Limited significance of repeated long-term radiological and hormonal examination in nonfunctioning adrenal incidentalomas

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0235


ORIGINAL ARTICLE

Masayuki Tasaki 1, Takashi Kasahara 1, Itsuhiro Takizawa 1, Kazuhide Saito 1, Tsutomu Nishiyama 1, Yoshihiko Tomita 1
1 Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan

ABSTRACT

Purpose: The purposes of the present study were to evaluate growth rate of nonfunc¬tioning adrenal incidentalomas (AIs) and their development to hormonal hypersecre¬tion on follow-up.
Materials and methods: A retrospective study was conducted from the electronic medi¬cal records. A total of 314 patients were diagnosed with adrenal tumors between 2000 and 2016. After excluding patients who had overt adrenal endocrine disorders or whose adrenal tumors were clinically diagnosed as metastatic malignancies, we investigated 108 patients with nonfunctioning AIs including characteristics, the treatment, the way of follow-up and pathology.
Results: Fifteen patients received immediate adrenalectomy because of the initial tu¬mor size or patient’s preference. Pathological examination revealed malignancy in 2 patients. In the remaining 93 patients, radiological examinations were performed periodically. Tumor enlargement of ≥ 1.0cm was observed in 8.6% of the patients who were followed up as nonfunctioning AIs with a median follow-up period of 61.5 months (range: 4-192). Eleven patients underwent adrenalectomy. On the pathologi¬cal examinations, all of the tumors, which showed a size increase, were diagnosed as benign tumors. Regarding the followed up patients without adrenalectomy, only 2.4% of the patients had tumor enlargement during the prolonged follow-up. Furthermore, none of the patients developed hormonal hypersecretion or clinical signs such as obe¬sity, glucose intolerance or poorly controlled hypertension.
Conclusions: Tumor enlargement of AIs did not correlate with malignancy. The value of repeat radiological and hormonal examinations may be limited in the long-term follow-up of patients whose AIs are not enlarged.

Keywords: Adrenal incidentaloma [Supplementary Concept]; Adrenalectomy; Radiology

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