Evaluation and surgical outcome of Adrenal Incidentalomas: Surgical Outcome of Adrenal Incidentalomas

Abstract

Objective: To observe the presentation, radiological and endocrine evaluation, and management of incidentally discovered adrenal masses at our institution.

Study Design: Retrospective

Place and duration:  Study was conducted at Agha Khan University Hospital Karachi from July 1988 and December 2011.

Methodology:  Case records of patients undergoing adrenalectomy from July 1988 to December 2011 were reviewed. Patients with known or suspected adrenal disease prior to imaging were excluded. The clinical presentation, demographic data, preoperative workup and preoperative clinical diagnosis was reviewed and compared with the final histopathological diagnosis.  

Results: Out of 56 patients undergoing adrenalectomy, 23 had an adrenal incidentalomas (AI) which includes 14 males and 9 females. The mean age was 40 (± 14) years. Mean size of the adrenal mass was 6 (± 6) cm.  Incidenataloma was detected on ultrasound in 12 patients, CT scan in 10 patients, and MRI in 1 patient. Twenty patients (87 %,) underwent biochemical evaluation, including urinary Vanillylmandelic acid (VMA) level in 15, serum cortisol in 10 and aldosterone level in 7. 

Conclusion: Complete metabolic workup in essential in all patients with incidentally detected adrenal mass. Although malignancy is a valid concern in >4cm adrenal mass, the possibility of subclinical functioning adrenal adenoma or pheochromocytoma should not be ignored.