Oncological screening tests are necessary in all incidentalomas. Tumours > or = 30 mm should be operated but smaller ones can be followed-up, because they are usually benign and rarely show progressive growth. Cortical adenomas with subtle hormonal overproduction and hypertension, diabetes or osteoporosis should be operated, irrespective of their size, but in the absence of relevant clinical symptoms they can be followed-up.

To assess its differential diagnostic value, dehydroepiandrosterone sulfate (DHEA-S) was measured in a nonselected cohort of 84 patients with incidentally detected adrenal tumors (incidentaloma). Of the 38 histologically confirmed cases, 6 of 12 patients with primary or metastatic malignant tumor of the adrenals and 7 of 14 patients with benign cortical adenoma had low DHEA-S levels. Thus, the sensitivity, specificity, and predictive value of a low DHEA-S level to indicate a benign adrenal tumor were 0.35, 0.50, and 0.60, and the values to indicate a cortical adenoma were 0.50, 0.67, and 0.47, respectively. Of the 14 cases of histologically confirmed benign cortical adenoma, 10 had signs of hormonal activity, but DHEA-S was suppressed in only 7 cases. Thus, the sensitivity, specificity, and predictive value of a low DHEA-S level to indicate clinically significant hormonal activity of a benign cortical adenoma were 0.60, 0.75, and 0.86, respectively. For comparison, 5 of 5 males and 2 of 5 females with metastatic carcinomatosis, but without involvement of the adrenals, also had low DHEA-S levels. The data clearly show that in nonselected cases of incidentaloma a suppressed DHEA-S level is not a good predictor of hormonal activity and that DHEA-S measurement may be valuable only after having ascertained the cortical origin and benign feature of the tumor.

Ultrasongraphy of the thyroid gland was performed in a screening study of 177 chronically ill, hospitalized geriatric patients older than 60 years of age, from an area with only moderate iodine deficiency. The normal reference ranges of thyroid volume for males (1.7 mL to 22.2 mL) and for females 2.4 mL to 20.9 mL) were similar. The thyroid volume decreased with age in the euthyroid group and was also smaller in euthyroid females in bad health. The prevalence of goiter and thyroid nodules were 7.9% and 11.3%, respectively. Thus, the decrease of the thyroid volume in this geriatric population is probably related to both old age and diseases of the aged.

The aim of this study was to investigate the prevalence of thyroid dysfunction in different geriatric subpopulations from a moderately iodine-deficient Hungarian region and to compare the efficacy of clinical versus hormonal screening. A screening study was done on 279 chronically ill geriatric patients (Group I) and 256 consecutive hospital admissions over 60 years of age (Group II). The method of clinical screening was different from those used so far: the object was not to search for symptoms of hypo- or hyperthyroidism but to find any sign justifying a further thyrotrophin-based biochemical evaluation, i.e. history of thyroid disease or goitre or any clinical sign of hormonal dysfunction. The rates of overt hypothyroidism, overt hyperthyroidism, subclinical hypothyroidism and subclinical hyperthyroidism discovered by the hormonal screening were 2.9, 1.1, 3.6 and 5.7% in Group I and 3.5, 2.3, 3.9 and 2.0% in Group II. The sensitivities of the clinical screening to suspect overt or overt+subclinical dysfunctions were, respectively, 0.82 and 0.64 in Group I and 1.0 and 0.7 in Group II (or 0.67 and 0.4 if the clinical investigation was done not by an endocrinologist but by the medical attendants). A primarily clinical investigation-based screening would have spared 171/279 thyrotrophin estimation in Group I and 161/256 in Group II, but would have missed 2/11 overt and 11/26 subclinical dysfunctions in Group I. In Group II, no overt but 9/15 subclinical dysfunctions would have been lost in this way. Our approach of a clinical investigation-based screening was rather efficient in suspicion of overt thyroid dysfunction but failed to detect many cases with subclinical dysfunction.(ABSTRACT TRUNCATED AT 250 WORDS)

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