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Radiological evaluations lead to earlier detection of adrenal incidentalomas
Ng VWS. Arch Intern Med. 2010;170:2017-2020.
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The widespread use of radiological technologies and hormonal evaluations has boosted physicians’ ability to detect adrenal incidentalomas and distinguish functional or primary malignancies from benign masses, thereby providing more treatment options and better outcomes, recent data suggest.
During a retrospective study, researchers reviewed cases of adrenal incidentalomas referred to a hospital in Hong Kong. They collected information using patient histories, physical examination findings and clinical indications for conducting radiological imaging.
Of 139 patients with a mean age of 57.4 years, 56.8% had adrenal lesions identified via CT, 38.8% by ultrasonography and 4.3% through MRI, according to study results. The researchers reported that 47.5% of adrenal incidentalomas were found on the left side and 12.9% were bilateral. They also noted that median incidentaloma size was 2.5 cm.
Nonfunctional benign adrenal adenomas were discovered in 43.9% of patients. Of the 37.4% with functional lesions, 19.4% of lesions secreted excess cortisol and 8.6% had aldosterone-secreting lesions. A further 8.6% had lesions with excess catecholamine secretion and 0.7% had a lesion that secreted cortisol and aldosterone, according to the researchers.
Of the 27 patients with lesions secreting cortisol, only five exhibited symptoms of excess cortisol levels.
Radiological results and histological diagnoses identified malignant adrenal lesions in 15 patients, with six having primary adrenal carcinoma, eight having adrenal metastases and one having adrenal lymphoma. Stage I adrenal cancer was present in two patients, although after surgical resection, they did not experience tumor recurrence during at least 5 years of follow-up.
Data also indicated that no nonfunctional adrenal incidentalomas became functional or malignant after a median of 30.2 months.
“In conclusion, adrenal incidentaloma is a commonly encountered medical problem,” the researchers wrote. “Functional or primary malignant adrenal incidentalomas can be detected at an earlier stage during hormonal and radiological evaluations, which provides an opportunity for further management.”
Disclosures: The researchers reported no relevant financial disclosures.
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