Incidentally detected adrenal tumours (incidentalomas): histological heterogeneity and differentiated therapeutic approach
- 1 June 1995
- journal article
- Published by Wiley in Journal of Internal Medicine
- Vol. 237 (6), 585-589
- https://doi.org/10.1111/j.1365-2796.1995.tb00889.x
Abstract
To find a differentiated therapeutical approach to incidentalomas. Prospective study of incidentalomas: their histology, hormonal activity, and growth if primarily non-operated. Admissions to an academic tertiary care centre because of incidentaloma. Thirty-eight female, 25 male, 27-85 years old. Ultrasound, computed tomography and adrenal scintigraphy when appropriate; investigations to exclude malignancy giving metastasis into the adrenal gland; ACTH, cortisol, aldosterone, renin activity, androgene, catecholamine measurements; surgery or follow-up. Rate of malignancy; linkage of tumour size to probability of malignancy; prevalence of tumours with subtle hormone excess. Cortical adenomas occurred in 13/31, metastases in 7/31 of the histologically confirmed cases. In 10/31 cases, the computed tomography indicated a size that was smaller than the pathological size (mean = 20 mm). 20.6% of all incidentalomas and 61.5% of the 13 operated corticol adenomas showed subtle hormonal activity. Twenty-seven incidentalomas < 30 mm were followed-up (3-41 months; mean 18 months) and showed growth in only one case. Sensitivity, specificity, and predictive value (PV) of a tumour > or = 30 mm to indicate malignancy were: 1.0, 0.56 and 0.27, respectively. The PV of a < 30 mm tumour to exclude malignancy was 1.0. Oncological screening tests are necessary in all incidentalomas. Tumours > or = 30 mm should be operated but smaller ones can be followed-up, because they are usually benign and rarely show progressive growth. Cortical adenomas with subtle hormonal overproduction and hypertension, diabetes or osteoporosis should be operated, irrespective of their size, but in the absence of relevant clinical symptoms they can be followed-up.Keywords
This publication has 21 references indexed in Scilit:
- Addisonʼs DiseaseThe Endocrinologist, 1993
- Incidentally Discovered Adrenal Masses: a Functional and Morphological StudyExperimental and Clinical Endocrinology & Diabetes, 1993
- Adrenal incidentaloma and patients with homozygous or heterozygous congenital adrenal hyperplasiaJournal of Clinical Endocrinology & Metabolism, 1992
- Clinical Features of Adrenocortical Carcinoma, Prognostic Factors, and the Effect of Mitotane TherapyNew England Journal of Medicine, 1990
- Serendipitous adrenal masses: Prevalence, significance, and managementThe American Journal of Surgery, 1985
- Adrenal “incidentalomas”: Need for surgeryUrology, 1985
- Comparative histologic study of 43 metastasizing and nonmetastasizing adrenocortical tumorsThe American Journal of Surgical Pathology, 1984
- Incidental asymptomatic adrenal masses detected by computed tomographic scanning. Is operation required?Jama-Journal Of The American Medical Association, 1982
- Nonfunctioning adrenal masses: incidental discovery on computed tomographyAmerican Journal of Roentgenology, 1982
- ON THE PREVALENCE OF ADRENOCORTICAL ADENOMAS IN AN AUTOPSY MATERIAL IN RELATION TO HYPERTENSION AND DIABETESActa Medica Scandinavica, 1968