Functional and radiological evaluation of adrenal masses, comparison of preoperative and postoperative outcomes

Objective: This study aimed to evaluate the long-term imaging outcomes of patients diagnosed with adrenal adenoma in our hospital, to compare the clinical, radiological, and biochemical findings between operated and non-operated patients, and to assess these findings in conjunction with histopathological results. Materials and Methods: This retrospective study included 267 patients over 18 years of age, diagnosed with adrenal masses and followed up at the Endocrinology and Metabolism Outpatient Clinic of İnönü University Turgut Özal Medical Center. Demographic characteristics, clinical data, biochemical test results, radiological imaging findings, follow-up records, and histopathological diagnoses of operated patients were reviewed and recorded using the hospital information system. Functional status of the masses, changes in size, suspicion of malignancy, and factors influencing the decision for surgery were evaluated. Statistical analysis was performed using SPSS version 22 (SPSS Inc., Chicago, IL). Results: A total of 267 patients, including 174 women and 93 men, were included in the study. The mean age of the patients was 53.4 ± 12.49 years. All patients were evaluated based on clinical, laboratory, imaging, and pathological findings. Unilateral involvement was observed in 233 patients, while bilateral involvement was detected in 33 patients. The mean lesion size was between 1 and 4 cm in 63.8% of the patients. The majority of the lesions were found to be benign and hormonally inactive. Functional lesions were identified in 55 patients. Surgical intervention was performed in 34.5% of the patients, with hormonal activity being the most common indication for surgery, followed by lesion size. A significant association was found between lesion size and the rate of surgical intervention. Among the operated patients, adrenal cortical adenoma was the most frequently identified pathology, whereas malignant pathology was detected in 23 patients. During follow-up, no significant changes in lesion size were observed in the majority of the patients. Conclusion: The combined use of biochemical tests and imaging modalities in the management of adrenal masses enables appropriate patient selection, prevents unnecessary surgeries, and facilitates effective treatment planning. Our study showed that most adrenal masses are benign and non-functional, although a considerable proportion displayed hormonal activity and, rarely, malignant potential. Furthermore, even small lesions can exhibit clinically significant hormonal activity, whereas the risk of malignancy increases with larger lesions. In conclusion, a multidisciplinary and individualized approach, integrating morphological, biochemical, and clinical data, is essential in the management of adrenal masses. Keywords: Adrenal mass, Adrenal incidentaloma, Adrenal adenoma, Functional lesion, Non-functional lesion, Adrenalectomy