Adrenal Incidentaloma Prevalence and Clinical Management- A Retrospective Study

Authors

  • Waleed Abdalrazig Dosogi Elzain Armed Forces Hospital, Southern Region KSA, Tamniah, Saudi Arabia
  • Abdullah Mohammed Alshalaan Armed Forces Hospital, Southern Region KSA, Tamniah, Saudi Arabia
  • Mohammed Mana Mohammed Al Qahtani Armed Forces Hospital, Southern Region KSA, Tamniah, Saudi Arabia
  • Hind Ali Abdullah Al Qahtani Armed Forces Hospital, Southern Region KSA, Tamniah, Saudi Arabia
  • Dawlah Hadi Assiri Armed Forces Hospital, Southern Region KSA, Tamniah, Saudi Arabia
  • Halimah Hussain Alshehri Armed Forces Hospital, Southern Region KSA, Tamniah, Saudi Arabia
  • Eman Mohammed Alsultan Armed Forces Hospital, Southern Region KSA, Tamniah, Saudi Arabia
  • Fahad Obaid Mohammed Alnamshah Armed Forces Hospital, Southern Region KSA, Tamniah, Saudi Arabia
  • Mohammed Abdullah Salem Alshehri Armed Forces Hospital, Southern Region KSA, Tamniah, Saudi Arabia

DOI:

https://doi.org/10.54536/ajmsi.v3i1.2332

Keywords:

Adrenal Incidentaloma, Adrenal Gland, Cushing’s Syndrome, Diagnosis, Imaging, Surgery, Tumor

Abstract

This study aims to investigate the characteristics and prevalence of adrenal incidentalomas and subsequent clinical practice among patients in Armed Forces Hospital Southern Region -Saudi Arabia, 2021. An observational retrospective study was conducted in Armed Forces Hospital Southern Region -Saudi Arabia on the medical records of 383 consecutive patients. Patients with incidental adrenal tumors who underwent abdominal CT scans with intravenous contrast during the period from January 2013 and December 2021. A total of 300 patients were included in this study. However, the data were analyzed using statistical tests. The results revealed that most patients with adrenal incidentalomas were above 60 (53.3%%). The gender distribution was nearly equal, with 50.3% females and 49.7% males. Most observed tumors were unilateral (96.0%), while a small percentage was bilateral (4.0%). In terms of size, the majority were less than 1 cm (59.0%), followed by sizes greater than 4 cm (31.0%) and 1-4 cm (10.0%). Further analysis indicated that 49.3% were found to have functioning tumors, while 50.7% had non-functioning tumors. The specific types of functioning tumors included non-functioning adrenal adenoma (50.7%), pheochromocytoma (16.9%), Cushing’s syndrome (5.8%), and other functional tumor types (28.0%). Most of these patients were not referred to endocrine clinics. Adrenal incidentalomas are prevalent in the above-60 age group, with most tumors being non-functional. Further research into adrenal incidentalomas associated with diabetes and hypertension is required.

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References

Ahn, S. H., Kim, J. H., Baek, S. H., Kim, H., Cho, Y. Y., Suh, S., Kim, B.-J., Hong, S., Koh, J.-M., & Lee, S. H. (2018). Characteristics of adrenal incidentalomas in a large, prospective computed tomography-based multicenter study: the COAR study in Korea. Yonsei Medical Journal, 59(4), 501-510.

Albano, D., Agnello, F., Midiri, F., Pecoraro, G., Bruno, A., Alongi, P., Toia, P., Di Buono, G., Agrusa, A., & Sconfienza, L. M. (2019). Imaging features of adrenal masses. Insights into imaging, 10(1), 1-16.

Arnaldi, G., & Boscaro, M. (2012). Adrenal incidentaloma. Best practice & research Clinical endocrinology & metabolism, 26(4), 405-419.

Aron, D., Terzolo, M., & Cawood, T. (2012). Adrenal incidentalomas. Best practice & research Clinical endocrinology & metabolism, 26(1), 69-82.

Bancos, I., & Prete, A. (2021). Approach to the patient with adrenal incidentaloma. The Journal of Clinical Endocrinology & Metabolism, 106(11), 3331-3353.

Bhargav, P., Mishra, A., Agarwal, G., Agarwal, A., Verma, A. K., & Mishra, S. K. (2008). Adrenal incidentalomas: experience in a developing country. World journal of surgery, 32, 1802-1808.

