| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Original Studies |
Division of Endocrinology, Department of Internal Medicine, University of Ancona and the Division of Internal Medicine, Department of Clinical and Biological Sciences, University of Torino (M.T., G.Os., A.Al., A.An.), Italy
Address all correspondence and requests for reprints to: Franco Mantero, M.D., Clinica di Endocrinologia, Az. Ospedaliera "Umberto I", sede dTorrette, 60100 Ancona, Italy. E-mail: clendo{at}popcsi.unian.it
The aim of this study was to perform a national survey on occasionally discovered adrenal masses [adrenal incidentalomas (AI)] under the auspices of the Italian Society of Endocrinology. This multicentric and retrospective evaluation of patients with AI includes 1096 cases collected in 26 centers between 1980 and 1995. Relevant information was obtained by means of a specifically tailored questionnaire. Of the 1096 forms received, 1004 were retained for final analysis. Patients were 420 males and 584 females, aged between 1586 yr (median, 58 yr). Mass size (computed tomography measurement) ranged from 0.525 cm (median, 3.0 cm). Hormonal work-up demonstrated that 85% of the masses were nonhypersecretory, 9.2% were defined as subclinical Cushings syndrome, 4.2% were pheochromocytomas, and 1.6% were aldosteronomas. Adrenalectomy was performed in 380 patients with removal of 198 cortical adenomas (52%), 47 cortical carcinomas (12%), 42 pheochromocytomas (11%), and other less frequent tumor types. Patients with carcinoma were significantly younger than patients with adenoma (median, 46; range, 1784; vs. 57, 1683 yr; P = 0.05). Adenomas were significantly smaller than carcinomas (3.5, 115 vs. 7.5, 2.625 cm; P < 0.001), and a cut-off at 4.0 cm had the highest sensitivity (93%) in differentiating between benign and malignant tumors. Hormonal work-up of patients with subclinical Cushings syndrome showed low baseline ACTH in 79%, cortisol unsuppressibility after 1 mg dexamethasone in 73%, above normal urinary free cortisol in 75%, disturbed cortisol rhythm in 43%, and blunted ACTH response to CRH in 55%. Only 43% of patients with pheochromocytoma were hypertensive, and 86% showed elevated urinary catecholamines. All patients with aldosteronoma were hypertensive and had suppressed upright PRA.
These results indicate that mass size is the most reliable variable in separating benign from malignant AI. Adrenalectomy should be recommended for AI greater than 4.0 cm because of the increased risk of malignancy, especially in young patients. Endocrine evaluation should be performed in all patients to identify silent states of hormone excess.
This article has been cited by other articles:
![]() |
T. Deutschbein, N. Unger, J. Hinrichs, M. K Walz, K. Mann, and S. Petersenn Late-night and low-dose dexamethasone-suppressed cortisol in saliva and serum for the diagnosis of cortisol-secreting adrenal adenomas Eur. J. Endocrinol., November 1, 2009; 161(5): 747 - 753. [Abstract] [Full Text] [PDF] |
||||
![]() |
T J Cawood, P J Hunt, D O'Shea, D Cole, and S Soule Recommended evaluation of adrenal incidentalomas is costly, has high false-positive rates and confers a risk of fatal cancer that is similar to the risk of the adrenal lesion becoming malignant; time for a rethink? Eur. J. Endocrinol., October 1, 2009; 161(4): 513 - 527. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. Terzolo, G. Reimondo, and A. Angeli Definition of an optimal strategy to evaluate and follow-up adrenal incidentalomas: time for further research Eur. J. Endocrinol., October 1, 2009; 161(4): 529 - 532. [Abstract] [Full Text] [PDF] |
