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Risk of concomitant malignancy in hyperfunctioning adrenal incidentalomas.
[adrenal incidentaloma]
Adrenal
masses
are
common
incidental
findings
on
radiologic
imaging
.
The
association
between
malignancy
and
hormonal
hyperactivity
found
in
incidentally
discovered
adrenal
tumors
,
however
,
remains
unclear
.
A
retrospective
analysis
of
prospectively
collected
data
from
patients
who
underwent
adrenalectomy
for
incidentally
discovered
adrenal
tumors
at
a
single
institution
.
Outcomes
and
operative
data
were
compared
by
univariate
analysis
.
Area
under
the
curve
was
used
to
analyze
the
effect
of
tumor
size
in
predicting
malignancy
.
There
were
49
patients
who
initially
presented
with
adrenal
incidentalomas
that
underwent
adrenalectomy
.
Most
patients
were
Caucasian
women
with
an
average
age
of
51
±
14
years
.
Of
this
group
,
24
patients
underwent
resection
for
hyperfunctioning
adrenal
glands
.
There
were
no
significant
differences
in
malignancy
rates
between
hyperfunctional
and
nonfunctional
tumors
(
4
.
1
%
vs
.
12
.
0
%
,
P
=
0
.
32
)
.
On
final
histopathology
,
there
were
four
patients
with
adrenal
malignancies
:
two
adrenocortical
carcinomas
and
two
metastatic
from
renal
carcinoma
.
Only
one
patient
with
a
hyperfunctioning
adrenal
tumor
had
underlying
malignancy
.
Overall
,
invasion
of
adjacent
structures
(
P
<
0
.
001
)
,
presence
of
lymphadenopathy
(
P
=
0
.
02
)
,
metastasis
(
P
=
0
.
03
)
,
irregular
tumor
margins
(
P
=
0
.
01
)
,
heterogeneity
(
P
=
0
.
05
)
,
and
tumor
size
>
6
cm
(
P
=
0
.
04
)
on
radiologic
imaging
were
strongly
associated
with
malignancy
in
adrenal
incidentalomas
.
The
risk
of
concomitant
malignancy
and
hormonal
hyperactivity
in
adrenal
incidentalomas
is
very
low
.
Tumor
size
(
>
6
cm
)
and
radiographic
features
remain
the
most
important
predictors
of
adrenal
malignancy
,
regardless
of
tumor
function
.
Diseases
Validation
Diseases presenting
"adrenocortical carcinomas"
symptom
adrenal incidentaloma
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