Incidentally Discovered Adrenal Tumors: A Lesson from Observation of 1444 Patients
Abstract
This study was aimed at summarizing our experience in the management of 1,444 patients with incidentally found adrenal tumors observed at a single endocrinological centre. Hormonal determinations were performed in all patients at the beginning of the observation period to detect subclinical adrenal hyperfunction. The imaging phenotype on CT and MRI was analyzed for defining the malignant potential of the tumors. Based on the results of these examinations we diagnosed among our cohort probably benign masses in 87%, malignant tumors in 10% (adrenal carcinoma - 9%), and metastases in 3%. Subclinical hyperfunction was diagnosed in 8%; the most frequent was the pre-Cushing's syndrome. A subgroup of 480 patients (33%) was submitted to surgery because of oncological or endocrinological indications. The patients not qualified for surgery were carefully controlled by imaging and hormonal examinations. Malignancy is the most serious risk in the group of patients with incidentally discovered adrenal tumors.
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Previous imaging studies have reported that AIs are more common in females; however, this has not been observed in autopsy studies.
“Previous imaging studies have reported that AIs are more common in females (66,71,73); however, this has not been observed in autopsy studies (11,85).”
From Adrenal incidentaloma (2020) · cites this paper as [71]
All studies consistently report a higher incidence of ACC if the adrenal mass is greater than 4 cm in size.
“However, it should be noted that all studies consistently report a higher incidence of ACC if the adrenal mass is greater than 4 cm in size (39,49,63,66,71).”
From Adrenal incidentaloma (2020) · cites this paper as [71]
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Sherlock, M., Scarsbrook, A., Abbas, A., Fraser, S., Limumpornpetch, P., Dineen, R., & Stewart, P. M. (2020) · Endocrine Reviews · doi:10.1210/endrev/bnaa008 · Cited by 347 · see citing works
“Among autopsy and radiology series, the prevalence of AIs increases with age, showing a peak incidence in the fifth to seventh decades (Table 3 (39,40,42,46-84)).”
BackgroundInfluentialPrete, A., Subramanian, A., Bancos, I., Chortis, V., Tsagarakis, S., Lang, K., Macech, M., Delivanis, D. A., Pupovac, I. D., Reimondo, G., et al. (2022) · Annals of Internal Medicine · doi:10.7326/m21-1737 · Cited by 154 · see citing works
Medical and Surgical Evaluation and Treatment of Adrenal Incidentalomas
Zeiger, M. A., Siegelman, S. S., & Hamrahian, A. H. (2011) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-0085 · Cited by 134 · see citing works
“1–11% for pheochromocytomas in patients with adrenal incidentalomas has been reported, but it is probably closer to 3% (2, 7, 75, 76).”
BackgroundManagement of adrenal incidentaloma
Terzolo, M., Bovio, S., Pia, A., Reimondo, G., & Angeli, A. (2009) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2009.04.001 · Cited by 113 · see citing works
Adrenal incidentaloma: a diagnostic challenge
Anagnostis, P. G., Karagiannis, A. I., Τζιόμαλος, Κ., Kakafika, A. I., Athyros, V. G., & Mikhailidis, D. P. (2009) · HORMONES · doi:10.14310/horm.2002.1233 · Cited by 79 · see citing works
“Subclinical hyperfunction was diagnosed in 8% (Table 1).(14)”
BackgroundBednarczuk, T., Bolanowski, M., Sworczak, K., Górnicka, B., Cieszanowski, A., Otto, M., Ambroziak, U., Pachucki, J., Kubicka, E., Babińska, A., et al. (2016) · Endokrynologia Polska · doi:10.5603/ep.a2016.0039 · Cited by 71 · see citing works