||||
![]() |
I. Veytsman, L. Nieman, and T. Fojo Management of Endocrine Manifestations and the Use of Mitotane As a Chemotherapeutic Agent for Adrenocortical Carcinoma J. Clin. Oncol., September 20, 2009; 27(27): 4619 - 4629. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. Boscaro and G. Arnaldi Approach to the Patient with Possible Cushing's Syndrome J. Clin. Endocrinol. Metab., September 1, 2009; 94(9): 3121 - 3131. [Abstract] [Full Text] [PDF] |
||||
![]() |
R. Kopetschke, M. Slisko, A. Kilisli, U. Tuschy, H. Wallaschofski, M. Fassnacht, M. Ventz, F. Beuschlein, M. Reincke, N. Reisch, et al. Frequent incidental discovery of phaeochromocytoma: data from a German cohort of 201 phaeochromocytoma Eur. J. Endocrinol., August 1, 2009; 161(2): 355 - 361. [Abstract] [Full Text] [PDF] |
||||
![]() |
P. J. Mazzaglia and J. M. Monchik Limited Value of Adrenal Biopsy in the Evaluation of Adrenal Neoplasm: A Decade of Experience Arch Surg, May 1, 2009; 144(5): 465 - 470. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. Sereg, A. Szappanos, J. Toke, K. Karlinger, K. Feldman, E. Kaszper, I. Varga, E. Glaz, K. Racz, and M. Toth Atherosclerotic risk factors and complications in patients with non-functioning adrenal adenomas treated with or without adrenalectomy: a long-term follow-up study Eur. J. Endocrinol., April 1, 2009; 160(4): 647 - 655. [Abstract] [Full Text] [PDF] |
||||
![]() |
D. Henneman, Y. Chang, R. A. Hodin, and D. L. Berger Effect of Laparoscopy on the Indications for Adrenalectomy Arch Surg, March 1, 2009; 144(3): 255 - 259. [Abstract] [Full Text] [PDF] |
||||
![]() |
C. Fagour, S. Bardet, V. Rohmer, Y. Arimone, P. Lecomte, N. Valli, and A. Tabarin Usefulness of adrenal scintigraphy in the follow-up of adrenocortical incidentalomas: a prospective multicenter study Eur. J. Endocrinol., February 1, 2009; 160(2): 257 - 264. [Abstract] [Full Text] [PDF] |
||||
![]() |
M.-L. Nunes, S. Vattaut, J.-B. Corcuff, A. Rault, H. Loiseau, B. Gatta, N. Valli, L. Letenneur, and A. Tabarin Late-Night Salivary Cortisol for Diagnosis of Overt and Subclinical Cushing's Syndrome in Hospitalized and Ambulatory Patients J. Clin. Endocrinol. Metab., February 1, 2009; 94(2): 456 - 462. [Abstract] [Full Text] [PDF] |
||||
![]() |
B. Kola, M. Christ-Crain, F. Lolli, G. Arnaldi, G. Giacchetti, M. Boscaro, A. B. Grossman, and M. Korbonits Changes in Adenosine 5'-Monophosphate-Activated Protein Kinase as a Mechanism of Visceral Obesity in Cushing's Syndrome J. Clin. Endocrinol. Metab., December 1, 2008; 93(12): 4969 - 4973. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. Friedrich-Rust, G. Schneider, R. M. Bohle, E. Herrmann, C. Sarrazin, S. Zeuzem, and J. Bojunga Contrast-Enhanced Sonography of Adrenal Masses: Differentiation of Adenomas and Nonadenomatous Lesions Am. J. Roentgenol., December 1, 2008; 191(6): 1852 - 1860. [Abstract] [Full Text] [PDF] |
||||
![]() |
