1,161 patients with adrenal incidentalomas: indications for surgery

• Published in: Langenbeck's archives of surgery Vol. 393; no. 2; pp. 121 - 126
• Main Authors: Kasperlik-Załuska, A. A., Otto, M., Cichocki, A., Rosłonowska, E., Słowinska-Srzednicka, J., Zgliczyński, W., Jeske, W., Papierska, L., Tołłoczko, T., Polański, J., Słapa, R.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.03.2008
• Subjects: Abdominal Surgery; Adolescent; Adrenal Gland Neoplasms - diagnosis; Adrenal Gland Neoplasms - pathology; Adrenal Gland Neoplasms - secondary; Adrenal Gland Neoplasms - surgery; Adrenal Glands - pathology; Adrenalectomy; Adult; Aged; Aged, 80 and over; Cardiac Surgery; Child; Diagnosis, Differential; Female; General Surgery; Humans; Incidental Findings; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Pituitary ACTH Hypersecretion - diagnosis; Pituitary ACTH Hypersecretion - pathology; Pituitary ACTH Hypersecretion - surgery; Thoracic Surgery; Tomography, X-Ray Computed; Traumatic Surgery; Vascular Surgery; Chromaffin tumors; Adrenal tumor; Adrenal incidentaloma; Adrenal cancer
• ISSN: 1435-2443; 1435-2451
• DOI: 10.1007/s00423-007-0238-6

Background and aims The aim of this study is to analyze the clinical data and criteria for surgery in a group of over 1,100 patients with adrenal incidentalomas (AI) observed at the Department of Endocrinology. Patients and methods The material consisted of 1,161 patients (842 women and 319 men, 10–87 years old) with AI ranging in size from 1.0 to 23.0 cm. The methods included clinical examination, imaging studies, hormonal determinations in the blood and in the urine as well as histological and immunocytochemical investigations in 390 patients treated by surgery. Results Basing on these studies, we diagnosed 112 patients with primary malignant adrenal tumors (100 with carcinoma), 45 with metastatic infiltrations, and 1,004 with probable benign AI. Imaging phenotypes (especially high density on computed tomography, CT) were characteristic of malignant and chromaffin tumors. Subclinical adrenal hyperactivity was found in 8% of the patients with pre-Cushing’s syndrome as the most frequent form (6.5%). Chromaffin tumors were detected in 3%. Conclusions (1) Indications for surgery include malignant tumors (both primary and metastatic), tumors with subclinical hyperfunction, and chromaffin tumors. High density on CT, >20 HU, appeared to be an important indication for surgery. (2) A slight prevalence of oncological indications over endocrinological indications (14 vs. 11%) was found.