Bhat, H. S., & Tiyadath, B. N. (2017). Management of adrenal masses. Indian journal of surgical oncology, 8, 67-73.

Calissendorff, J., Juhlin, C. C., Sundin, A., Bancos, I., & Falhammar, H. (2023). Adrenal cysts: an emerging condition. Nature Reviews Endocrinology, 1-9.

Chatzellis, E., & Kaltsas, G. (2019). Adrenal incidentalomas. Endotext [Internet].

Comlekci, A., Yener, S., Ertilav, S., Secil, M., Akinci, B., Demir, T., Kebapcilar, L., Bayraktar, F., Yesil, S., & Eraslan, S. (2010). Adrenal incidentaloma, clinical, metabolic, follow-up aspects: single centre experience. Endocrine, 37, 40-46.

Crafa, A., Condorelli, R. A., Cannarella, R., Aversa, A., Calogero, A. E., & La Vignera, S. (2022). Physical Examination for Endocrine Diseases: Does It Still Play a Role? Journal of Clinical Medicine, 11(9), 2598.

Cuthbertson, D. J., Alam, U., Davison, A. S., Belfield, J., Shore, S. L., & Vinjamuri, S. (2023). Investigation and assessment of adrenal incidentalomas. Clinical Medicine, 23(2), 135-140.

Demidowich, A. P., Asia, M., & Bertherat, J. (2019). Adrenal Tumours: Adrenocortical Functioning Adenomas, Pheochromocytomas, Incidentalomas, and Adrenocortical Cancer. Advanced Practice in Endocrinology Nursing, 679-704.

Dunn, B. K., Woloshin, S., Kramer, B. S., & Xie, H. (2022). Cancer overdiagnosis: a challenge in the era of screening. Journal of the National Cancer Center.

Farrugia, F., Martikos, G., Surgeon, C., Tzanetis, P., Misiakos, E., Zavras, N., & Charalampopoulos, A. (2017). Radiology of the adrenal incidentalomas. Review of the literature. Endocrine Regulations, 51(1), 35-51.

Fassnacht, M., Arlt, W., Bancos, I., Dralle, H., Newell-Price, J., Sahdev, A., Tabarin, A., Terzolo, M., Tsagarakis, S., & Dekkers, O. M. (2016). Management of adrenal incidentalomas: European society of endocrinology clinical practice guideline in collaboration with the European network for the study of adrenal tumors. European journal of endocrinology, 175(2), G1-G34.

Francis, I. R., & Mayo-Smith, W. W. (2023). Adrenal Diseases. In Diseases of the Abdomen and Pelvis 2023-2026: Diagnostic Imaging (pp. 145-152). Springer.

Griffing, G. T. (2022). Adrenal Incidentaloma Treatment & Management. Medscape.

Grumbach, M. M., Biller, B. M., Braunstein, G. D., Campbell, K. K., Carney, J. A., Godley, P. A., Harris, E. L., Lee, J. K., Oertel, Y. C., & Posner, M. C. (2003). Management of the clinically inapparent adrenal mass (incidentaloma). Annals of internal medicine, 138(5), 424-429.

Higgs, J. A., Quinn, A. P., Seely, K. D., Richards, Z., Mortensen, S. P., Crandall, C. S., & Brooks, A. E. (2022). Pathophysiological link between Insulin resistance and adrenal incidentalomas. International Journal of Molecular Sciences, 23(8), 4340.

Hiraishi, K., Yoshimoto, T., Tsuchiya, K., Minami, I., Doi, M., Izumiyama, H., Sasano, H., & Hirata, Y. (2011). Clinicopathological features of primary aldosteronism associated with subclinical Cushing’s syndrome. Endocrine Journal, 58(7), 543-551.

Ichijo, T., Ueshiba, H., Nawata, H., & Yanase, T. (2020). A nationwide survey of adrenal incidentalomas in Japan: the first report of clinical and epidemiological features. Endocrine Journal, 67(2), 141-152.

Imbroll, M. G., Vassallo, J., & Gruppetta, M. (2020). Approach to adrenal incidentalomas: a review.

Jabarkhel, F. (2019). Adrenal Incidentaloma: Clinical Assessment of 483 Patients between 2014-2018.

Jackson, B. S. (2023). Adrenal Incidentaloma Controversial Size Recommendations. Urology Research and Practice, 49(2), 96.

