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Is surgery necessary for incidentally discovered adrenal masses in children?
Peter T Masiakos1, J Ted Gerstle, Timothy Cheang
1Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
No guidelines exist for managing incidental adrenal masses (IAM) in children. This study found a high proportion of malignant lesions, recommending resection for all pediatric IAMs due to unpredictable outcomes.
Area of Science:
- Pediatric Endocrinology
- Pediatric Oncology
- Diagnostic Imaging
Background:
- No established guidelines for managing incidental adrenal masses (IAM) in children.
- Need to identify a subset of IAMs suitable for conservative observation.
- Retrospective analysis of pediatric adrenal masses.
Purpose of the Study:
- To determine if a subset of incidental adrenal masses (IAM) in children can be safely observed.
- To evaluate the characteristics and outcomes of pediatric IAMs.
- To inform management strategies for pediatric adrenal lesions.
Main Methods:
- Retrospective analysis of 91 adrenal masses resected or biopsied (1990-2002).
- Definition of IAM: solitary mass without metastases or biochemical activity.
- Inclusion criteria: masses discovered via physical exam or imaging for other indications.
Main Results:
- 26 incidental adrenal masses (IAMs) detected (mean age 4.6 years).
- Pathologic diagnoses included neuroblastoma (7), ganglioneuroma (6), and adrenocortical adenoma (4).
- Eight masses (30.8%) were malignant; no significant difference in size or presentation between benign and malignant lesions.
Conclusions:
- Predicting benign incidental adrenal masses (IAM) in children is challenging.
- A significant proportion of pediatric IAMs are malignant.
- Recommendation for resection of all pediatric incidental adrenal masses (IAMs).
Background:
There are no guidelines that exist to direct the management of incidental adrenal masses (IAM) in children. The aim of this study was to determine if there is a subset of IAMs that could be safely observed.
Methods:
A retrospective analysis was conducted of all adrenal masses that were either resected or biopsied between 1990 and 2002 (n = 91) at the Hospital for Sick Children, Toronto. IAM was defined as a solitary adrenal mass discovered by either physical examination (n = 6; 23.1%) or diagnostic imaging for other indications (n = 20; 76.9%), without metastases or biochemical activity.
Results:
Twenty-six (28.6%) IAMs were detected (mean age, 4.6 years [range, antenatal to 17 years]; 11 boys, 15 girls). Pathologic diagnoses included neuroblastoma (n = 7), ganglioneuroma (n = 6), adrenocortical adenoma (n = 4), adrenal cyst/pseudocyst (n = 3), adrenal hemorrhage (n = 3), ganglioneuroblastoma (n = 1), nodular cortical hyperplasia (n = 1), and teratoma (n = 1). Eight masses were malignant (30.8%). Two of the 5 masses discovered on antenatal ultrasound scan were neuroblastoma. In comparing the benign with malignant lesions, there was no significant difference in mean size (4.8 cm v 4.3 cm; P =.57), radiologic characteristics, or mode of presentation. Benign lesions occurred more frequently in older children (mean age, 6.5 years v 1.3 years; P =.03).
Conclusions:
Clear guidelines cannot be established to predict benign IAM in children. Given the high proportion of malignant lesions, we recommend that all pediatric IAMs should be resected.
