Outcome of non-operated adrenal masses in 126 patients observed from 1986 to 1999.

Study aim: CT scan performed for non-adrenal related symptoms detects an ad renal mass or 'incidentaloma' in 0.4 to 4.3% of cases, and most authors adv ocate a non-operative policy, after minimal but careful work-up aimed at ex cluding pheochromocytoma and aldosteronoma. The breakthrough of laparoscopi c adrenalectomy has led some to challenge this attitude. This retrospective study focused on the outcome of non-operated adrenal masses. Patients and method: From 1986 through 1999, 126 patients (64 men and 62 wo men) presented with an incidental mass of the adrenal fossa, and a non-surg ical attitude was elicited. Mean size was 36.5 mm in diameter. All patients underwent an in-depth clinical, biochemical and imaging work-up. They have been stratified into two groups: group I: no contraindication to surgery ( n = 95); and group II: contraindication to surgery (frail patients, invasiv e adrenal or metastatic extra-adrenal cancer) (n = 31). Results: With a mean follow-up of 4.3 years, 17 patients were lost to follo w-up (13.5%), including 11/95 in group I; 36 were dead (28.5%), including 1 2/95 in group I (no adrenal-related death) and 24/31 in group II; 72 were a live and well without operation, including only one in group II; one patien t was operated for a benign adrenal adenoma removed at the time of surgery for aortic aneurysm. Conclusion: Careful clinical, biochemical, imaging and nor-iodo-cholesterol scintigraphy with definite uptake by the adrenal mass, a strong indicator of benignancy, allows surgical indication to be postponed, and is likely to cancel it if, at one-year follow-up, imaging studies show no change in the mass. (C) 2001 Editions scientifiques et medicales Elsevier SAS.