Self-citationCohort study of patients with adrenal lesions discovered incidentally
Muth, A., Hammarstedt, L., Hellström, M., Sigurjónsdóttir, H. Á., Almqvist, E. G., & Wängberg, B. (2011) · British journal of surgery · doi:10.1002/bjs.7566 · Cited by 54 · see citing works
Ahn, S. H., Kim, J. H., Baek, S. H., Kim, H., Cho, Y. Y., Suh, S., Kim, B.-J., Hong, S., Koh, J.-M., Lee, S. H., et al. (2018) · Yonsei Medical Journal · doi:10.3349/ymj.2018.59.4.501 · Cited by 43 · see citing works
Clinical Characteristics and Follow-Up Results of Adrenal Incidentaloma
Yılmaz, N., Avşar, E., Tazegül, G., Sarı, R., Altunbaş, H., & Balcı, M. K. (2020) · Experimental and Clinical Endocrinology & Diabetes · doi:10.1055/a-1079-4915 · Cited by 37 · see citing works
Endocrine incidentalomas—challenges imposed by incidentally discovered lesions
Vassiliadi, D. A., & Tsagarakis, S. (2011) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2011.92 · Cited by 37 · see citing works
Maher, D. I., Williams, E., Grodski, S., Serpell, J. W., & Lee, J. C. (2018) · Surgery · doi:10.1016/j.surg.2018.07.011 · Cited by 35 · see citing works
Musella, M., Conzo, G., Milone, M., Corcione, F., Belli, G., Palma, M. D., Tricarico, A., Santini, L., Palazzo, A., Bianco, P., et al. (2013) · BMC Surgery · doi:10.1186/1471-2482-13-57 · Cited by 30 · see citing works
“[7-9,25,26], one instance of incidental cancer in a 2 cm lesion is probably not enough to suggest a shift in surgical indication, especially if we consider the entire series of 282 incidentalomas.”
BackgroundKaštelan, D., Kraljević, I., Dušek, T., Knežević, N., Solak, M., Gardijan, B., Kralik, M., Poljičanin, T., Skoric‐Polovina, T., & Kaštelan, Ž. (2015) · European Journal of Endocrinology · doi:10.1530/eje-15-0199 · Cited by 28 · see citing works
Standards of ultrasound imaging of the adrenal glands
Słapa, R. Z., Jakubowski, W. S., Dobruch‐Sobczak, K., et al. (2015) · Journal of Ultrasonography · doi:10.15557/jou.2015.0035 · Cited by 27 · see citing works
“Najczęstszym źródłem przerzutów do nadnerczy, szerzących się drogą naczyń krwionośnych, jest rak płuca i rak nerki(1,2).”
BackgroundSelf-citationIoachimescu, A. G., Remer, E. M., & Hamrahian, A. H. (2015) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2015.02.005 · Cited by 28 · see citing works
Evaluation of patients with adrenal incidentalomas
Kannan, S., Remer, E. M., & Hamrahian, A. H. (2013) · Current Opinion in Endocrinology Diabetes and Obesity · doi:10.1097/med.0b013e328360a43b · Cited by 23 · see citing works
“1–11% for PHEO in patients with adrenal incidentalomas has been reported, but it is probably close to 3% [1,2,8,59].”
BackgroundPathophysiological Link between Insulin Resistance and Adrenal Incidentalomas
Higgs, J. A., Quinn, A. P., Seely, K. D., Richards, Z., Mortensen, S. P., Crandall, C. S., & Brooks, A. E. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms23084340 · Cited by 23 · see citing works
Kannan, S., Purysko, A. S., Faiman, C., Remer, E. M., Shah, L., Bena, J., SIPERSTEIN, A. E., Berber, E., Fergany, A., Bravo, E. L., et al. (2014) · Clinical Endocrinology · doi:10.1111/cen.12420 · Cited by 23 · see citing works
Qin, H.-Y., Sun, H., Wang, X., Bai, R., Li, Y., & Zhao, J. (2013) · PLoS ONE · doi:10.1371/journal.pone.0079911 · Cited by 21 · see citing works
“[7] reported that of 1,444 incidentally discovered adrenal tumors, 87% were considered benign.”
