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Adrenal incidentaloma – follow-up results from a Swedish prospective study

Department of Medicine, Ryhov Hospital, 55185 Jönköping, Sweden, ¹ Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden, ² Department of Surgery, University Hospital, Linköping, Sweden, ³ Department of Medicine, Eskilstuna Hospital, Sweden, ⁴ Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Solna, Sweden, ⁵ Department of Endocrinology, Metabolism and Diabetology, Karolinska University Hospital, Huddinge, Sweden and ⁶ Department of Endocrinology and Diabetology, University Hospital, Lund, Sweden

(Correspondence should be addressed to B Bülow; Email: b.bulow{at}telia.com)

Objectives: To examine the risk of developing adrenal carcinomas and clinically overt hypersecreting tumours during short-term follow-up in patients with adrenal incidentalomas.

Design: 229 (98 males and 131 females) patients with adrenal incidentalomas were investigated in a prospective follow-up study (median time 25 months; range 3–108 months). The patients were registered between January 1996 and July 2001 and followed until December 2004. Twenty-seven Swedish hospitals contributed with follow-up results.

Methods: Diagnostic procedures were undertaken according to a protocol including reinvestigation with computed tomography scans after 3–6 months, 15–18 months and 27–30 months, as well as hormonal evaluation at baseline and after 27–30 months of follow-up. Operation was recommended when the incidentaloma size increased or if there was a suspicion of a hypersecreting tumour.

Results: The median age at diagnosis of the 229 patients included in the follow-up study was 64 years (range 28–84 years) and the median size of the adrenal incidentalomas when discovered was 2.5 cm (range 1–8 cm). During the follow-up period, an increase in incidentaloma size of 0.5 cm was reported in 17 (7.4%) and of 1.0 cm was reported in 12 (5.2%) of the 229 patients. A decrease in size was seen in 12 patients (5.2%). A hypersecreting tumour was found in 2% of the hormonally investigated patients: Cushing’s syndrome (n = 2) and phaeochromocytoma (n = 1). Eleven patients underwent adrenalectomy, but no cases of primary adrenal malignancy were observed.

Conclusions: Patients with adrenal incidentaloma had a low risk of developing malignancy or hormonal hypersecretion during a short-term follow-up period.

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