Related Experiment Video
Updated: May 13, 2026
A Novel Method: Super-selective Adrenal Venous Sampling
Published on: September 15, 2017
Presentation and Clinical Patterns of Bilateral Adrenal Lesions: A Retrospective Cohort Study
Haibo Lu1,2, Eishvauk Aggarwal2, Alaaeldin Y Hodhod2
1Luoyang Key Laboratory of Clinical Multiomics and Translational Medicine, Key Laboratory of Hereditary Rare Diseases of Health Commission of Henan Province, Henan Key Laboratory of Rare Diseases, Endocrinology and Metabolism Center, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, 471003, China.
Context:
The clinical relevance of etiologic concordance and temporal presentation in bilateral adrenal masses remains poorly defined, creating uncertainty in diagnostic evaluation and management.
Objective:
To characterize the etiologic spectrum of bilateral adrenal masses, evaluate patterns by concordance and synchronicity, and identify predictors of discordance and malignant or pheochromocytoma contralateral lesions.
Design:
Retrospective cohort study (2010-2025).
Setting:
Tertiary referral center.
Participants:
Adults with bilateral adrenal masses.
Main Outcome Measures:
Etiology, concordance, synchronicity, interval to contralateral lesion, and factors associated with discordance and malignant or pheochromocytoma contralateral lesions.
Results:
Among 1,035 patients (median age 59.6 years; 51% women), 85% had concordant and 15% discordant etiologies. Concordant cases were predominantly bilateral benign cortical lesions (76%), whereas discordant cases were heterogeneous (benign 35%, malignant 31%, indeterminate 34%). Presentation was synchronous in 84% and asynchronous in 16%, with a median interval of 45 months (IQR 15-87). Asynchronous disease was associated with higher discordance (23% vs 13%, P=0.001) and greater prevalence of malignant lesions (bilateral malignant: 17% vs 7%; discordant malignant: 8% vs 4%; overall P<0.001). Among asynchronous cases, shorter interval to contralateral lesion (<2 vs ≥5 years) was independently associated with malignant or pheochromocytoma etiology (adjusted OR 2.63, 95% CI 1.01-6.85), as was larger tumor size (adjusted OR 1.06 per mm, 95% CI 1.02-1.09).
Conclusions:
Most bilateral adrenal masses are benign and concordant; however, discordant or asynchronous disease identifies a higher-risk subgroup enriched for malignancy. Early contralateral lesion development and larger tumor size are key risk factors.
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