Retrospective evaluation of adrenal incidentalomas in a tertiary care institution

Introduction: We retrospectively evaluated all patients with adrenal tumours treated in our Department from 1.1.1999 – 1.10.2013

Patients and methods: 189 patients (110 females: 79 males, mean age of 57,5 y.) were treated because of adrenal tumours. All patients underwent hormonal analysis and testing in order to check for hormonal activity. Tumours were classified according to gender, age at diagnosis, tumour localisation and size, as well as benignity and malignancy when postinterventional histopathological examination was conducted.

Results: 133 patients had non-hormone secreting tumours (non-functional incidentalomas; 70,4%), 18 pheochromocytoma (9,5%), 13 Conn-syndrome (6,9%), 12 adrenal Cushing's disease (6,3%), 1 AGS and 2 sexual hormone-secreting tumours. 10 tumours could not be classified due to unclear test-results (5,3%). Cushing's disease was present in 11 females and 1 male. 164 (87%) tumours were unilateral thereof 96 (50,8%) on the left and 68 (36%) on the right and 25 (13,2%) patients had bilateral tumours. Tumour size < 3 cm occurred in 120 (63,5%), 3 – 6 cm in 54 (28,6%) and > 6 cm in 15 (7,9%) of the cases. 61 (32%) patients were operated, thereof 88,8% of the cases with hormone-active tumours, and 8 (4%) were evaluated with ultrasound-guided biopsy. Malignancy was diagnosed in 10 individuals (5,3%; 3 non-functional tumours, 3 pheochromocytomas, 2 Cushing's patients and 2 sexual-hormone secreting tumours) and benignity was confirmed in 56 (30%) patients. 2 surgical specimens with histopathological diagnosis of pheochromocytoma were suspicious of malignant alterations, 1 biopsy was not diagnostic.

Conclusions: Adrenal incidentaloma prevalence is rising due to widely available imaging devices. The majority is benign, of small size (< 3 cm) and hormonally inactive. Adrenalectomy presents as the therapeutic method of choice in confirmed hormone-secreting tumours.