BackgroundHormonal activity in clinically silent adrenal incidentalomas
Babińska, A., Siekierska-Hellmann, M., Błaut, K., Lewczuk, A., Wiśniewski, P., Gnacińska, M., Obołończyk, Ł., Świątkowska−Stodulska, R., & Sworczak, K. (2012) · Archives of Medical Science · doi:10.5114/aoms.2012.27288 · Cited by 20 · see citing works
“An incidentally discovered adrenal tumour (incidentaloma) is a mass in one or both adrenal glands detected accidentally during an imaging study performed for other reasons [1-3].”
BackgroundWang, T. S., Cheung, K., Roman, S. A., & Sosa, J. A. (2012) · Surgery · doi:10.1016/j.surg.2012.08.011 · Cited by 18 · see citing works
Muth, A., Taft, C., Hammarstedt, L., Björneld, L., Hellström, M., & Wängberg, B. (2012) · Endocrine · doi:10.1007/s12020-012-9856-z · Cited by 19 · see citing works
Partial Adrenalectomy—Why Should it be Considered?
Madala, A., Daugherty, M. R., & Bratslavsky, G. (2015) · Urology Practice · doi:10.1016/j.urpr.2015.03.006 · Cited by 17 · see citing works
Kasperlik-Zaluska, A. A., Slowinska-Srzednicka, J., Rosłonowska, E., et al. (2010) · PubMed · Cited by 17 · see citing works
Self-citationBabińska, A., Pęksa, R., & Sworczak, K. (2015) · World Journal of Surgical Oncology · doi:10.1186/s12957-015-0711-6 · Cited by 15 · see citing works
“Most patients with PAL have bilateral disease on admission, and most of them have adrenal insufficiency subsequent to destruction of more than 90 % of adrenal parenchyma by the disease [5, 12, 13].”
BackgroundContemporary imaging of incidentally discovered adrenal masses
Gross, M. D., KOROBKIN, M. T., Bou-Assaly, W. B., Dwamena, B. A., & Djekidel, M. (2009) · Nature Reviews Urology · doi:10.1038/nrurol.2009.100 · Cited by 15 · see citing works
“However, it is possible that a biochemically inactive (that is, nonhypersecretory) mass could become hyperfunctioning, and there are reports of conversion of nonhypersecretory to hypersecretory masses, which supports the importance of regular biochemical, and perhaps anatomic, follow-up of adrenal adenomas”
BackgroundThe indeterminate adrenal mass
Harrison, B. J. (2011) · Langenbeck s Archives of Surgery · doi:10.1007/s00423-011-0845-0 · Cited by 14 · see citing works
“ACC accounts for 0% [8], <5% [5, 20], 9% [21], and 10% [22] of adrenal incidentalomas with a median value of 1.”
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Makris, K. I., Clark, D. L., Buffie, A. W., Steen, E. H., Ramsey, D. J., & Singh, H. (2022) · Journal of Surgical Research · doi:10.1016/j.jss.2022.02.049 · Cited by 12 · see citing works
Work-up of the Incidental Adrenal Mass
Baltzer, P., Clauser, P., Klatte, T., & Walz, J. C. (2015) · European Urology Focus · doi:10.1016/j.euf.2015.12.003 · Cited by 10 · see citing works
“1% to 11% of AIs, even in normotensive patients [46–48].”
BackgroundSłapa, R. Z., Kasperlik-Zaluska, A. A., Migda, B., et al. (2014) · Endokrynologia Polska · doi:10.5603/ep.2014.0017 · Cited by 9 · see citing works
“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-citationAdrenal glands transabdominal ultrasonography - pictorial essay
Chira, R. I., Chira, A., Manzat-Saplacan, R. M., et al. (2017) · Medical Ultrasonography · doi:10.11152/mu-978 · Cited by 9 · see citing works
Castleman's disease - an unusual indication for laparoscopic adrenalectomy.
Otto, M., Wieprzowski, Ł., Dzwonkowski, J., et al. (2011) · Videosurgery and Other Miniinvasive Techniques · doi:10.5114/wiitm.2011.25620 · Cited by 9 · see citing works
“Adrenal cortical carcinoma, angiosarcoma and oncocytoma are those causes we learn about only after histopathological data are obtained [8-11].”
