Adrenal incidentalomas: risk of adrenocortical carcinoma and clinical outcomes.
BACKGROUND
The number of incidentally discovered adrenal lesions is increasing due to the widespread use of abdominal imaging. Although most incidentalomas are benign, larger suspicious lesions will require adrenalectomy. The aim of this study is to determine the risk of malignancy in patients undergoing surgery for adrenal incidentaloma; and to compare clinical outcomes in those with adrenocortical carcinoma (ACC) based on the mode of presentation.


METHODS
A retrospective study of consecutive patients who underwent adrenalectomy between 1995 and 2008 was performed. Data were retrieved from a prospectively maintained adrenal tumor database. Those with adrenal incidentaloma were selected and histopathology reviewed. All patients with ACC (presenting with symptoms or incidentally) during the same time period were identified and clinical outcomes compared.


RESULTS
Adrenalectomy was performed in 274 patients of whom 73 (27%) were characterized pre-operatively as incidentaloma. Benign, non-functioning adrenocortical adenoma was the most common histopathological finding (46 patients, 63%). There was a trend (P = 0.08) towards increased survival amongst the seven patients with ACC presenting incidentally compared to the nine patients with symptomatic ACC.


CONCLUSIONS
Adrenal incidentalomas have a small but important risk of malignancy. ACC presenting as incidentaloma appear to have a more favorable prognosis than symptomatic or functioning ACC.
O'Neill
Christine J
CJ
University of Sydney Endocrine Surgical Unit, St. Leonards, New South Wales, Australia.
Spence
Andrew
A
Logan
Barney
B
Suliburk
James W
JW
Soon
Patsy S
PS
Learoyd
Diana L
DL
Sidhu
Stan B
SB
Sywak
Mark S
MS
D000293:Adolescent; D000306:Adrenal Cortex Neoplasms / Q000473:pathology* / Q000601:surgery; D000315:Adrenalectomy; D018268:Adrenocortical Carcinoma / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D006801:Humans; D033162:Incidental Findings; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012306:Risk; D016896:Treatment Outcome; D055815:Young Adult