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 "however" symptom

adrenal incidentaloma

alexander disease

alpha-thalassemia

aromatase deficiency

benign recurrent intrahepatic cholestasis

cushing syndrome

dedifferentiated liposarcoma

dracunculiasis

dystrophic epidermolysis bullosa

esophageal carcinoma

focal myositis

heparin-induced thrombocytopenia

hodgkin lymphoma, classical

hydrocephalus with stenosis of the aqueduct of sylvius

junctional epidermolysis bullosa

krabbe disease

lamellar ichthyosis

megacystis-microcolon-intestinal hypoperistalsis syndrome

monosomy 21

neuralgic amyotrophy

oculocutaneous albinism

omenn syndrome

primary hyperoxaluria type 1

pyruvate dehydrogenase deficiency

sneddon syndrome

thoracic outlet syndrome

von hippel-lindau disease

wiskott-aldrich syndrome

x-linked adrenoleukodystrophy

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