Adrenal incidentalomas-seven years follow-up
Adrenal Incidentalomas
Abstract
Objectives. This study was conducted to evaluate morphological and functional features of adrenal incidentalomas (AI) seven years after initial diagnosis.
Patients and methods. Thirty-eight AI patients were monitored for seven years, with CT scans used for morphological follow-up. Hormonal activity assessments included basal cortisol levels, adrenocorticotropic hormone, overnight dexamethasone suppression test, plasma or urinary metanephrines, vanillymandelic acid, electrolytes, hematocrit, acid-base status, oral glucose tolerance test, and chromogranin A.
Results: Functional activity was confirmed in 6 patients, with mild autonomous cortisol secretion (MACS) detected in 2. Nine patients underwent adrenalectomy. Histopathological examination revealed hormonal activity in 6 cases, adrenocortical carcinoma in one, and secondary deposits from bronchial carcinoma in another. Among the remaining 29 patients observed for the first year, tumor size remained stable. After seven years, two patients experienced tumor enlargement ≥1 cm, along with the development of MACS on endocrine evaluation. Adrenalectomy was recommended for one patient due to tumor size exceeding 4 cm.
Conclusion: Initial AI evaluation must include comprehensive diagnostic procedures for surgical consideration. Subsequent follow-up should include CT imaging after 12 months to monitor tumor growth. Although mild autonomous cortisol secretion doesn't tend to progress to overt Cushing syndrome, it can develop in patients initially considered to have hormonally inactive tumor. Our findings suggest that even small adrenal masses (< 4cm) can enlarge over seven years, potentially evolving into MACS. Therefore, regular long-term monitoring every 5-7 years is recommended.
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