Evaluation of Functionality and Growth Rates in Adrenal Incidentalomas: Single Center Experience

Year 2020, Volume: 2 Issue: 3, 125 - 132, 01.11.2020

Suna Avcı Yüksel Aslı Ozturkmen Sayid Zuhur Gulkan Ozkan Elif Guven Nazan Demir Yuksel Altuntas

https://doi.org/10.38175/phnx.768414

Abstract

Objectives: In this study, we aimed to transfer observational data on incidentaloma cases, which we encountered in our center, in terms of their radiological, histopathologic features and hormonal activities, retrospectively review the growth rates during follow-up.
Material and Method: In this retrospective study 137 incidentaloma cases that met the inclusion criteria were analyzed. The medical records of all cases were analyzed statistically by recording age, sex information, hormonal examinations and imaging results, functional status of masses, histopathological findings, and information on adrenal mass diameter change during follow-up.
Results: In this study, 97 (71%) patients were female and 40 (29%) were male. 99 patients (72.3%) were diagnosed with nonfunctional adenomas (NFA), 21 patients (15%) with subclinical Cushing syndrome (SCS), 9 patients (6%) with pheochromocytoma, 6 patients (4%) with hyperaldosteronism, and 2 patients (1%) with congenital adrenal hyperplasia (CAH). Patients with functional masses were significantly younger than patients with NFA (p: 0.04). Malignancy was identified in 6 patients (4%). The mean follow-up period of the patients was 20.2 ± 19.86 months. Growth in mass size was detected in 24 patients (17%). In 6 of the masses (26% of the growing masses, 4% of all the masses), growth of over 1 cm was observed. The growth rate of the masses in male patients was significantly higher than the growth rate in female patients (p: 0.031).
Conclusion: The incidence of mass growth and malignancy was higher in older age and male sex. Patient’s age and sex should be bear in mind for their duration and frequency of follow-up in terms of functionality and malignant conversion.

Keywords

Adrenal, Incidentaloma,, Subclinical Cushing, Pheochromocytoma, Hyperaldosteronism, Adrenocortical Cancer

Supporting Institution

----

Project Number

Ethics Committee of Şişli Etfal Training and Research Hospital (25.09.2012 number 94).

Thanks

----

Adrenal İnsidentalomalarda Fonksiyonellik ve Büyüme Oranlarının Değerlendirilmesi: Tek Merkez Deneyimi

Abstract

Amaç: Bu çalışmada merkezimizde karşılaştığımız insidentaloma vakalarının radyolojik, histopatolojik özellikleri ve hormonal aktiviteleri yönünden gözlemsel verilerini aktarmayı, takipleri esnasında büyüme oranlarını retrospektif olarak incelemeyi amaçladık.
Gereç ve Yöntem: Dahil edilme kriterlerine uyan 137 insidentaloma vakaları retrospektif olarak incelendi. Tüm olguların medikal kayıtlarından yaş, cinsiyet bilgileri, hormonal tetkik ve görüntüleme sonuçları, kitlelerin fonksiyonellik durumları, histopatolojik bulguları ve takipleri boyunca adrenal kitle çapındaki değişim bilgileri kaydedilerek istatistiksel yöntemlerle analiz edildi.
Bulgular: Hastaların 97’si (%71) kadın, 40’ı (%29) erkek idi. 99 (%72.3) hastaya nonfonksiyonel adenom (NFA), 21 (%15) hastaya subklinik Cushing sendromu (SCS), 9 (%6) hastaya feokromasitoma, 6 (%4) hastaya hiperaldosteronizm, 2 (%1) hastaya konjenital adrenal hiperplazi (KAH) tanısı koyuldu. Fonksiyonel kitleye sahip olan hastalar anlamlı olarak daha genç saptandı (p:0,04). 6 (%4) hastada malignite saptandı. Hastaların ortalama takip süresi 20.2±19.86 ay idi. Takipler sırasında 24 hastada (%17) kitle boyutunda büyüme saptandı. Kitlelerin 6’sında (büyüyen kitlelerin %26, tüm kitlelerin %4 ü) 1 cm üzerinde büyüme görüldü. Erkek hastalardaki kitlelerin büyüme miktarı, kadın hastaların kitlelerdeki büyüme miktarından anlamlı olarak daha yüksekti (p:0.031).
Sonuç: Kitle büyüme miktarı ve malignite görülme sıklığı ileri yaş ve erkek cinsiyette daha fazla saptanmıştır. İnsidentalomaların fonksiyonellik ve malign dönüşüm açısından takibinde hastaların yaşı ve cinsiyeti göz önünde bulundurulmalıdır.

Keywords

Subklinik Cushing, Feokromasitoma, Hiperaldesteronizm, Adrenokortikal Kanser, Adrenal, İnsidentaloma

Project Number

Ethics Committee of Şişli Etfal Training and Research Hospital (25.09.2012 number 94).