BackgroundSelf-citationChromogranin A (CgA) in adrenal tumours
Glinicki, P., Jeske, W., Papierska, L., et al. (2013) · Endokrynologia Polska · doi:10.5603/ep.2013.0018 · Cited by 9 · see citing works
“The majority of incidentally found adrenal tumours are clinically silent, however some of them may be malignant or pose other potential threats to life [1–3].”
BackgroundSelf-citationLaparoscopic Adrenalectomy in Elderly Patients
Weinandt, M., Gaujoux, S., Khayat, A., et al. (2017) · Surgical Laparoscopy Endoscopy & Percutaneous Techniques · doi:10.1097/sle.0000000000000465 · Cited by 7 · see citing works
Pheochromocytoma of the adrenal gland selectively secreting dopamine -- a case report.
Belowska-Bień, K., Kucharski, W., Janczak, D., & Urban, J. (2012) · PubMed · Cited by 5 · see citing works
The Spectrum of Adrenal Lesions in a Tertiary Referral Center
Martin, S. C., Andrei, M., Voicu, B., Riță, M. A., Taralunga, A. A., Sîrbu, A. M., Cima, L., Stoian, I., Barbu, C. G., Calu, V., et al. (2024) · Biomedicines · doi:10.3390/biomedicines12102214 · Cited by 4 · see citing works
Słapa, R. Z., Kasperlik-Zaluska, A. A., Migda, B., et al. (2015) · Journal of Ultrasonography · doi:10.15557/jou.2015.0034 · Cited by 4 · see citing works
“Incydentaloma nadnerczy nie mogą być lekceważone i wymagają dalszej diagnostyki, gdyż blisko 25% tych zmian jest leczonych chirurgicznie z przyczyn onkologicznych lub endokrynologicznych(2,3).”
BackgroundSelf-citationSurgical treatment of adrenal tumours.
Otto, M. (2010) · PubMed · Cited by 4 · see citing works
Self-citationThe Etiological Profile of Adrenal Incidentalomas
Lahmamssi, F.-Z., Saadaoui, L., Aynaou, H., Salhi, H., & Ouahabi, H. E. (2022) · Cureus · doi:10.7759/cureus.32564 · Cited by 3 · see citing works
“However, the incidence of adrenocortical carcinoma becomes higher when the size exceeds 4 cm, more frequent in females with an age between 40 and 50 years, such as in our study [9-11].”
BackgroundAkkuş, G., Aksoydan, Ü. P., Odabaş, F., Binokay, H., Sert, M., & Tetıker, T. (2025) · Current Medical Imaging Formerly Current Medical Imaging Reviews · doi:10.2174/0115734056347340241009102228 · Cited by 2 · see citing works
Otto, M., Dzwonkowski, J., Ciąćka, T., et al. (2008) · Polish Journal of Surgery · doi:10.2478/v10035-008-0069-3 · Cited by 2 · see citing works
“We more and more often operate on subclinical Cushing’s syndromes and carcinomas of the adrenal gland at an early stage (15, 16).”
