Presentation and management of patients with adrenal masses: a large tertiary centre experience

Onnicha Suntornlohanakul, Sumedha Mandal, Pratyusha Saha, Emre Sedar Saygili, Miriam Asia, Wiebke Arlt, Yasir Elhassan, Alessandro Prete, Cristina Ronchi*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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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 to 2022. Sub-analysis compares outcomes before and after implementing the 2016 guidelines.
Results: 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 (CT) 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 (ACA, 56.0%), phaeochromocytoma (12.7%), adrenocortical carcinoma (10.6%), and metastases (5.7%). At multivariable analysis, significant predictors of malignancy included HU >20 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.
Original languageEnglish
Article numberlvae131
JournalEuropean Journal of Endocrinology
Early online date19 Oct 2024
DOIs
Publication statusE-pub ahead of print - 19 Oct 2024

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