P K Singh and H N Buch Adrenal incidentaloma: evaluation and management J. Clin. Pathol., November 1, 2008; 61(11): 1168 - 1173. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. W. Funder, R. M. Carey, C. Fardella, C. E. Gomez-Sanchez, F. Mantero, M. Stowasser, W. F. Young Jr., and V. M. Montori Case Detection, Diagnosis, and Treatment of Patients with Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline J. Clin. Endocrinol. Metab., September 1, 2008; 93(9): 3266 - 3281. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. T. Adler, G. Y. Meyer-Rochow, H. Chen, D. E. Benn, B. G. Robinson, R. S. Sippel, and S. B. Sidhu Pheochromocytoma: Current Approaches and Future Directions Oncologist, July 1, 2008; 13(7): 779 - 793. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. H. Song, F. S. Chaudhry, and W. W. Mayo-Smith The Incidental Adrenal Mass on CT: Prevalence of Adrenal Disease in 1,049 Consecutive Adrenal Masses in Patients with No Known Malignancy Am. J. Roentgenol., May 1, 2008; 190(5): 1163 - 1168. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. M. DeWitt Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Right Adrenal Masses: Report of 2 Cases J. Ultrasound Med., February 1, 2008; 27(2): 261 - 267. [Abstract] [Full Text] [PDF] |
||||
![]() |
S. Bernichtein, E. Petretto, S. Jamieson, A. Goel, T. J. Aitman, J. M. Mangion, and I. T. Huhtaniemi Adrenal Gland Tumorigenesis after Gonadectomy in Mice Is a Complex Genetic Trait Driven by Epistatic Loci Endocrinology, February 1, 2008; 149(2): 651 - 661. [Abstract] [Full Text] [PDF] |
||||
![]() |
I. Ilias, A. Sahdev, R. H Reznek, A. B Grossman, and K. Pacak The optimal imaging of adrenal tumours: a comparison of different methods Endocr. Relat. Cancer, September 1, 2007; 14(3): 587 - 599. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. A. Lee, R. Zarnegar, W. T. Shen, E. Kebebew, O. H. Clark, and Q.-Y. Duh Adrenal Incidentaloma, Borderline Elevations of Urine or Plasma Metanephrine Levels, and the "Subclinical" Pheochromocytoma Arch Surg, September 1, 2007; 142(9): 870 - 874. [Abstract] [Full Text] [PDF] |
||||
![]() |
I. K Johnsen, M. Slawik, I. Shapiro, M. F Hartmann, S. A Wudy, B. D Looyenga, G. D Hammer, M. Reincke, and F. Beuschlein Gonadectomy in mice of the inbred strain CE/J induces proliferation of sub-capsular adrenal cells expressing gonadal marker genes. J. Endocrinol., July 1, 2006; 190(1): 47 - 57. [Abstract] [Full Text] [PDF] |
||||
![]() |
B. Allolio and M. Fassnacht Adrenocortical Carcinoma: Clinical Update J. Clin. Endocrinol. Metab., June 1, 2006; 91(6): 2027 - 2037. [Abstract] [Full Text] [PDF] |
||||
![]() |
B. Bulow, S. Jansson, C. Juhlin, L. Steen, M. Thoren, H. Wahrenberg, S. Valdemarsson, B. Wangberg, B. Ahreen, and on behalf of the Swedish Research Council Study Gr Adrenal incidentaloma - follow-up results from a Swedish prospective study. Eur. J. Endocrinol., March 1, 2006; 154(3): 419 - 423. [Abstract] [Full Text] [PDF] |
||||
![]() |
S.-i. Takeda, M. Minami, Y. Inoue, and H. Matsuda Synchronous Mediastinal Ganglioneuroma and Retroperitoneal Pheochromocytoma Ann. Thorac. Surg., October 1, 2005; 80(4): 1525 - 1527. [Abstract] [Full Text] [PDF] |
||||
![]() |
R Nawar and D Aron Adrenal incidentalomas -- a continuing management dilemma Endocr. Relat. Cancer, September 1, 2005; 12(3): 585 - 598. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. Terzolo, S. Bovio, A. Pia, P. A. Conton, G. Reimondo, C. Dall'Asta, D. Bemporad, A. Angeli, G. Opocher, M. Mannelli, et al. Midnight serum cortisol as a marker of increased cardiovascular risk in patients with a clinically inapparent adrenal adenoma Eur. J. Endocrinol., August 1, 2005; 153(2): 307 - 315. [Abstract] [Full Text] [PDF] |
