Adrenal Incidentaloma Needs thorough Biochemical Evaluation - An Institutional Experience

Area of Science:

• Endocrinology
• Radiology
• Pathology

Background:

• Adrenal incidentalomas (AIs) are common findings in asymptomatic individuals, necessitating thorough evaluation for hormonal activity and malignancy.
• Guidelines from the European Society of Endocrinology and the European Network for the Study of Adrenal Tumors inform AI management.

Purpose of the Study:

• To analyze the clinical, biochemical, and imaging features of patients with adrenal incidentalomas.
• To correlate diagnostic findings with histopathology in surgically treated patients.

Main Methods:

• Retrospective observational study of 48 patients with adrenal incidentalomas (January 2017-January 2021).
• Evaluation included imaging, hormonal assays, and biopsy results.
• Diagnosis was based on imaging, hormonal status, and histopathology.

Main Results:

• Myelolipoma was the most common diagnosis (16 cases), followed by pheochromocytoma (10) and adenoma (9).
• Nineteen patients had hormone-secreting masses; two pheochromocytomas were normotensive.
• Discordance between imaging and hormonal status occurred in two cases; one patient presented with extramedullary erythropoiesis, sickle cell anemia, and adrenal insufficiency.

Conclusions:

• Highlights the potential for discrepancy between non-contrast CT findings and the functional status of adrenal incidentalomas.
• Underscores the rare possibility of extramedullary erythropoiesis presenting as AI, leading to adrenal insufficiency.
• Recommends specific evaluations for rare possibilities in AI cases based on clinical presentation.