Presentation and management of patients with adrenal masses: a large tertiary centre experience

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dc.authoridSaygılı, Emre Sedar / 0000-0003-0022-5704
dc.contributor.authorSuntornlohanakul, Onnicha
dc.contributor.authorMandal, Sumedha
dc.contributor.authorSaha, Pratyusha
dc.contributor.authorSaygılı, Emre Sedar
dc.contributor.authorAsia, Miriam
dc.contributor.authorArlt, Wiebke
dc.contributor.authorElhassan, Yasir S.
dc.date.accessioned2025-01-27T21:04:03Z
dc.date.available2025-01-27T21:04:03Z
dc.date.issued2024
dc.departmentÇanakkale Onsekiz Mart Üniversitesi
dc.description.abstractBackground Adrenal masses are found in up to 5%-7% of adults. The 2016 European guidelines on the management of adrenal incidentalomas have standardised the workup of these patients, but evidence of their impact on clinical practice is lacking. Methods Retrospective review of clinical presentation, radiological characteristics, and final diagnosis of a large cohort of patients with adrenal masses referred to a tertiary care centre 1998-2022. Sub-analysis compares outcomes before and after implementing the 2016 guidelines. Results A total of 1397 patients (55.7% women; median age 60 years [interquartile range {IQR}, 49-70]) were included. Incidental discovery was the most frequent mode of presentation (63.7%) and 30.6% of patients had masses ≥ 4 cm (median 2.9 cm [IQR, 1.9-4.7]). Unenhanced computed tomography Hounsfield units (HU) were available for 763 patients; of these, 32.9% had heterogeneous masses or >20 HU. The most common diagnoses were adrenocortical adenoma (56.0%), phaeochromocytoma (12.7%), adrenocortical carcinoma (10.6%), and metastases (5.7%). At multivariable analysis, significant predictors of malignancy included >20 HU or heterogeneous density (odds ratio [OR] 28.40), androgen excess (OR 27.67), detection during cancer surveillance (OR 11.34), size ≥ 4 cm (OR 6.11), and male sex (OR 3.06). After implementing the 2016 guidelines, the number of adrenalectomies decreased (6.1% pre-2016 vs 4.5% post-2016) and the number of patients discharged increased (4.4% pre-2016 vs 25.3% post-2016) for benign non-functioning adrenal masses. Conclusion Implementing the 2016 guidelines positively impacted clinical practice, reducing unnecessary surgeries and increasing the discharge rate for benign adrenal masses, thereby preserving healthcare resources and patient burden.
dc.description.sponsorshipEuropean Reference Network on Rare Endocrine Conditions [CA20122]; EU COST Action
dc.description.sponsorshipWe thank all the core members of the UHB Adrenal MDT and the medical students (Shadman Ahmed and Jessica Parkin-Crawshaw) who helped us collect the data. We also thank the EU COST Action CA20122 Harmonisation for supportive networking (www.goharmonisation.com).
dc.identifier.doi10.1093/ejendo/lvae131
dc.identifier.endpage490
dc.identifier.issn0804-4643
dc.identifier.issn1479-683X
dc.identifier.issue5
dc.identifier.pmid39425921
dc.identifier.scopus2-s2.0-85208204958
dc.identifier.scopusqualityQ1
dc.identifier.startpage481
dc.identifier.urihttps://doi.org/10.1093/ejendo/lvae131
dc.identifier.urihttps://hdl.handle.net/20.500.12428/27538
dc.identifier.volume191
dc.identifier.wosWOS:001347969100001
dc.identifier.wosqualityN/A
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.language.isoen
dc.publisherOxford Univ Press
dc.relation.ispartofEuropean Journal of Endocrinology
dc.relation.publicationcategoryinfo:eu-repo/semantics/openAccess
dc.rightsinfo:eu-repo/semantics/openAccess
dc.snmzKA_WoS_20250125
dc.subjectadrenal tumour
dc.subjectadrenal incidentaloma guidelines
dc.subjectadrenocortical carcinoma
dc.subjectadrenocortical adenoma
dc.titlePresentation and management of patients with adrenal masses: a large tertiary centre experience
dc.typeArticle

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