Presentation and management of patients with adrenal masses: a large tertiary centre experience
File(s)
Published version
Author(s)
Type
Journal Article
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.
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.
Date Issued
2024-11
Date Acceptance
2024-10-17
Citation
European Journal of Endocrinology, 2024, 191 (5), pp.481-490
ISSN
0804-4643
Publisher
Oxford University Press
Start Page
481
End Page
490
Journal / Book Title
European Journal of Endocrinology
Volume
191
Issue
5
Copyright Statement
© The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Endocrinology.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and
reproduction in any medium, provided the original work is properly cited.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and
reproduction in any medium, provided the original work is properly cited.
License URL
Identifier
http://dx.doi.org/10.1093/ejendo/lvae131
Publication Status
Published
Date Publish Online
2024-10-19