The natural history of incidentally discovered adrenocortical adenomas: A retrospective evaluation

• Published in: Journal of endocrinological investigation Vol. 24; no. 11; pp. 846 - 855
• Main Authors: GROSSRUBATSCHER, E, VIGNATI, F, POSSA, M, LOLI, P
• Format: Journal Article
• Language: English
• Published: Milano Kurtis 01.12.2001
• Subjects: 17-alpha-Hydroxyprogesterone - blood; Adenoma - blood; Adenoma - diagnostic imaging; Adenoma - surgery; Adrenal Cortex Neoplasms - blood; Adrenal Cortex Neoplasms - diagnostic imaging; Adrenal Cortex Neoplasms - surgery; Adrenalectomy; Adrenals. Adrenal axis. Renin-angiotensin system (diseases); Adult; Aged; Aged, 80 and over; Biological and medical sciences; Dehydroepiandrosterone Sulfate - blood; Endocrinopathies; Female; Humans; Hydrocortisone - blood; Hypothalamus. Hypophysis. Epiphysis (diseases); Male; Medical sciences; Middle Aged; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Tomography, X-Ray Computed; Endocrinopathy; Adrenal cortex diseases; Bilateral; Male; Hyperadrenocorticism; Adenoma; History; Hydrocortisone; Surgery; Adrenal gland diseases; Evolution; Female; Benign neoplasm; Diagnosis; Hormonal investigation; Medium term; Hydroxyprogesterone; Human; Dexamethasone; Deficiency; Cushing syndrome; ACTH test; Retrospective; Mass; Computerized axial tomography; Incidentaloma; Tracers
• ISSN: 0391-4097; 1720-8386
• DOI: 10.1007/BF03343941

Adrenal adenoma is the most frequent lesion among adrenal incidentalomas. The present retrospective study was undertaken to investigate medium-term evolution of supposed or ascertained adrenocortical adenomas in a group of 53 subjects (16 males and 37 females, aged 31-83 yr), with bilateral (no.=8) or monolateral (no.=45) incidentally discovered adrenal masses (size 10-50 mm, median 25 mm), who were followed-up for 6-78 months (median 24 months). Diagnosis of adenoma was based on size and morphovolumetric aspect of the lesion at computed tomography (CT), scintigraphic pattern using NP59 as a tracer, and it was histologically confirmed in 7 patients. After an extensive hormonal investigation including morning (no.=53) and midnight (no.=28) serum cortisol, plasma ACTH (no.=50), serum DHEAS (no.=51), daily urinary free cortisol excretion (no.=52), post-dexamethasone (1 mg) cortisol (no.=42) and ACTH stimulation test for 17-hydroxyprogesterone (17-OHP) response (no.=48) at the time of diagnosis, patients were periodically re-evaluated for hormonal function and radiological aspect of the lesion(s) by CT. Seven patients underwent surgery 6-42 months after incidentaloma demonstration, with histological diagnosis of adrenal adenoma. During follow-up an increase in the size of the lesion was demonstrated in 22 patients (41.5%); the increase was greater than 10 mm in 8 cases. In 3 patients with unilateral mass, a contralateral lesion appeared 10-52 months after first demonstration. Six patients (11.3%) showed reduction or disappearance of the lesions. On the basis of the hormonal evaluation 3 patients were considered to have subclinical Cushing's syndrome and 10 patients exhibited 17-OHP hyperresponse to ACTH test consistent with partial 21 -hydroxylase deficiency. A significant difference in the size of the lesions was observed between patients with or without 17-OHP hyperresponse to ACTH test (31.1 1.9 vs 24.1 +/- 1.2 mm; p<0.01). No significant changes in the hormonal parameters were observed in the patients, when retested. In conclusion, although none of the patients of the present series exhibited evolution to hypersecretion or to aberrant growth, in more than 40% of patients an increase in the size of the mass was observed, even after a long period of "quiescence". This suggests that a radiological re-evaluation of lesions should be periodically undertaken.