||||
![]() |
R. G. Dluhy, M. M. Maher, and C.-L. Wu Case 7-2005 - A 59-Year-Old Woman with an Incidentally Discovered Adrenal Nodule N. Engl. J. Med., March 10, 2005; 352(10): 1025 - 1032. [Full Text] [PDF] |
||||
![]() |
T. M Seccia, A. Fassina, G. G Nussdorfer, A. C Pessina, and G. P. Rossi Aldosterone-producing adrenocortical carcinoma: an unusual cause of Conn's syndrome with an ominous clinical course Endocr. Relat. Cancer, March 1, 2005; 12(1): 149 - 159. [Abstract] [Full Text] [PDF] |
||||
![]() |
F. de Fraipont, M. El Atifi, N. Cherradi, G. Le Moigne, G. Defaye, R. Houlgatte, J. Bertherat, X. Bertagna, P.-F. Plouin, E. Baudin, et al. Gene Expression Profiling of Human Adrenocortical Tumors Using Complementary Deoxyribonucleic Acid Microarrays Identifies Several Candidate Genes as Markers of Malignancy J. Clin. Endocrinol. Metab., March 1, 2005; 90(3): 1819 - 1829. [Abstract] [Full Text] [PDF] |
||||
![]() |
A. H. Hamrahian, A. G. Ioachimescu, E. M. Remer, G. Motta-Ramirez, H. Bogabathina, H. S. Levin, S. Reddy, I. S. Gill, A. Siperstein, and E. L. Bravo Clinical Utility of Noncontrast Computed Tomography Attenuation Value (Hounsfield Units) to Differentiate Adrenal Adenomas/Hyperplasias from Nonadenomas: Cleveland Clinic Experience J. Clin. Endocrinol. Metab., February 1, 2005; 90(2): 871 - 877. [Abstract] [Full Text] [PDF] |
||||
![]() |
G. A. Kaltsas, G. M. Besser, and A. B. Grossman The Diagnosis and Medical Management of Advanced Neuroendocrine Tumors Endocr. Rev., June 1, 2004; 25(3): 458 - 511. [Abstract] [Full Text] [PDF] |
||||
![]() |
H. Minn, A. Salonen, J. Friberg, A. Roivainen, T. Viljanen, J. Langsjo, J. Salmi, M. Valimaki, K. Nagren, and P. Nuutila Imaging of Adrenal Incidentalomas with PET Using 11C-Metomidate and 18F-FDG J. Nucl. Med., June 1, 2004; 45(6): 972 - 979. [Abstract] [Full Text] [PDF] |
||||
![]() |
G. Mansmann, J. Lau, E. Balk, M. Rothberg, Y. Miyachi, and S. R. Bornstein The Clinically Inapparent Adrenal Mass: Update in Diagnosis and Management Endocr. Rev., April 1, 2004; 25(2): 309 - 340. [Abstract] [Full Text] [PDF] |
||||
![]() |
L Zendron, J Fehrenbach, C Taverna, and M Krause Pitfalls in the diagnosis of phaeochromocytoma BMJ, March 13, 2004; 328(7440): 629 - 630. [Full Text] [PDF] |
||||
![]() |
G. Arnaldi, A. Angeli, A. B. Atkinson, X. Bertagna, F. Cavagnini, G. P. Chrousos, G. A. Fava, J. W. Findling, R. C. Gaillard, A. B. Grossman, et al. Diagnosis and Complications of Cushing's Syndrome: A Consensus Statement J. Clin. Endocrinol. Metab., December 1, 2003; 88(12): 5593 - 5602. [Abstract] [Full Text] [PDF] |
||||
![]() |
B. Catargi, V. Rigalleau, A. Poussin, N. Ronci-Chaix, V. Bex, V. Vergnot, H. Gin, P. Roger, and A. Tabarin Occult Cushing's Syndrome in Type-2 Diabetes J. Clin. Endocrinol. Metab., December 1, 2003; 88(12): 5808 - 5813. [Abstract] [Full Text] [PDF] |
||||
![]() |
S. Minowada, T. Fujimura, N. Takahashi, H. Kishi, K. Hasuo, and M. Minami Computed Tomography-Guided Percutaneous Acetic Acid Injection Therapy for Functioning Adrenocortical Adenoma J. Clin. Endocrinol. Metab., December 1, 2003; 88(12): 5814 - 5817. [Abstract] [Full Text] [PDF] |
||||
![]() |
W. M. Manger In Search of Pheochromocytomas J. Clin. Endocrinol. Metab., September 1, 2003; 88(9): 4080 - 4082. [Full Text] [PDF] |
