Adrenal Incidentalomas: Experience in a Developing Country

• Published in: World journal of surgery 2008-08, Vol.32 (8), p.1802-n/a
• Main Authors: Bhargav, P. R. K., Mishra, Anjali, Agarwal, Gaurav, Agarwal, Amit, Verma, Ashok Kumar, Mishra, Saroj Kanta
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adenoma - diagnosis; Adenoma - epidemiology; Adenoma - surgery; Adolescent; Adrenal Cortex Neoplasms - diagnosis; Adrenal Cortex Neoplasms - epidemiology; Adrenal Cortex Neoplasms - surgery; Adrenal Gland Neoplasms - diagnosis; Adrenal Gland Neoplasms - epidemiology; Adrenal Gland Neoplasms - surgery; Adrenal Incidentaloma; Adrenal Lesion; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cardiac Surgery; Developing Countries; DHEA; Diagnostic Imaging; Female; General aspects; General Surgery; Humans; Incidence; Incidental Findings; India - epidemiology; Justify Procedure; Laparoscopic Adrenalectomy; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Retrospective Studies; Surgery; Thoracic Surgery; Treatment Outcome; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-008-9550-8

Background The incidence of adrenal incidentalomas is rising worldwide. There is a concern about malignancy in large incidentalomas. There are few published articles from developing countries on this entity. The aim of this study was to analyze the clinical presentation, functional status, and final diagnosis of adrenal incidentalomas and, in particular, to look into the incidence of adrenal cortical carcinoma (ACC) in large adrenal incidentalomas managed at a tertiary referral hospital in northern India. Methods This is a retrospective study (January 1991–December 2005) of 59 patients with adrenal incidentaloma managed at our department. The mean tumor diameter was 7.8 ± 4.0 cm. In all cases, clinical details, radiology findings, laboratory findings, intervention details, histology findings, and follow-up data were noted. Six patients in which the mass was ultimately found to arise from extra-adrenal tissue were excluded from final analysis Results Mean age of the patients was 46 ± 12 years (M:F = 1:1.1). The incidentaloma measured more than 3 cm in 91% of cases and more than 6 cm in 70% of cases. The clinical scenarios leading to detection of incidentaloma included abdominal (56.6%), genitourinary (24.5%), and systemic complaints (15.1%) and routine medical checkup (3.7%). Most of cases were found by ultrasonography ( n  = 41), and remaining by CT scan ( n  = 10), and MRI ( n  = 2). The incidence of functioning tumors was 41.5% (hypercatecholinism 37.7 % and hypercortisolism 1.9%). Forty-nine patients were operated on. The important final pathology included ACC (7.5%), pheochromocytoma (PCC) (43%), adrenal cysts (13.2%), myelolipoma (11.3%), and inflammatory lesions (9.4%). Conclusion In our experience, the incidence of PCC was high among large adrenal incidentalomas while that of ACC was lower than expected. Inflammatory lesions contribute to a significant number of cases of incidentaloma in developing countries. Adrenalectomy is a justified procedure for large incidentalomas, although the concern may not always be an underlying malignancy.