Adrenal incidentalomas: diagnostic evaluation and long-term follow-up.
OBJECTIVE
To evaluate the cause and the clinical and laboratory features of adrenal incidentalomas (AI) in 52 patients and to assess the evolution of nonsurgically treated lesions during long-term follow-up.


METHODS
We retrospectively analyzed the medical records of 52 patients with AI undergoing routine follow-up in 2 Brazilian endocrine centers.


RESULTS
In our study group, nonfunctioning adenomas were the most frequent cause of AI (42%), followed by cortisol-secreting adenomas (15%), metastatic disease (10%), pheochromocytomas (8%), myelolipomas (6%), cysts (6%), carcinomas (4%), lymphomas (4%), tuberculosis (4%), and aldosteronoma (2%). Only 13 lesions (25%) were functioning (8 cortisol-secreting adenomas, 4 pheochromocytomas, and 1 aldosteronoma). Carcinomas were the largest adrenal masses (mean diameter, 11.7 +/- 1.3 cm). With the exception of 1 pheochromocytoma, 1 cyst, and 1 myelolipoma, all AI larger than 6 cm were carcinomas. During follow-up of 21 patients with nonsurgically treated AI for 6 to 36 months (mean, 24.8 +/- 8.9), no patient had tumor reduction or disappearance. After 12 months of follow-up, however, a 45-year-old woman had adrenal mass enlargement from 3.2 cm to 4.4 cm; the excised lesion proved to be an adenoma. Moreover, evidence of cortisol hypersecretion developed after 24 months of follow-up in a 30-year-old man with a 3.5-cm adenoma in the left adrenal gland.


CONCLUSIONS
Our findings demonstrate that most AI are nonfunctioning benign lesions and emphasize the need for long-term follow-up of patients with conservatively managed lesions, in light of the potential for evolution to hormonal hypersecretion or tumor growth.
Vilar
Lucio
L
Division of Endocrinology, Hospital das Clínicas da Universidade Federal de Pernambuco, Recife, Brazil.
Freitas
Maria da Conceição
Mda C
Canadas
Viviane
V
Albuquerque
José Luciano
JL
Botelho
Carlos A
CA
Egito
Célia S
CS
Arruda
Maria Juliana
MJ
Moura e Silva
Lidiane
L
Coelho
Carlos E
CE
Casulari
Luiz Augusto
LA
Naves
Luciana A
LA
D000236:Adenoma / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D000306:Adrenal Cortex Neoplasms / Q000097:blood / Q000175:diagnosis / Q000601:surgery; D000310:Adrenal Gland Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D018246:Adrenocortical Adenoma / Q000097:blood / Q000175:diagnosis / Q000601:surgery; D000328:Adult; D001938:Brazil; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D033162:Incidental Findings; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies
D006854:Hydrocortisone