||||
![]() |
G. La Cava, A. Imperiale, C. Olianti, G. R. Gheri, C. Ladu, M. Mannelli, and A. Pupi SPECT Semiquantitative Analysis of Adrenocortical 131I-6{beta}-Iodomethyl-Norcholesterol Uptake to Discriminate Subclinical and Preclinical Functioning Adrenal Incidentaloma J. Nucl. Med., July 1, 2003; 44(7): 1057 - 1064. [Abstract] [Full Text] [PDF] |
||||
![]() |
T. Mancini, B. Kola, F. Mantero, and G. Arnaldi Functional and Nonfunctional Adrenocortical Tumors Demonstrate a High Responsiveness to Low-Dose Adrenocorticotropin J. Clin. Endocrinol. Metab., May 1, 2003; 88(5): 1994 - 1998. [Abstract] [Full Text] [PDF] |
||||
![]() |
A. Angeli and M. Terzolo Adrenal Incidentaloma--A Modern Disease with Old Complications J. Clin. Endocrinol. Metab., November 1, 2002; 87(11): 4869 - 4871. [Full Text] [PDF] |
||||
![]() |
L. Tauchmanova, R. Rossi, B. Biondi, M. Pulcrano, V. Nuzzo, E.-A. Palmieri, S. Fazio, and G. Lombardi Patients with Subclinical Cushing's Syndrome due to Adrenal Adenoma Have Increased Cardiovascular Risk J. Clin. Endocrinol. Metab., November 1, 2002; 87(11): 4872 - 4878. [Abstract] [Full Text] [PDF] |
||||
![]() |
Y Inoue, M Akahane, T Kitazawa, H Ijichi, S Obi, K Yoshikawa, K Ohtomo, and M Omata False positive uptake of metaiodobenzylguanidine in hepatocellular carcinoma Br. J. Radiol., June 1, 2002; 75(894): 548 - 551. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. Terzolo, A. Pia, A. Ali, G. Osella, G. Reimondo, S. Bovio, F. Daffara, M. Procopio, P. Paccotti, G. Borretta, et al. Adrenal Incidentaloma: A New Cause of the Metabolic Syndrome? J. Clin. Endocrinol. Metab., March 1, 2002; 87(3): 998 - 1003. [Abstract] [Full Text] [PDF] |
||||
![]() |
G. G. M. Garrapa, P. Pantanetti, G. Arnaldi, F. Mantero, and E. Faloia Body Composition and Metabolic Features in Women with Adrenal Incidentaloma or Cushing's Syndrome J. Clin. Endocrinol. Metab., November 1, 2001; 86(11): 5301 - 5306. [Abstract] [Full Text] [PDF] |
||||
![]() |
G. P. Rossi, A. Sacchetto, M. Chiesura-Corona, R. De Toni, M. Gallina, G. P. Feltrin, and A. C. Pessina Identification of the Etiology of Primary Aldosteronism with Adrenal Vein Sampling in Patients with Equivocal Computed Tomography and Magnetic Resonance Findings: Results in 104 Consecutive Cases J. Clin. Endocrinol. Metab., March 1, 2001; 86(3): 1083 - 1090. [Abstract] [Full Text] |
||||
![]() |
K. Pacak, W. M. Linehan, G. Eisenhofer, M. M. Walther, and D. S. Goldstein Recent Advances in Genetics, Diagnosis, Localization, and Treatment of Pheochromocytoma Ann Intern Med, February 20, 2001; 134(4): 315 - 329. [Abstract] [Full Text] [PDF] |
||||
![]() |
G. Osella, G. Reimondo, P. Peretti, A. Alì, P. Paccotti, A. Angeli, and M. Terzolo The Patients with Incidentally Discovered Adrenal Adenoma (Incidentaloma) Are Not at Increased Risk of Osteoporosis J. Clin. Endocrinol. Metab., February 1, 2001; 86(2): 604 - 607. [Abstract] [Full Text] |
||||
![]() |
R. Rosse and L. Tauchmanovà Authors' Response: Metabolic Abnormalities in Patients with Adrenal Incidentaloma J. Clin. Endocrinol. Metab., February 1, 2001; 86(2): 951 - 952. [Full Text] |
||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| Endocrinology | Endocrine Reviews | J. Clin. End. & Metab. |
| Molecular Endocrinology | Recent Prog. Horm. Res. | All Endocrine Journals |