ORIGINAL ARTICLES   

Minerva Endocrinologica 2000 March;25(1):19-27

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: Italian

Adrenal incidentalomas: our experience and letterature review

Letizia C. ¹, Coassin S. ¹, Massa R. ², Caliumi C. ¹, De Toma G. ³, Reale M. G. ⁴, Delfini E. ¹, D’Erasmo E. ¹

¹ Università degli Studi di Roma, «La Sapienza» - Roma, Dipartimento di Scienze Cliniche, Cattedra di Patologia Medica IV; ² Università degli Studi di Roma, «La Sapienza» - Roma, Istituto di Medicina Nucleare; ³ Università degli Studi di Roma, «La Sapienza» - Roma, Istituto di Clinica Chirurgica; ⁴ Università degli Studi di Roma, «La Sapienza» - Roma, Dipartimento di Medicina Sperimentale e Patologia

Background. The grow­ing use of sen­si­tive non-inva­sive meth­ods to ­image the abdo­men ­such as ultra­so­nog­ra­phy, com­put­ed tomog­ra­phy (CT) and mag­net­ic res­o­nance imag­ing (MRI), ­have result­ed in increas­ing rec­og­ni­tion of adren­al inci­den­tal­o­mas.
Methods. In ­this ­study, we ­report the clin­i­cal, endo­crine and radio­log­ic eval­u­a­tion of 75 ­patients (50 wom­en and 25 men, ­mean age 56±14 ­years) ­with adren­al inci­den­tal­o­ma (­size 1 to 18 cm, ­mean 3±2.5 cm). None of the ­patients ­showed any simp­toms or clin­i­cal ­signs ­that ­might indi­cate the exis­tence of adren­al dys­func­tion. The ­patients under­went ­basal and dynam­ic eval­u­a­tion of the hypo­ta­lam­ic-pitui­tary-adren­al ­axis, ­renin-angio­ten­sin-aldos­te­rone ­system, and adre­nom­e­dul­lary func­tion. Moreover, CT and MRI ­scan and Iodo-cho­les­te­rol (NP-59) scin­tig­ra­phy ­were per­formed.
Results. The endo­crine eval­u­a­tion indi­cat­ed 11 cas­es of pre-clin­i­cal Cushing’s syn­drome, 2 cas­es of phe­och­rom­o­cy­to­ma and 62 not-func­tion­al­ly adren­al mass­es. On the ­basis of endo­crine and mor­pho­log­ic ­data, 29 ­patients under­went sur­gi­cal treat­ment: 20 adren­o­cor­ti­cal aden­o­ma, 2 phe­och­rom­o­cy­to­mas, 2 not-cor­ti­sol-secret­ing adren­al car­ci­no­mas, 1 adren­al lym­pho­ma, 1 adren­al metas­ta­sis, 1 mye­lo­lip­o­ma, 1 hem­or­rhage and 1 pseu­do­cys­tis.
Conclusions. In con­clu­sion, ­patient ­with an inci­den­tal­ly dis­cov­ered ­mass has to be inves­ti­gate to ­detect malig­nan­cy and sub­tle hor­mo­nal over­pro­duc­tion, to ­select the cas­es for sur­gi­cal treat­ment.