Many faces of adrenal lesions in a large patient cohort: What has changed over the last two decades?
Exp Clin Endocrinol Diabetes 2023;
131:242-250. [PMID:
36787883 DOI:
10.1055/a-2035-6091]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVE
To review the presentation characteristics, clinical and hormonal evaluations, and histopathological results of patients with adrenal lesions over a period of 21 years and to evaluate the changes across the two decades.
METHODS
This single-center, retrospective study included 1003 patients with adrenal lesions who presented to our department between the years of 2000 and 2021. Clinical, metabolic, hormonal, radiological, and pathological data of the patients were collected.
RESULTS
Forty-seven percent of the lesions were non-functioning adrenal adenomas. Possible autonomous cortisol secretion and autonomous cortisol secretion were detected in 22.2% of the patients. The percentages of the patients diagnosed with pheochromocytoma, primary hyperaldosteronism, adrenal Cushing syndrome, adrenocortical carcinoma, and adrenal metastasis were 7.4%, 4.8%, 4.7%, 0.9%, and 5.6%, respectively. Adrenalectomy was performed in 31.3% of the patients. Functional adrenal lesions were the leading cause of surgery (46.5%), followed by large size and/or suspicious imaging features (38.6%). Among the patients referred to surgery due to large size (6 cm), 19% had a diagnosis of metastasis and 12.1% had a diagnosis of primary adrenocortical carcinoma. In patients with adrenal lesions with a size of 4-6 cm and suspicious imaging properties, the rates of metastasis and primary adrenocortical carcinoma were 44.4% and 4.8%, respectively. From the first to the second decade, major differences in presentation characteristics were the increased detection of bilateral lesions and increased prevalence of possible autonomous cortisol secretion and autonomous cortisol secretion.
CONCLUSIONS
Adrenal lesions are common in the adult population, and while it is important to avoid overtreatment, hormone secretion and malignancy should not be overlooked.
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