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[Adrenal incidentaloma: proposal for a correct treatment]
G Favia1, F Lumachi, M Gregianin
1Istituto di Clinica Chirurgica Generale I Università degli Studi di Padova.
Annali Italiani Di Chirurgia
|July 1, 1997
Summary
Adrenal incidentalomas, or unsuspected adrenal masses, are increasingly found. A scoring system helps identify patients needing adrenalectomy due to higher malignancy rates in these masses.
Area of Science:
- Endocrinology
- Oncology
- Radiology
Background:
- The incidence of adrenal incidentalomas detected via CT scans is rising.
- Adrenal incidentalomas require clear management guidelines due to potential malignancy.
Purpose of the Study:
- To establish management guidelines for adrenal incidentalomas.
- To identify criteria for appropriate patient selection for adrenalectomy.
Main Methods:
- Retrospective analysis of 61 patients with adrenal incidentalomas (>1 cm) from 1986-1995.
- Evaluated patients through biochemical tests, CT-guided fine-needle biopsy (FNAB), 75-Se-selenomethyl-norcholesterol scintigraphy, and MRI.
- A management score was calculated based on patient age, mass size, scintigraphy, and MRI findings.
Main Results:
- Malignancy was found in 12 (26.7%) of adrenal incidentalomas.
- A significant difference in management scores was observed between malignant (12.17 ± 2.95) and benign (9.09 ± 1.33) masses (p < 0.01).
- Adrenalectomy was performed in 45 patients, guided by the score or specific indications like size increase or suspected malignancy.
Conclusions:
- Adrenal incidentalomas have a higher malignancy rate than other adrenal tumors.
- A scoring system incorporating age, size, scintigraphy, and MRI can aid in risk stratification.
- Patients with a score greater than 9 are recommended for adrenalectomy.