[Which adrenal incidentalomas are to be operated?]

Area of Science:

• Endocrinology
• Surgical Oncology
• Radiology

Background:

• Adrenal incidentalomas are adrenal masses discovered incidentally during imaging for other conditions.
• A significant proportion of these masses may be hormonally active or malignant, challenging initial diagnosis.
• Reliable criteria are needed to differentiate benign from potentially harmful adrenal tumors.

Purpose of the Study:

• To determine the incidence of symptomatic or hormone-secreting tumors misclassified as incidentalomas.
• To evaluate the diagnostic accuracy of existing criteria for adrenal tumors found incidentally.
• To assess the reliability of imaging and clinical factors in differentiating benign from malignant adrenal masses.

Main Methods:

• Retrospective analysis of 147 patients who underwent surgery for adrenal masses ≥3 cm on CT scan.
• Correlation of clinical, laboratory, hormonal, and imaging data (CT, MRI, scintigraphy) with operative and histologic findings.
• Comparison of traditional open surgery versus video-endoscopic techniques.

Main Results:

• 28% of tumors were reclassified as false incidentalomas (symptomatic/hormone-secreting) postoperatively.
• In the remaining 72%, 10 were malignant, 2 were pheochromocytomas, and 94 were benign.
• Tumor size, growth rate, and radiological appearance were unreliable predictors of malignancy.

Conclusions:

• Only tumors of indeterminate and non-specific nature should be classified as incidentalomas.
• Imaging and clinical criteria are insufficient for differentiating benign from malignant adrenal tumors.
• Surgical excision of adrenal tumors ≥3 cm is recommended due to the risk of malignancy or pheochromocytoma.
• Video-endoscopic adrenalectomy is a viable alternative for experienced centers.