Adrenal incidentalomas: A seven-year follow-up single-center experience

Abstract

Introduction/Aim. Adrenal incidentalomas (AIs) are defined as tumours revealed during imaging procedures of abdomen or abdominal laparotomy, performed in patients without previous suspicion for adrenal disease. This study was conducted to evaluate morphological and functional features of AIs seven years after the initial diagnosis. Patients and methods. Thirty-eight AI patients were monitored for seven years, with CT scans used for morphological follow-up. Hormonal activity assessments included basal cortisol levels, adrenocorticotropic hormone, overnight Dexamethasone suppression test, plasma or urinary metanephrines, vanillymandelic acid, electrolytes, hematocrit, acid-base status, oral glucose tolerance test, and chromogranin A. Results. Functional activity was confirmed in six patients, with mild autonomous cortisol secretion (MACS) detected in two patients. Nine patients underwent adrenalectomy. Histopathological examination revealed hormonal activity in six cases, adrenocortical carcinoma was found in one patient, while secondary deposits from bronchial carcinoma were detected in one patient. Among the remaining 29 patients observed for the first year, tumor size remained stable. After seven years, two patients experienced tumor enlargement ≥ 1 cm, along with the development of MACS on endocrine evaluation. Adrenalectomy was recommended for one patient due to tumor size exceeding 4 cm. Conclusion. The initial adrenal incidentaloma (AI) evaluation must include comprehensive diagnostic procedures for surgical consideration. Subsequent follow-up should include CT imaging after 12 months to monitor the tumor growth. Although mild autonomous cortisol secretion does not tend to progress to overt Cushing's syndrome, it can develop in patients initially considered to have hormonally inactive tumor. Our findings suggest that even small adrenal masses (< 4 cm) can enlarge over seven years, potentially evolving into MACS. Therefore, regular long-term monitoring every 5 - 7 years is recommended.