Adrenal incidentaloma – follow-up results from a Swedish prospective study

Abstract

Objectives: To examine the risk of developing adrenal carcinomas and clinically overt hypersecreting tumours during short-term follow-up in patients with adrenal incidentalomas. Design: 229 (98 males and 131 females) patients with adrenal incidentalomas were investigated in a prospective follow-up study (median time 25 months; range 3-108 months). The patients were registered between January 1996 and July 2001 and followed until December 2004. Twenty-seven Swedish hospitals contributed with follow-up results. Methods: Diagnostic procedures were undertaken according to a protocol including reinvestigation with computed tomography scans after 3-6 months, 15 -18 months and 27-30 months, as well as hormonal evaluation at baseline and after 27-30 months of follow-up. Operation was recommended when the incidentaloma size increased or if there was a suspicion of a hypersecreting tumour. Results: The median age at diagnosis of the 229 patients included in the follow-up study was 64 years (range 28-84 years) and the median size of the adrenal incidentalomas when discovered was 2.5 cm (range 1-8 cm). During the follow-up period, an increase in incidentaloma size of $ 0.5 cm was reported in 17 (7.4%) and of $1.0 cm was reported in 12 (5.2%) of the 229 patients. A decrease in size was seen in 12 patients (5.2%). A hypersecreting tumour was found in 2% of the hormonally investigated patients: Cushing's syndrome (n ¼ 2) and phaeochromocytoma (n ¼ 1). Eleven patients underwent adrenalectomy, but no cases of primary adrenal malignancy were observed. Conclusions: Patients with adrenal incidentaloma had a low risk of developing malignancy or hormonal hypersecretion during a short-term follow-up period.

Przypadkowo wykryty guz nadnercza (incydentaloma) u dorosłych — zasady postępowania rekomendowane przez Polskie Towarzystwo Endokrynologiczne

“…Control tests (both imaging and laboratory) should be planned individually taking into consideration such factors as tumour size, image and growth dynamics, clinical manifestations, hormonal tests results, as well as concomitant diseases, including neoplasms [57][58][59][60][61][62][63]. …”

“…Tumours larger than 3 cm are more frequently hormonally active than smaller lesions [61]. The risk of an excessive hormonal secretion by an adrenal tumour reaches a plateau after 3-5 years [58]; hence, further control is not necessary. -Patients with suspected subclinical hypercortisolism require control tests assessing adrenocortical axis function as well as a precise control of the diseases associated with an excess of glucocorticoids (obesity, diabetes, hypertension, osteoporosis).…”

“…Guzy powyżej 3 cm częściej wykazują aktywność hormonalną częściej niż guzy mniejsze [61]. Ryzyko nadmiernej sekrecji hormonów przez guz nadnercza osiąga plateau po 3-5 latach [58], więc dalsza kontrola chorych nie jest już konieczna. -Chorzy z podejrzeniem subklinicznej hipokortyzolemii wymagają wykonania kontrolnych testów oceniających funkcję osi adrenokortykotropowej oraz dokładną ocenę przebiegu chorób związanych z nadmiarem glukokortykosteroidów (otyłość, cukrzyca, nadciśnienie tętnicze, osteoporoza).…”

“…Badania kontrolne (obrazowe i laboratoryjne) należy ustalać indywidualnie, biorąc pod uwagę między innymi wielkość, obraz i dynamikę wzrostu guza, objawy kliniczne, wyniki badań hormonalnych oraz choroby współistniejące (w tym choroby nowotworowe) [57][58][59][60][61][62][63].…”

Laparoscopic transperitoneal adrenalectomy: Our initial results

“…[10,11] However, diverse opinions about approach to smaller mass lesions are available in the literature. Bulow et al [12] followed up 229 patients with adrenal masses for 30 months, and observed development of hormonal activity only in 3% of these patients. On the other hand, Liebe et al [13] followed up 64 patients for 3 years, and reported development of endocrinological disorders in 28% of these patients, and higher risk in patients with adrenal masses greater than 3 cm in diameter.…”