CAN ADRENAL INCIDENTALOMAS BE SAFELY OBSERVED

We currently recommend excision of adrenal incidentalomas greater than or equal to 4 cm in size and all hormonally active tumors. The optima l management and follow-up of smaller nonfunctioning tumors are contro versial. The aim of this study was to determine the clinical outcome o f a well defined population of patients with incidentalomas followed w ithout operative intervention, The study group comprised 231 patients, identified from the records of abdominal or thoracic computed tomogra phic (CT) scans performed between 1985 and 1989. The primary outcome v ariable analyzed was survival. Follow-up was obtained by office record s, telephone contact, or letter, There were 101 male and 130 female pa tients with a mean age at diagnosis of 64 years (range 5-86 years). Mo st adrenal tumors were unilateral (right 113; left 98); 20 were bilate ral. Mean tumor size was 2 cm (range 1-6 cm), In nine (4%) patients th e tumor was greater than or equal to 4 cm, Follow-up [mean 7 years; ra nge 1 month (patient died) to 11.7 years] was complete in 224 (97%) pa tients. Ninety-one (39%) patients had one or more additional CT scans performed during the follow-up period, with only four patients demonst rating a > 1 cm increase in the size of the adrenal mass, Surgical exc ision of these four lesions identified benign pathology. Eighty-one (3 5%) patients died of conditions unrelated to adrenal pathology. No pat ient developed subsequent adrenal hyperfunction or adrenal malignancy. Within the context of our guidelines, conservative management of adre nal incidentalomas considered benign or nonfunctioning at diagnosis is appropriate. Additional information provided by repeat CT scanning ap pears to confer limited benefit. This study does not support laparosco pic removal of small, nonfunctional adrenal tumors, as has been sugges ted.