherr, D. S. (2004) · Current Urology Reports · doi:10.1007/s11934-004-0014-x · Cited by 8
“Other smaller series also have found a similar frequency of incidental adrenocortical carcinoma, ranging from 2% to 9% [ 16 ,17].”
BackgroundWilson, M. P., Randhawa, S., Bao, B., Croutze, R., Murad, M. H., McInnes, M. D. F., & Low, G. (2023) · Journal of the American College of Radiology · doi:10.1016/j.jacr.2023.04.027 · Cited by 7
Hamidi, O., Miljanic, M., Tumyan, G., Christie, A. L., Mirfakhraee, S., Ali, S., Dohopolski, M. J., Gottumukkala, S., Brugarolas, J., Timmerman, R. D., et al. (2024) · Cancers · doi:10.3390/cancers16183140 · Cited by 7
Multiple endocrinological failures as a clinical presentation of a metastatic lung adenocarcinoma
Ach, T., Wojewoda, P., Toullet, F., et al. (2020) · Endocrinology Diabetes and Metabolism Case Reports · doi:10.1530/edm-20-0024 · Cited by 6
Insulin sensitivity in patients with adrenal incidentaloma
Ivović, M., Vujović, S., Penezić, Z., Žarković, M., & Drezgić, M. (2006) · Srpski arhiv za celokupno lekarstvo · doi:10.2298/sarh0608315i · Cited by 6
Metadata
- Authors
- Kasperlik‐Załuska, A. A., Rosłonowska, E., Słowińska‐Srzednicka, J., Migdalska, B., Jeske, W., Makowska, A., & Snochowska, H.
- ORCID
- Makowska, A.
- Venue
- Clinical Endocrinology
- Publisher
- Wiley
- Published
- 1997-01
- Volume
- 46
- Issue
- 1
- Pages
- 29-37
- ISSN
- 0300-0664 (ISSN-L)
- 1365-2265
- OpenAlex
- W1995742999
- Cited by
- 155
- References
- 0
- Citations by year
- 2025: 1 · 2024: 5 · 2023: 4 · 2022: 1 · 2021: 1 · 2020: 4 · 2018: 1 · 2017: 1 · 2016: 6 · 2015: 4 · 2014: 9 · 2013: 4 · 2012: 7
- FWCI
- 11.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Keywords
- adrenal incidentaloma, adrenal tumors, dehydroepiandrosterone sulfate, cortisol hypersecretion, Cushing's syndrome, adrenal adenoma, adrenocortical carcinoma, pheochromocytoma, myelolipoma, adrenal metastasis, adrenalectomy, adrenal insufficiency, ACTH, dexamethasone suppression test
- MeSH terms
- Adenoma, Adolescent, Adrenal Gland Neoplasms, Adrenocorticotropic Hormone, Adult, Aged, Carcinoma, Female, Humans, Hydrocortisone, Male, Middle Aged, Pheochromocytoma, Ultrasonography, 17-Hydroxycorticosteroids, Patient Selection, Dehydroepiandrosterone Sulfate
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