Jason, D. S., & Oltmann, S. C. (2019). Evaluation of an adrenal incidentaloma. Surgical Clinics, 99(4), 721-729.

Jing, Y., Hu, J., Luo, R., Mao, Y., Luo, Z., Zhang, M., Yang, J., Song, Y., Feng, Z., & Wang, Z. (2022). Prevalence and Characteristics of Adrenal Tumors in an Unselected Screening Population: A Cross-Sectional Study. Annals of internal medicine, 175(10), 1383-1391.

Kahramangil, B., Kose, E., Remer, E. M., Reynolds, J. P., Stein, R., Rini, B., Siperstein, A., & Berber, E. (2022). A modern assessment of cancer risk in adrenal incidentalomas: analysis of 2219 patients. Annals of surgery, 275(1), e238-e244.

Kebebew, E. (2021). Adrenal incidentaloma. New England Journal of Medicine, 384(16), 1542-1551.

KHALIL, M., & ASA, S. L. (2023). Endocrine Pathology Exam Essentials. Pathology Review and Practice Guide, 302.

Kim, J., Bae, K. H., Choi, Y. K., Jeong, J. Y., Park, K. G., Kim, J. G., & Lee, I. K. (2013). Clinical characteristics for 348 patients with adrenal incidentaloma. Endocrinology and Metabolism, 28(1), 20-25.

Korivi, B. R., & Elsayes, K. M. (2013). Cross-sectional imaging work-up of adrenal masses. World journal of radiology, 5(3), 88.

Lyraki, R., & Schedl, A. (2021). Adrenal cortex renewal in health and disease. Nature Reviews Endocrinology, 17(7), 421-434.

Muscogiuri, G., Sorice, G. P., Prioletta, A., Mezza, T., Cipolla, C., Salomone, E., Giaccari, A., Pontecorvi, A., & Della Casa, S. (2011). The size of adrenal incidentalomas correlates with insulin resistance. Is there a cause‐effect relationship? Clinical endocrinology, 74(3), 300-305.

Nieman, L., Speiser, P., & Young, W. F., Jr. (2013). Adrenal Incidentalomas. The Journal of Clinical Endocrinology & Metabolism, 98(8), 37A-38A. https://doi.org/10.1210/jc.2013-v98i8.37A

Reimondo, G., Castellano, E., Grosso, M., Priotto, R., Puglisi, S., Pia, A., Pellegrino, M., Borretta, G., & Terzolo, M. (2020). Adrenal incidentalomas are tied to increased risk of diabetes: findings from a prospective study. The Journal of Clinical Endocrinology & Metabolism, 105(4), e973-e981.

Rowe, N. E., Kumar, R. M., Schieda, N., Siddiqi, F., McGregor, T., McAlpine, K., Violette, P. D., Bathini, V., Eng, M., & Izard, J. (2023). Canadian Urological Association guideline: Diagnosis, management, and followup of the incidentally discovered adrenal mass. Canadian Urological Association Journal, 17(2), 12.

Sada, A., & McKenzie, T. J. (2023). Surgical approaches to the adrenal gland. Current Opinion in Endocrinology & Diabetes and Obesity, 30(3), 161-166.

Samsel, R., Nowak, K., Papierska, L., Karpeta, E., Roszkowska-Purska, K., Smiertka, W., Ostrowski, T., Chrapowicki, E., Grabowski, A., & Leszczyńska, D. (2023). Risk of malignancy in adrenal tumors in patients with a history of cancer. Frontiers in Oncology, 13.

Sancho, J. J., Triponez, F., Montet, X., & Sitges-Serra, A. (2012). Surgical management of adrenal metastases. Langenbeck’s archives of surgery, 397, 179-194.

Schumm, M., Hu, M.-Y., Sant, V., Kim, J., Tseng, C.-H., Sanz, J., Raman, S., Yu, R., & Livhits, M. (2023). Automated extraction of incidental adrenal nodules from electronic health records. Surgery, 173(1), 52-58.

Sconfienza, E., Tetti, M., Forestiero, V., Veglio, F., Mulatero, P., & Monticone, S. (2023). Prevalence of functioning adrenal incidentalomas: a systematic review and meta-analysis. The Journal of Clinical Endocrinology & Metabolism, dgad044.

Şenoğlu, Y., Balık, A. Y., Ediz, E., Yüksel, A., & Baba, D. (2022). The Current Approach for Small Adrenal Masses. Bull Urooncol, 21(3), 80-86.

