EVALUATION OF HORMONAL FUNCTION IN A SERIES OF INCIDENTALLY DISCOVERED ADRENAL MASSES

The discovery of an asymptomatic adrenal mass (incidentaloma) during t he investigation of an unrelated condition is relatively common. In th is study, we report the clinical, radiologic, and endocrine evaluation of 38 patients (22 women and 16 men aged 24 to 84 years) with adrenal incidentaloma (size, 1 to 12 cm). The patients underwent basal and dy namic evaluation of the hypothalamic-pituitary-adrenal (HPA) axis, ren in-angiotensin-aldosterone system, and adrenomedullary function. Moreo ver, computed tome grapy (CT) scan and I-131-6 beta-iodomethyl-19-norc holest-5(10)-en-3 beta-ol (NP-59) and/or I-131-metaiodobenzylguanidine (MIBG) scintigraphy were performed. The endocrine evaluation indicate d two cases of pheochromocytoma and four cases of preclinical Gushing' s syndrome, three of which underwent surgery with histologic diagnosis of two adrenocortical adenomas and one carcinoma. Low levels of serum dehydroepiandrosterone sulfate (DHEA-S), associated with a markedly i ncreased 17-hydroxyprogesterone (17-OHP) response to a corticotropin ( ACTH) test, were found in patients with incidentaloma. On the basis of endocrine and morphologic data, 13 patients underwent surgical treatm ent: five adrenocortical adenomas (two functioning), two pheochromocyt omas, two ganglioneuromas, one cortisol-secreting adrenal carcinoma, o ne lymphangiomatous cyst, one myelolipoma, and one hemorrhage were fou nd. Careful diagnostic assessment of incidentally discovered adrenal m asses must be performed to exclude the presence of malignant and/or fu nctioning lesions and to verify the possibility that patients with inc identaloma have a genetic or acquired deficit of adrenal steroidogenic activity. Copyright (C) 1997 by W.B. Saunders Company