title: Bilateral adrenal masses: a single-centre experience.
abstract: BACKGROUND
  Bilateral adrenal masses may have aetiologies like hyperplasia and infiltrative lesions, besides tumours. Hyperplastic and infiltrative lesions may have coexisting hypocortisolism. Bilateral tumours are likely to have hereditary/syndromic associations. The data on clinical profile of bilateral adrenal masses are limited.
  
  
  OBJECTIVE
  To analyse clinical, biochemical and radiological features, and management outcomes in patients with bilateral adrenal masses.
  
  
  METHODS
  Retrospective analysis of 70 patients with bilateral adrenal masses presenting to a single tertiary care endocrine centre from western India (2002-2015).
  
  
  RESULTS
  The most common aetiology was pheochromocytoma (40%), followed by tuberculosis (27.1%), primary adrenal lymphoma (PAL) (10%), metastases (5.7%), non-functioning adenomas (4.3%), primary bilateral macronodular adrenal hyperplasia (4.3%), and others (8.6%). Age at presentation was less in patients with pheochromocytoma (33 years) and tuberculosis (41 years) compared with PAL (48 years) and metastases (61 years) (P<0.001). The presenting symptoms for pheochromocytoma were hyperadrenergic spells (54%) and abdominal pain (29%), whereas tuberculosis presented with adrenal insufficiency (AI) (95%). The presenting symptoms for PAL were AI (57%) and abdominal pain (43%), whereas all cases of metastasis had abdominal pain. Mean size of adrenal masses was the largest in lymphoma (5.5cm) followed by pheochromocytoma (4.8cm), metastasis (4cm) and tuberculosis (2.1cm) (P<0.001). Biochemically, most patients with pheochromocytoma (92.8%) had catecholamine excess. Hypocortisolism was common in tuberculosis (100%) and PAL (71.4%) and absent with metastases (P<0.001).
  
  
  CONCLUSIONS
  In evaluation of bilateral adrenal masses, age at presentation, presenting symptoms, lesion size, and biochemical features are helpful in delineating varied underlying aetiologies.
authors.affiliation: Department of EndocrinologySeth G S Medical College, KEM Hospital, Mumbai, Maharashtra, India enileshlomte@gmail.com.
authors.forename: Nilesh
authors.initials: N
authors.lastname: Lomte
authors.affiliation: Department of EndocrinologySeth G S Medical College, KEM Hospital, Mumbai, Maharashtra, India.
authors.forename: Tushar
authors.initials: T
authors.lastname: Bandgar
authors.affiliation: Department of EndocrinologySeth G S Medical College, KEM Hospital, Mumbai, Maharashtra, India.
authors.forename: Shruti
authors.initials: S
authors.lastname: Khare
authors.affiliation: Department of EndocrinologySeth G S Medical College, KEM Hospital, Mumbai, Maharashtra, India.
authors.forename: Swati
authors.initials: S
authors.lastname: Jadhav
authors.affiliation: Department of EndocrinologySeth G S Medical College, KEM Hospital, Mumbai, Maharashtra, India.
authors.forename: Anurag
authors.initials: A
authors.lastname: Lila
authors.affiliation: Department of EndocrinologySeth G S Medical College, KEM Hospital, Mumbai, Maharashtra, India.
authors.forename: Manjunath
authors.initials: M
authors.lastname: Goroshi
authors.affiliation: Department of EndocrinologySeth G S Medical College, KEM Hospital, Mumbai, Maharashtra, India.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Kasaliwal
authors.affiliation: Department of EndocrinologySeth G S Medical College, KEM Hospital, Mumbai, Maharashtra, India.
authors.forename: Kranti
authors.initials: K
authors.lastname: Khadilkar
authors.affiliation: Department of EndocrinologySeth G S Medical College, KEM Hospital, Mumbai, Maharashtra, India.
authors.forename: Nalini S
authors.initials: NS
authors.lastname: Shah
keywords: adrenal; endocrine cancers