Incidentalomi surrenalici: Proposta per un corretto trattamento

Background: The incidence of unsuspected adrenal masses (incidentalomas) based on CT-scan results to be higher than in the past. The aim for our study was to establish some guidelines for an appropriate management. Methods: From 1986 to 1995, 61 patients with no history or clinical findings suggestive of adrenal mass or adrenal hyper/unction were discovered by radiologic examination to have an incidentaloma larger than 1 cm. In each patient basal biochemical evaluations were obtained to exclude the presence of adrenal cortical or medullary dysfunction. There were 28 men and 33 (54.1 %) women, with a mean age of 53 years (range 16-74). 19 patients underwent CT-guided fine-needle biopsy to exclude metastatic tumors. Furthermore in 29 patients 75-Se-selenomethyl- norcholesterol was performed and 17 were studied by MRI. Results: At CT-scan mean lesion diameter was 5.48±3.76 cm (range 2-23); 32 adrenal masses were right sided and 3 (4.9%) were bilateral. 17 patients had concordant scintigraphic imaging pattern, 6 bilateral uptake and 6 had discordant imaging. CT-guided FNAB showed malignancy in 9. Adrenalectomy was performed in 45 patients according to a score calculated by 4 parameters: age of the patients, size of the mass, scintigraphic pattern, MR imaging. Twenty-four had a score greater than 9 and in the remaining 21 patients in spite of a score lower than 10 adrenalectomy was performed based on: 1) increased size at CT scan follow-up (15 pts); 2) either suspected primitive malignant neoplasm at CT-guided FNAB or history of malignancy (6 pts);3) elevated 24-hour dopamine (4pts). In 12 (26.7%) patients a malignant tumor was found. There were not any statistically significant differences (t>0.05) between the age of the patients with malignant neoplasms and those with benign masses, and between the size of the masses, which were 7.58±5.93 cm (range 2-23) and 5.03±2.81 cm (range 3-17) respectively. The difference in scores between the patients with malignant masses (12.17±2.95) and those with benign ones (9.09±1.33) was statistically significant (p 9 should undergo adrenalectomy.