Frequency of adrenal lesions in patients applying to Oncology Clinic

The incidence of cancer is increasing in the world and in Turkey. Adrenal masses are detected by computerized tomography (CT), magnetic resonance imaging (MRI), positron emission tomography/computed tomography (PET/CT) and ultrasonography (USG), which are used in the diagnosis and staging of cancer. Benign, malignant or metastatic masses can be found in the adrenal glands. Adrenal masses are examined in two groups as incidentalomas detected incidentally and noninsidentalomas detected during examinations for adrenal gland diseases. Adrenal masses can be functional or nonfunctional. Functional adrenal masses can be seen with the clinical features of Cushing syndrome, primary hyperaldosteronism, congenital adrenal hyperplasia and pheochromocytoma. Non-functional masses can be caused by adenoma, cyst, myelolipoma, neuroblastoma, hemorrhage, infection, adrenocortical carcinoma and metastasis. In our study, we aimed to investigate the adrenal lesions detected by imaging during diagnosis, treatment follow-up and staging in patients who applied to the oncology clinic in a 5-year period in terms of benign, malignant and metastatic status, mass sizes, radiological features, correlation with oncological diagnoses, incidence, patient age and gender distribution. In the 5-year period, 5071 patients who applied to the oncology clinic were examined and adrenal lesions were detected in 910 patients. Of the patients included in our study, 40.4% (n=368) were female and 59.6% (n=542) were male. The mean age was 63.95 ±11.23 years. When the distribution of oncological diagnoses of the patients was examined, lung cancers were in the first place with 32.5% (n=296), breast cancers were in the second place with 13.6% (n=124), and colon cancers were in the third place with 10.2% (n=93). When the anatomical localization of adrenal lesions was examined, localization was observed in both adrenal glands with 29.56% (n=269). It was determined that unilateral adrenal lesions were in the right adrenal gland with 26.68% (n=171), and in the left adrenal gland with 73.32% (n=470). Of the patients examined, 93.07% (n=847) underwent CT, 61.2% (n=557) underwent 18FDG-PET/CT, and 33.30% (n=303) underwent MRI. 11 different lesions were described radiologically in the adrenal glands. The most frequently identified lesion radiologically was nodular thickening (30.7%) (n=279), followed by diffuse thickening (24%) (n=218). Metastasis was reported at a rate of 20.2% (n=184), adenoma at a rate of 17.3% (n=157), and hyperplasia at a rate of 5.7% (n=52). The most common diagnosis in patients with adrenal metastasis was lung cancer with a rate of 57.1% (n=105). Colorectal cancer was detected at a rate of 8.7% (n=16), breast cancer at a rate of 8.2% (n=15), and renal carcinoma at a rate of 6.5% (n=12). There were 5 adrenocortical carcinomas examined in our study. In our study evaluating the assumption that adrenal masses detected in cancer patients are metastases, the frequency of adrenal incidentalomas in CT scans was 14.4%, which is higher than the 4.2-7.1% reported in the literature. Our results show that our metastasis rate is 20.2%. It shows that 79.8% of adrenal lesions detected in cancer patients are not metastases. Follow-up and evaluation of incidental adrenal masses detected during diagnosis, staging and follow-up of cancer patients may lead to the detection of other malignancies and comorbidities that may affect the general management of the patient. Therefore, incidentalomas should be evaluated with appropriate imaging methods and biochemical tests to evaluate their malignant potential and functional status. The guidelines in the management of incidentalomas should be followed. Further studies are needed to confirm the results of our study, to standardize the radiology reports that affect clinician decisions, and to decide which patients will receive further examination and treatment. Keywords: Incidentaloma, adrenocortical carcinoma, Cushing syndrome, pheochromocytoma, primary hyperaldosteronism, metastasis.