Management of adrenal incidentaloma: the role of adrenalectomy may be underestimated.
BACKGROUND
To demonstrate clinical characteristics of adrenal incidentaloma in South China and explore its comprehensive management.


METHODS
The clinical data of patients with adrenal neoplasm from Jan 1998 to Dec 2012 were retrospectively analysed. Patients with suspicion of adrenal abnormalities or those in whom adrenal abnormalities were detected in the staging procedures of other cancers were excluded. Most patients with adrenal incidentaloma chose to have adrenalectomy, and some chose surveillance. The relationships between clinical features were analysed with a chi-square test and rank sum test.


RESULTS
In total, 634 patients with adrenal incidentaloma were studied. Their age ranged from 17 to 85 years old with a median age of 50 years. Of 478 cases with pathological results, adenoma was the most common tumour (233/478), with 84 cases of pheochromocytoma and 36 cases of adrenocortical carcinoma were 84 and 36. When the tumour size was ≤4 cm, >95 % were benign; when the tumour size was >6 cm, 33 % were malignant. For patients with a tumour size ≤4 cm, 249/376 cases had an adrenalectomy performed. Due to anxiety over a potential malignant transformation and enlargement, most patients (>80 %) under surveillance preferred to undergo adrenalectomy.


CONCLUSIONS
Pheochromocytoma and adrenocortical carcinoma were not rare tumours of adrenal incidentaloma, and 4 cm is a good size cutoff to use in the diagnosis of an adrenal incidentaloma. Other than surveillance, laparoscopic adrenalectomy may become the method of choice for management of small adrenal incidentaloma.
Department of Urology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, China.
Yun-Lin
YL
Ye
Department of Urology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, 510080, China.|Department of Urology, Jiangmen Central Hospital, Jiangmen, Guangdong, 529030, China.
Xiao-Xu
XX
Yuan
Department of Urology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, China.|Department of Urology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, 510630, China.
Ming-Kun
MK
Chen
Department of Urology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, 510080, China.
Yu-Ping
YP
Dai
Department of Urology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, China.
Zi-Ke
ZK
Qin
Department of Urology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, 510080, China. 94028977@qq.com.
Fu-Fu
FF
Zheng
D000236:Adenoma / Q000175:diagnosis / Q000601:surgery; D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D018268:Adrenocortical Carcinoma / Q000175:diagnosis / Q000601:surgery; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000175:diagnosis / Q000601:surgery; D012189:Retrospective Studies; D055815:Young Adult
Adenoma; Adrenal tumor; Adrenalectomy; Incidentaloma