Adrenal incidentaloma: does an adequate workup rule out surprises?
BACKGROUND
Adrenal incidentaloma remains a diagnostic challenge. Despite well-established management guidelines, the long-term results of following these guidelines are unknown. We sought to determine how accurately these guidelines identify functioning incidentalomas and how often these guidelines result in adrenalectomy for benign tumors.


METHODS
We catalogued adrenal incidentalomas from a retrospective review of 500 consecutive adrenalectomies at a single institution. The outcome measures studied were patient demographics, preoperative biochemical analysis, imaging characteristics, tumor size, type of operation performed, and postoperative histologic diagnosis.


RESULTS
Eighty-one of the 500 adrenalectomies performed were for incidentalomas. Size was the only significant characteristic that distinguished cortical cancers from benign adenomas. Only 1 out of 26 functioning tumors was incorrectly identified on preoperative workup. We also found that 25% of cortisol-secreting incidentalomas were cystic, and that benign adenomas accounted for 42% of all tumors resected.


CONCLUSIONS
Current guidelines accurately predict the functional status of adrenal incidentalomas. Some cystic lesions may be functioning and should therefore be screened for hormonal hypersecretion. However, even with the most up-to-date diagnostic tools available, most adrenal incidentalomas resected are benign tumors.
Grogan
Raymon H
RH
Department of Endocrine Surgery, University of California San Francisco, San Francisco, CA 94143, USA.
Mitmaker
Elliot
E
Vriens
Menno R
MR
Harari
Avital
A
Gosnell
Jessica E
JE
Shen
Wen T
WT
Clark
Orlo H
OH
Duh
Quan-Yang
QY
D000236:Adenoma / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D000305:Adrenal Cortex Hormones / Q000378:metabolism; D000306:Adrenal Cortex Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D000315:Adrenalectomy; D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies
D000305:Adrenal Cortex Hormones