Presentation and management of patients with adrenal masses: a large tertiary centre experience.
Suntornlohanakul, Onnicha Mandal, Sumedha Saha, Pratyusha Saygili, Emre S Asia, Miriam Arlt, Wiebke Elhassan, Yasir S Prete, Alessandro Ronchi, Cristina L
Suntornlohanakul, Onnicha
Mandal, Sumedha
Saha, Pratyusha
Saygili, Emre S
Asia, Miriam
Arlt, Wiebke
Elhassan, Yasir S
Prete, Alessandro
Ronchi, Cristina L
Abstract
Background: Adrenal masses are found in up to 5%-7% of adults. The 2016 European guidelines on the management of adrenal incidentalomas have standardised the workup of these patients, but evidence of their impact on clinical practice is lacking.
Methods: Retrospective review of clinical presentation, radiological characteristics, and final diagnosis of a large cohort of patients with adrenal masses referred to a tertiary care centre 1998-2022. Sub-analysis compares outcomes before and after implementing the 2016 guidelines.
Results: A total of 1397 patients (55.7% women; median age 60 years [interquartile range {IQR}, 49-70]) were included. Incidental discovery was the most frequent mode of presentation (63.7%) and 30.6% of patients had masses ≥ 4 cm (median 2.9 cm [IQR, 1.9-4.7]). Unenhanced computed tomography Hounsfield units (HU) were available for 763 patients; of these, 32.9% had heterogeneous masses or >20 HU. The most common diagnoses were adrenocortical adenoma (56.0%), phaeochromocytoma (12.7%), adrenocortical carcinoma (10.6%), and metastases (5.7%). At multivariable analysis, significant predictors of malignancy included >20 HU or heterogeneous density (odds ratio [OR] 28.40), androgen excess (OR 27.67), detection during cancer surveillance (OR 11.34), size ≥ 4 cm (OR 6.11), and male sex (OR 3.06). After implementing the 2016 guidelines, the number of adrenalectomies decreased (6.1% pre-2016 vs 4.5% post-2016) and the number of patients discharged increased (4.4% pre-2016 vs 25.3% post-2016) for benign non-functioning adrenal masses.
Conclusion: Implementing the 2016 guidelines positively impacted clinical practice, reducing unnecessary surgeries and increasing the discharge rate for benign adrenal masses, thereby preserving healthcare resources and patient burden.
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Date
2024-10-29
Type
Article
Subject
Endocrinology
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Citation
Suntornlohanakul O, Mandal S, Saha P, Saygili ES, Asia M, Arlt W, Elhassan YS, Prete A, Ronchi CL. Presentation and management of patients with adrenal masses: a large tertiary centre experience. Eur J Endocrinol. 2024 Oct 29;191(5):481-490. doi: 10.1093/ejendo/lvae131. PMID: 39425921.
Journal / Source Title
European Journal of Endocrinology
DOI
10.1093/ejendo/lvae131
PMID
39425921
Publisher
Oxford University Press
Publisher’s URL
https://academic.oup.com/ejendo/