INCIDENTALLY DETECTED ADRENAL-TUMORS (INCIDENTALOMAS) - HISTOLOGICAL HETEROGENEITY AND DIFFERENTIATED THERAPEUTIC APPROACH

Objectives. To find a differentiated therapeutical approach to inciden talomas.Design. Prospective study of incidentalomas: their histology, hormonal activity, and growth if primarily non-operated. Setting. Admi ssions to an academic tertiary care centre because of incidentaloma. P atients. Thirty-eight female, 25 male, 27-85 years old. Interventions. Ultrasound, computed tomography and adrenal scintigraphy when appropr iate; investigations to exclude malignancy giving metastasis into the adrenal gland; ACTH, cortisol, aldosterone, renin activity, androgene, catecholamine measurements; surgery or follow-up. Main outcome measur es, Rate of malignancy; link age of tumour size to probability of mali gnancy; prevalence of tumours with subtle hormone excess. Results. Cor tical adenomas occurred in 13/31, metastases in 7/31 of the histologic ally confirmed cases. In 10/31 cases, the computed tomography indicate d a size that was smaller than the pathological size (mean = 20 mm). 2 0.6% of all incidentalomas and 61.5% of the 13 operated corticol adeno mas showed subtle hormonal activity. Twenty-seven incidentalomas < 30 mm were followed-up (3-41 months; mean 18 months) and showed growth in only one case. Sensitivity, specificity, and predictive value (PV) of a tumour greater than or equal to 30 mm to indicate malignancy were: 1.0, 0.56 and 0.27, respectively. The PV of a < 30 mm tumour to exclud e malignancy was 1.0. Conclusions. Oncological screening tests are nec essary in all incidentalomas. Tumours greater than or equal to 30 mm s hould be operated but smaller ones can be followed-up, because they ar e usually benign and rarely show progressive growth. Cortical adenomas with subtle hormonal overproduction and hypertension, diabetes or ost eoporosis should be operated, irrespective of their size, but in the a bsence of relevant clinical symptoms they can be followed-up.