Retrospective evaluation of clinical and laboratory features,follow-up and treatment outcomes of patientswith adrenal incidentaloma

Retrospective Evaluation of Clinical And Laboratory Features, Follow-Up And Treatment Outcomes of Patients with Adrenal Incidentaloma The term 'incidentaloma' indicates coincidentally found adrenal masses during radiological studies or abdominal surgical interventions in patients who have no symptoms or signs suggesting an adrenal mass. Adrenal masses are more frequently being discovered after widely availability of advanced imaging modalities for diagnosis. These are most often benign, nonfunctional masses and fewer of them are primary adrenocortical carcinoma or hormone secreting lesions. Adrenocortical carcinomas are uncommon tumors with poor prognosis. The objective of this study is to evaluate the follow-up and treatment outcomes of patients' clinical and laboratory features who were followed in our clinic with adrenal incidentaloma (AI) diagnosis between years 2005 and 2015. A total of 217 patients were identified. These patients were assessed according to their mass size. Hormonal tests were performed and the masses were identified whether functional or not. It was determined that 63.6% of 217 patients had nonfunctional masses (NFM) and within patients with functional masses 10.6% were identified to have subclinical Cushing's syndrome (SCS), 9.2% primary hyperaldosteronism (PHA), 9.2% pheochromocytoma, 6.9% Cushing's syndrome (CS) and 0.4% congenital adrenal hyperplasia (CAH). Adrenal incidentalomas were observed mostly in women. Average mass size was 28.38mm and they were most detected on the right adrenal gland. The imaging modality more often used at the time of initial diagnosis was detected as computed tomography (CT) scan. Gastroenterological disorders were also the most common indication for imaging modalities. Performing an analysis according to ages AIs were most commonly found between ages 40-64 while nonfunctional masses were more common in all age groups. Among the functional masses pheochromocytoma and PHA were principally observed between ages 18-39. SCS was the most commonly detected among functional masses after age 65. Mass size was significantly greater in patients with pheochromocytoma and CS compared to nonfunctional masses and PHA. It was observed that patients with pheochromocytoma were younger than patients with CAH. Hypertension (HT) was found more common in patients with functional masses than patients with NFM with regard to metabolic features. Serum potassium level was lower in patients with functional masses compared with NFMs with regard to biochemical parameters. This situation caused by PHA and cortisol secreting tumors respectively. In patients with cortisol secreting tumors total cholesterol, LDL cholesterol and triglyceride levels were found significantly higher than patients with NFMs. Making an assessment in terms of size both the majority of nonfunctional adenomas and functional masses were in <4cm group. According to the percentile ratios by tumor size groups NFA and PHA were most common in <4cm group, NFA, pheochromocytoma and CS in 4-6cm group and CS and ACC were the highest in >6cm group. Comparing adrenal incidentaloma tumor sizes <6cm with >6cm group, possibility of malignancy was significantly higher for tumors >6cm. Masses that required surgical operation were principally pheochromocytoma (24.5%), aldosterone secreting adenoma (18.9%), CS (12.2%), NFA (11.3%) and ACC (7.5%). Patients who underwent surgical intervention were younger than the ones who did not undergo surgery. Diabetes Mellitus (DM) was found significantly higher in patients with carcinoma compared with nonfunctional adenomas. Patients with subclinical CS were found to be significantly older by age compared with patients who had nonfunctional masses. Additionally, dyslipidemia, impaired fasting glucose, impaired glucose tolerance and DM were higher in patients with SCS than those who had NFM with statistical significance. During follow-up period of 56 cases 4% of them developed SCS and 4% of them developed idiopathic hyperaldosteronism. As a consequence AIs are more commonly being detected in an increasing pattern due to wide usage of abdominal imaging modalities. Most of the adrenal incidentalomas are benign, small sized (<4cm) and hormonally inactive tumors; very low percentage of them are primary adrenal carcinoma. Surgical treatment should be preferred for large and/or hormone secreting tumors. NFAs also must be followed for size and hormone secretion.