Serra, C. (2023). Indications for Adrenalectomy. In Posterior Retroperitoneoscopic Adrenalectomy: Indications, Technical Steps and Outcomes (pp. 11-25). Springer.

Shaikh, S., Nagendra, L., Shaikh, S., & Pappachan, J. M. (2023). Adrenal Failure: An Evidence-Based Diagnostic Approach. Diagnostics, 13(10), 1812.

Sherlock, M., Scarsbrook, A., Abbas, A., Fraser, S., Limumpornpetch, P., Dineen, R., & Stewart, P. M. (2020). Adrenal incidentaloma. Endocrine Reviews, 41(6), 775-820.

Spartalis, E., Drikos, I., Ioannidis, A., Chrysikos, D., Athanasiadis, D. I., Spartalis, M., & Avgerinos, D. (2019). Metastatic carcinomas of the adrenal glands: from diagnosis to treatment. Anticancer research, 39(6), 2699-2710.

Suvannarerg, V., Veerasomboonsin, V., & Teerasamit, W. (2018). Normal Adrenal Glands in Multidetector Computed Tomography. Siriraj Medical Journal, 70(6), 502-506.

Sydney, G. I., Ioakim, K. J., & Paschou, S. A. (2019). Insulin resistance and adrenal incidentalomas: a bidirectional relationship. Maturitas, 121, 1-6.

Szychlińska, M., Rzeczkowska, M., Gontarz-Nowak, K., Matuszewski, W., & Bandurska-Stankiewicz, E. (2023). Do Non-Functional Adrenal Adenomas Affect Metabolic Profile and Carotid Intima-Media Thickness? A Single Centre Study from Poland. Journal of Clinical Medicine, 12(14), 4612.

Terzolo, M., Reimondo, G., Chiodini, I., Castello, R., Giordano, R., Ciccarelli, E., Limone, P., Crivellaro, C., Martinelli, I., & Montini, M. (2012). Screening of Cushing’s syndrome in outpatients with type 2 diabetes: results of a prospective multicentric study in Italy. The Journal of Clinical Endocrinology & Metabolism, 97(10), 3467-3475.

Terzolo, M., Stigliano, A., Chiodini, I., Loli, P., Furlani, L., Arnaldi, G., Reimondo, G., Pia, A., Toscano, V., & Zini, M. (2011). AME position statement on adrenal incidentaloma. European journal of endocrinology, 164(6), 851-870.

Van Slycke, S., Van Den Heede, K., & Vandenwyngaerden, E.-A. (2022). Adrenal Glands: Anatomy, Physiology, and Pathophysiology. In Endocrine Surgery Comprehensive Board Exam Guide (pp. 437-455). Springer.

Vilela, L. A., & Almeida, M. Q. (2017). Diagnosis and management of primary aldosteronism. Archives of endocrinology and metabolism, 61, 305-312.

Wale, D. J., Wong, K. K., Viglianti, B. L., Rubello, D., & Gross, M. D. (2017). Contemporary imaging of incidentally discovered adrenal masses. Biomedicine & Pharmacotherapy, 87, 256-262.

Yilmaz, N., Avsar, E., Tazegul, G., Sari, R., Altunbas, H., & Balci, M. K. (2021). Clinical characteristics and follow-up results of adrenal incidentaloma. Experimental and Clinical Endocrinology & Diabetes, 129(05), 349-356.

Zeiger, M. A., Siegelman, S. S., & Hamrahian, A. H. (2011). Medical and surgical evaluation and treatment of adrenal incidentalomas. The Journal of Clinical Endocrinology & Metabolism, 96(7), 2004-2015.

Zuber, S. M., Kantorovich, V., & Pacak, K. (2011). Hypertension in pheochromocytoma: characteristics and treatment. Endocrinology and Metabolism Clinics, 40(2), 295-311.

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Published

2024-01-24

How to Cite

Dosogi Elzain, W. A., Alshalaan, A. M., Al Qahtani, M. M. M., Al Qahtani, H. A. A., Assiri, D. H., Alshehri, H. H., Alsultan, E. M., Alnamshah, F. O. M., & Salem Alshehri, M. A. (2024). Adrenal Incidentaloma Prevalence and Clinical Management- A Retrospective Study. American Journal of Medical Science and Innovation, 3(1), 8–17. https://doi.org/10.54536/ajmsi.v3i1.2332