Adrenal incidentalomas: experience in a developing country.
BACKGROUND
The incidence of adrenal incidentalomas is rising worldwide. There is a concern about malignancy in large incidentalomas. There are few published articles from developing countries on this entity. The aim of this study was to analyze the clinical presentation, functional status, and final diagnosis of adrenal incidentalomas and, in particular, to look into the incidence of adrenal cortical carcinoma (ACC) in large adrenal incidentalomas managed at a tertiary referral hospital in northern India.


METHODS
This is a retrospective study (January 1991-December 2005) of 59 patients with adrenal incidentaloma managed at our department. The mean tumor diameter was 7.8 +/- 4.0 cm. In all cases, clinical details, radiology findings, laboratory findings, intervention details, histology findings, and follow-up data were noted. Six patients in which the mass was ultimately found to arise from extra-adrenal tissue were excluded from final analysis


RESULTS
Mean age of the patients was 46 +/- 12 years (M:F = 1:1.1). The incidentaloma measured more than 3 cm in 91% of cases and more than 6 cm in 70% of cases. The clinical scenarios leading to detection of incidentaloma included abdominal (56.6%), genitourinary (24.5%), and systemic complaints (15.1%) and routine medical checkup (3.7%). Most of cases were found by ultrasonography (n = 41), and remaining by CT scan (n = 10), and MRI (n = 2). The incidence of functioning tumors was 41.5% (hypercatecholinism 37.7 % and hypercortisolism 1.9%). Forty-nine patients were operated on. The important final pathology included ACC (7.5%), pheochromocytoma (PCC) (43%), adrenal cysts (13.2%), myelolipoma (11.3%), and inflammatory lesions (9.4%).


CONCLUSIONS
In our experience, the incidence of PCC was high among large adrenal incidentalomas while that of ACC was lower than expected. Inflammatory lesions contribute to a significant number of cases of incidentaloma in developing countries. Adrenalectomy is a justified procedure for large incidentalomas, although the concern may not always be an underlying malignancy.
Bhargav
P R K
PR
Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow 226 014, India.
Mishra
Anjali
A
Agarwal
Gaurav
G
Agarwal
Amit
A
Verma
Ashok Kumar
AK
Mishra
Saroj Kanta
SK
D000236:Adenoma / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D000293:Adolescent; D000306:Adrenal Cortex Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003906:Developing Countries; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D015994:Incidence; D033162:Incidental Findings; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome