Adrenal Incidentaloma: An Overview of Clinical and Epidemiological Data from the National Italian Study Group

Abstract

Background: The incidental discovery of an adrenal mass raises the problem of distinguishing the frequent benign masses from the infrequent malignant ones that require surgery. At present, univocal guidelines to approach this problem are not available. The aim of the present study was to perform a multicentric retrospective analysis of adrenal masses incidentally discovered (adrenal incidentalomas). Patients and Methods: Hospital records of adrenal incidentalomas diagnosed over a 15-year period in 29 surgical and medical centers in Italy were scrutinized. Collected cases were 1,013, and 887 were analyzed. Results: The majority of patients were in the 5th and 6th decade and females were predominantly affected. The frequency of adrenocortical cancer was 12% among operated patients (316 cases). The tumor diameter was highly correlated with the risk of malignancy, as well as the CT characteristics such as density, shape and margins. The frequency of pheochromocytoma was 10% among operated patients. Conclusions: The occurrence of incidentally discovered adrenocortical carcinomas and pheochromocytomas is not rare. Evaluation of the mass size and CT characteristics are simple and effective methods to differentiate malignant lesions. Biochemical screening for pheochromocytoma is mandatory before surgery.

Antiphospholipid syndrome, adrenal failure, dilated cardiomyopathy and chronic hepatitis: an unusual manifestation of multiorgan autoimmune injury?

“…Adrenal haemorrhage manifests itself as a round or oval adrenal mass that decreases in both size and CT density with time (8,9,11). However, the sensitivity of ultrasound and CT to detect adrenal masses is reported to be 87% and 93% respectively, and a close correlation is also found between the sizes measured by both imaging procedures (12,13). Therefore, the ability of the two techniques to detect adrenal haematomas is similar.…”

Management of adrenal incidentalomas

“…8 Size There is a relationship between the size of a lesion and its malignant potential. 9 Lesions <4cm have a low malignant potential (2% carcinomas). Lesions >6cm are best considered malignant and treated as such.…”

Zufallsbefunde – Grundsätzliche Abklärungsschritte, Erlös unter Swiss DRG und ethische Überlegungen am Beispiel des Nebennieren-Inzidentaloms

“…Die Größe der Läsion scheint relativ gut mit der Inzidenz von Malignitäten übereinzustimmen, das heißt, je größer ein Inzidentalom, umso größer die Wahrscheinlichkeit einer Malignität [4]. Ein Befund von > 6 cm und insbesondere mit virilisierenden Verände-rungen sprechen für ein Nebennierenrindenkarzinom [5]; dessen Inzidenz ist unklar.…”