Original ArticleChange in Adrenal Mass Size as a Predictor of a Malignant Tumor
Section snippets
INTRODUCTION
The development of modern imaging techniques such as ultrasonography, computed tomography (CT), and magnetic resonance imaging has led to the detection of adrenal masses in patients with increasing frequency. Adrenal masses are found in up to 5% of patients undergoing CT scans of the abdomen (1., 2., 3., 4., 5.).
Whatever the reason for the discovery of an adrenal mass, one must determine whether the mass is functional or malignant (or both). Functionality or malignancy usually necessitates
PATIENTS AND METHODS
The data for this retrospective review study were extracted from an adrenal database approved by the Cleveland Clinic Institutional Review Board.
RESULTS
The baseline categorical and continuous variables of patients who underwent adrenalectomy or biopsy from 1997 to 2008 at the Cleveland Clinic and had 2 or more imaging studies, performed more than 2 months apart, are shown in Table 1 and Table 2, respectively. The 132 study subjects, when compared with the 740 patients in the database, were found to be older (mean ± SD) (57.4 ± 13.1 years versus 54.5 ± 15.0 years; P = .04), have more nonfunctional masses (50.0% versus 27.7%; P < .001), and have a
CONCLUSION
In the current study, the largest with histopathology results as the criterion standard for diagnosis, change in adrenal mass size on serial imaging was a statistically significant predictor of a malignant lesion, with the absolute growth cut point of 0.8 cm during a follow-up period of 3 to 12 months yielding the highest sum of sensitivity and specificity. We were unable, however, to identify a growth cut point, for a given growth measure, that provided 100% sensitivity or specificity for
ACKNOWLEDGMENT
We thank James Bena and Anne Tang from the Department of Biostatistics, Cleveland Clinic, and Dr. Shikhar Agarwal, from the Medicine Institute, Cleveland Clinic, for their skillful help with statistical analysis and preparation of the figures. Some of this material was presented at the 91st Annual Meeting of The Endocrine Society; June 10-13, 2009; Washington, DC, and subsequently published in abstract form by them.
DISCLOSURE
The authors have no multiplicity of interest to disclose.
REFERENCES (33)
- et al.
American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons medical guidelines for the management of adrenal incidentalomas: executive summary of recommendations
Endocr Pract
(2009) - et al.
Evaluation of hormonal function in a series of incidentally discovered adrenal masses
Metabolism
(1997) - et al.
Management approaches to adrenal incidentalomas: a view from Ancona, Italy
Endocrinol Metab Clin North Am
(2000) - et al.
Adrenal incidentalomas: diagnostic evaluation and long-term followup
Endocr Pract
(2008) - et al.
The clinically inapparent adrenal mass: update in diagnosis and management
Endocr Rev
(2004) - et al.
Incidentally discovered adrenal masses
Endocr Rev
(1995) - et al.
Management of the clinically inapparent adrenal mass ("incidentaloma")
Ann Intern Med
(2003) - et al.
Incidentally discovered adrenal tumors: an institutional perspective
Surgery
(1991) - et al.
A survey on adrenal incidentaloma in Italy
J Clin Endocrinol Metab
(2000) - et al.
Diagnosis and therapy of asymptomatic adrenal tumors [in German]
Dtsch Med Wochenschr
(1989)
Endocrine abnormalities in patients with adrenal tumours incidentally discovered on computed tomography
Acta Endocrinol (Copenh)
Conservative and surgical management of incidentally discovered adrenal tumors (incidentalomas)
J Endocrinol Invest
Endocrine evaluation of incidentally discovered adrenal masses (incidentalomas)
J Clin Endocrinol Metab
Incidentally detected adrenal tumours (incidentalomas): histological heterogeneity and differentiated therapeutic approach
J Intern Med
Outcome of incidental adrenal masses not operated on: 44 cases over 7 years
Eur J Surg
Incidentalomas of the adrenal gland: diagnostic and therapeutic implications
Am Surg
Cited by (50)
ACR Appropriateness Criteria® Adrenal Mass Evaluation: 2021 Update
2021, Journal of the American College of RadiologyApproach to the Patient with an Incidental Adrenal Mass
2021, Medical Clinics of North AmericaThe evaluation of incidentally discovered adrenal masses
2019, Endocrine PracticeAn Adrenocortical Carcinoma Evolving from A Small Adrenal Incidentaloma after Years of Latency
2018, AACE Clinical Case ReportsManagement of the Incidental Adrenal Mass
2016, European Urology Focus