BackgroundInfluentialSelf-citationDiagnostic Approach to Incidentaloma
Willenberg, H. S., & Bornstein, S. R. (2009) · Springer eBooks · doi:10.1007/978-0-387-77236-3_5 · Cited by 1 · see citing works
Qualification and Operative Difficulties of Laparoscopic Adrenalectomy
Otto, M., Dzwonkowski, J., Jędrasik, M., et al. (2010) · Polish Journal of Surgery · doi:10.2478/v10035-010-0007-z · Cited by 1 · see citing works
Self-citationAdrenal and Pituitary Disorders
Belchetz, P. E., & Hammond, P. J. (2010) · Elsevier eBooks · doi:10.1016/b978-1-4160-6231-8.10089-3 · Cited by 1 · see citing works
Adrenal gland schwannoma mimicking breast cancer metastasis. A case report
Balja, M. P., Dzombeta, T. R., Reljić, A., et al. (2011) · Revista Española de Patología · doi:10.1016/j.patol.2011.04.001
Carcinoma adrenal de rápida evolución
Calero, T. M. G., González, A. I. C., Martínez, J. C., & Curi, L. (2013) · DOAJ (DOAJ: Directory of Open Access Journals)
Incidentalomas adrenales. Unas sorpresas inesperadas
Arturo Orrego, M. (2017) · Revista Colombiana de Endocrinología Diabetes & Metabolismo · doi:10.53853/encr.4.1.103
Isolated Synchronous Adrenal Lesions in Patients with Newly Diagnosed Extra-Adrenal Malignancies
Lin, C.-T., Shao, I., Chuang, C., et al. (2018) · International Surgery · doi:10.9738/intsurg-d-18-00019.1
Інсиденталома надниркової залози: що це таке? Частина 1
Rybakov, S. I. (2021) · INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine) · doi:10.22141/2224-0721.17.2.2021.230571
A 15-cm Adrenal Incidentaloma Suggested on Upper Endoscopy and Resected Laparoscopically
Saleh, S., Bazzi, N., Shamma, H., Haj, N. N., & Safadi, M. F. (2022) · Cureus · doi:10.7759/cureus.29979
“The largest adrenal incidentaloma reported in the literature measured 23 cm [11] while the largest documented symptomatic adrenal tumor was as large as 32 cm [10].”
BackgroundTrandafir, A.-I., Stanciu, M., Albu, S. E., Stoian, V. R., CIOFU, I., Persu, C., Nistor, C., & Carşote, M. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12134244
Akhanlı, P., Hepşen, S., Kayhan, S., Doğan, Ö., Düzköprü, Y., & Çakal, E. (2023) · Journal of Health Sciences and Medicine · doi:10.32322/jhsm.1327229
Karahan, M., Okut, G., Mülküt, F., Sağlam, K., & Sümer, F. (2024) · Eastern Journal Of Medicine · doi:10.5505/ejm.2024.54533
Evaluation of Serum Neudesin Levels in Patients With Adrenal Incidentaloma
Özalp, F. R., Çolak, A., Baysoy, A., et al. (2025) · Cureus · doi:10.7759/cureus.85968
Incidentaloma surrenalico: dalla identificazione alla scelta terapeutica
Elisei, R., Bernini, G., Bacca, A., Carrara, D., Bernini, M., & Zampa, V. (2012) · L Endocrinologo · doi:10.1007/bf03344872
“La prevalenza dei FEO negli IS è molto variabile, tra 1,1 e 11%, ma gli Autori tendono a riportare il dato più verosimile al 3% (17).”
BackgroundClinicopathological characteristics of adrenal tumors in older adults: a cohort study
Tang, Y., Peng, M., Cui, R., & Gao, Y. (2026) · Frontiers in Endocrinology · doi:10.3389/fendo.2026.1852735
- Authors
- Kasperlik-Załuska, A., Otto, M., Cichocki, A., Rosłonowska, E., Słowińska-Srzednicka, J., Jeske, W., Papierska, L., & Zgliczyński, W.
- Venue
- Hormone and Metabolic Research
- Publisher
- Georg Thieme Verlag KG
- Published
- 2008-05
- Volume
- 40
- Issue
- 5
- Pages
- 338-341
- ISSN
- 0018-5043 (ISSN-L)
- 1439-4286
- OpenAlex
- W1989982630
- Cited by
- 56
- References
- 0
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 2 · 2022: 5 · 2021: 1 · 2020: 2 · 2018: 3 · 2017: 3 · 2016: 1 · 2015: 7 · 2014: 2 · 2013: 5 · 2012: 5
- FWCI
- 5.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Hormone and Metabolic Research (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Epidemiology › Neuroendocrine Tumor Research Advances
- Keywords
- incidental adrenal tumor, adrenal incidentaloma, adrenocortical carcinoma, adrenal metastasis, CT and MRI imaging features, surgical management, long-term follow-up
- MeSH terms
- Adolescent, Adrenal Gland Neoplasms, Adult, Aged, Aged, 80 and over, Child, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Neoplasms, Retrospective Studies, Tomography, X-Ray Computed
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