Jawanjal Abhijeet B, Sadananda Siddarth, Sriramaneni Nikitha, Ganavi Y P, Kalra Pramila, Selvan Chitra, Manjunath P R, Shetty Praneethi K
Department of Endocrinology, Ramaiah Medical College, Bengaluru, Karnataka, India.
Ann Afr Med. 2024 Oct 1;23(4):567-574. doi: 10.4103/aam.aam_212_23. Epub 2024 Aug 19.
Adrenal incidentalomas (AIs) are relatively uncommon neoplasms in 2% of apparently healthy individuals requiring evaluation for functionality and malignancy.
We aimed to study the clinical, biochemical, and radiological profiles of patients presenting with AI and histopathological outcomes of those undergoing adrenalectomy. Materials and Methods: This retrospective study enrolled 62 AI patients attending a tertiary care center in South India between January 2016 and October 2023. Demographic details, radiological features, functionality, and histopathological data were analyzed.
Out of 62 patients, total masses evaluated were 65 indicating bilaterality in 3 patients. The female: male ratio was 1.69, with a median age of 55 years (interquartile range: 44-64 years). 45.1% of individuals were >60 years. The most common indication for imaging was pain abdomen in 43 (69.4%). The median size was 3.2 cm. Fifty-five (88.7%) were assessed for functionality and 27 (49.1%) were functional. Among the 62 individuals, 14 (20.2%) had hypercortisolism, 11 (15.9%) had pheochromocytoma, 5 (7.24%) had primary hyperaldosteronism (PA), and 4 (5.7%) had hyperandrogenism including plurihormonal in 7. A mass size of 3.2 cm was of great value in distinguishing functional tumors with a sensitivity of 72% and specificity of 66% with an area under the curve of 0.682. A total of 34 (54.8%) patients underwent adrenalectomy. On histopathological examination, Adenoma (44.1%) was the most common followed pheochromocytoma (26.5%), adrenal cysts (8.8%), and Myelolipoma (5.9%). Two (5.9%) incidentalomas were adrenocortical carcinoma (ACC). Eight (53.3%) adenomas were functional with 6 having hypercortisolism (including 1 with hyperandrogenism) and 2 with PA.
In our experience, the incidence of pheochromocytoma was second most common after adenoma. Since most functional tumors (60%) and all ACCs were ≥4 cm, a thorough biochemical evaluation for hormonal excess and evaluation for malignancy followed by surgery should be considered for lesions, especially ≥4 cm. Thus, we report the baseline demographic and clinical characteristics of patients with AI from a single center in South India.
肾上腺偶发瘤（AIs）是相对罕见的肿瘤，在2%表面健康但需要评估功能和恶性程度的个体中出现。
我们旨在研究肾上腺偶发瘤患者的临床、生化和放射学特征，以及接受肾上腺切除术患者的组织病理学结果。材料与方法：这项回顾性研究纳入了2016年1月至2023年10月在印度南部一家三级医疗中心就诊的62例肾上腺偶发瘤患者。分析了人口统计学细节、放射学特征、功能和组织病理学数据。
62例患者中，共评估了65个肿块，表明3例为双侧性。女性与男性比例为1.69，中位年龄为55岁（四分位间距：44 - 64岁）。45.1%的个体年龄>60岁。最常见的影像学检查指征是43例（69.4%）的腹痛。中位大小为3.2厘米。55例（88.7%）进行了功能评估，27例（49.1%）有功能。在62例个体中，14例（20.2%）有皮质醇增多症，11例（15.9%）有嗜铬细胞瘤，5例（7.24%）有原发性醛固酮增多症（PA），4例（5.7%）有雄激素过多症，其中7例为多激素性。3.2厘米的肿块大小在区分功能性肿瘤方面具有重要价值，敏感性为72%，特异性为66%，曲线下面积为0.682。共有34例（54.8%）患者接受了肾上腺切除术。组织病理学检查显示，腺瘤（44.1%）最常见，其次是嗜铬细胞瘤（26.5%）、肾上腺囊肿（8.8%）和髓脂肪瘤（5.9%）。2例（5.9%）偶发瘤为肾上腺皮质癌（ACC）。8例（53.3%）腺瘤有功能，其中6例有皮质醇增多症（包括1例有雄激素过多症），2例有PA。
根据我们的经验，嗜铬细胞瘤的发病率在腺瘤之后排第二。由于大多数功能性肿瘤（60%）和所有ACC均≥4厘米，对于尤其是≥4厘米的病变，应考虑进行全面的激素过量生化评估和恶性程度评估，然后进行手术。因此，我们报告了印度南部一个单一中心肾上腺偶发瘤患者的基线人口统计学和临床特征。