References

• Kloos RT, Gross MD, Francis IR, Korobkin M, Shapiro B. Incidentally discovered adrenal masses. Endocr Rev 1995;16(4):460-84.
• Fassnacht M, Arlt W, Bancos I, Dralle H, Newell-Price J, Sahde A, et al. Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol. 2016;175(2): G1–G34.
• Pantalone KM, Gopan T, Remer EM, Faiman C, Ioachimescu AG, Levis HS et al. Change in adrenal mass size as a predictor of a malignant tumor. Endocr Pract. 2010;16(4):577–587.
• Mazzuco TL, Bordeau I, Lacroix A. Adrenal incidentalomas and subclinical Cushing’s syndrome: diagnosis and treatment. Curr Opin Endocrinol Diabetes Obes 2009;16(3):203-10.
• Mantero F, Terzolo M, Arnaldi G, Osella G, Masini AM, Ali A et al. A survey on adrenal incidentaloma in Italy. Study Group on Adrenal Tumors of the Italian Society of Endocrinology. J Clin Endocrinol Metab 2000;85(2):637-644.
• Comlekci A, Yener S, Ertilav S, Seçil M, Akinci B, Demir T, et al. Adrenal incidentaloma, clinical, metabolic, follow-up aspects: single centre experience. Endocrine. 2010;37(1):40-6.
• Bin X, Qing Y, Linhui W, Li G, Yinghao S. Adrenal incidentalomas: experience from a retrospective study in a Chinese population. Urol Oncol. 2011;29(3):270-4.
• Ahn SH, Kim JH, Baek SH, Kim H, Cho YY, Suh S, et al. Characteristics of adrenal ıncidentalomas in a large, prospective computed tomography-based multicenter study: the COAR study in Korea. Yonsei Med J. 2018;59(4):501–510.
• Tao H, Lu ZL, Li HZ. A clinical analysis of 103 cases of adrenal incidentaloma. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2003;25(2):172-5.
• Dobbie JW. Adrenocortical nodular hyperplasia: the ageing adrenal. J Pathol. 1969;99(1):1–18.
• Terzolo M, Stigliano A, Chiodini I, Loli P, Furlani L, Arnaldi G et al. AME position statement on adrenal incidentaloma. Eur J Endocrinol 2011;164(6):851-870.
• Mcleod MK, Thompson NW, Gross MD, Bondeson AG, Bondeson L. Sub-clinical Cushing's syndrome in patients with adrenal gland incidentalomas. Pitfalls in diagnosis and management. Am Surg. 1990;56(7):398-403.
• Barzon L, Sonino N, Fallo F, Palu G, Boscaro M. Prevalance and natural history of adrenal incidentalomas. Eur J Endocrinol, 2003;149(4):273-285.
• Terzolo M, Pia A, Reimondo G. Subclinical Cushing's syndrome: definition and management. Clin Endocrinol (Oxf). 2012;76(1):12–18.
• Bülow B, Ahrén B. Adrenal incidentaloma--experience of a standardized diagnostic programme in the Swedish prospective study. J Intern Med. 2002;252(3):239-46.
• Reincke M. Subclinical Cushing's syndrome. Endocrinol Metab Clin North Am 2000;29(1):42-56.
• Lee JM, Kim MK, Ko SH, Koh JM, Kim BY, Kim SW, et al. Clinical guidelines for the management of adrenal incidentaloma. Endocrinol Metab (Seoul). 2017;32(2):200–218.
• Cicala MV, Sartorato P, Mantero F. Incidentally discovered masses in hypertensive patients. Best Pract Res Clin Endocrinol Metab. 2006;20(3):451-66.
• Mannelli M, Ianni L, Cilotti A, Conti A. Pheochromocytoma in Italy: a multicentric retrospective study. Eur J Endocrinol. 1999;141(6):619-24.
• Bernini G, Moretti A, Argenio G, Salvetti A. Primary aldosteronism in normokalemic patients with adrenal incidentalomas. Eur J Endocrinol. 2002;146(4):523-9.
• Dunnick NR, Korobkin M. Imaging of adrenal incidentalomas: current status. American Journal of Roentgenology 2002;179:559–568.
• Quayle FJ, Spitler JA, Pierce RA, Lairmore TC, Moley JF, Brunt LM. Needle biopsy of incidentally discovered adrenal masses is rarely informative and potentially hazardous. Surgery. 2007;142(4):497-502.
• Sturgeon C, Shen WT, Clark OH, Duh QY, Kebebew E. Risk assessment in 457 adrenal cortical carcinomas: how much does tumor size predict the likelihood of malignancy? J Am Coll Surg. 2006;202(3):423-30.
• Dackiw AP, Lee JE, Gagel RF, Evans DB. Adrenal cortical carcinoma. World J Surg. 2001;25(7):914-26.
• Zeiger MA, Thompson GB, Duh QY, Hamrahian AH, Angelos P, Elaraj D, et al. The American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons medical guidelines for the management of adrenal incidentalomas. Endocr Pract. 2009;15 Suppl 1:1–20.
• Bernini GP, Moretti A, Oriandini C, Bardini M, Taurino C, Salvetti A. Long-term morphological and hormonal follow-up in a single unit on 115 patients with adrenal incidentalomas. Br J Cancer. 2005;92(6):1104-9.
• Zeiger MA, Siegelman SS, Hamrahian AH. Medical and surgical evaluation and treatment of adrenal incidentalomas. J Clin Endocrinol Metab. 2011;96(7):2004-15.
• Giordano R, Marinazzo E, Berardelli R, Picu A, Maccario M, Ghigo E, Arvat E. Long-term morphological, hormonal, and clinical follow-up in a single unit on 118 patients with adrenal incidentalomas. Eur J Endocrinol. 2010;162(4):779-85.
• Bülow B, Jansson S, Juhlin C, Steen L, Thoren M, Wahrenberg H, et al. Adrenal incidentaloma-follow-up results from a Swedish prospective study. Eur J Endocrinol. 2006;154(3):419-23.
• Ferrari M, Mantero F. Male aging and hormones: the adrenal cortex. J Endocrinol Invest. 2005;28 (11 Suppl Proceedings):92-5.
• Libè R, Dall'asta C, Barbetta L, Baccarelli A, Beck-peccoz P, Ambrosi B. Long-term follow-up study of patients with adrenal incidentalomas. Eur J Endocrinol. 2002;147(4):489-94.
• Kaltsas G, Chrisoulidou A, Piaditis G, Kassi E, Chrousos G. Current status and controversies in adrenal incidentalomas. Trends Endocrinol Metab. 2012;23(12):602-9.