Incidentally detected adrenal tumors – characteristics of patients and incidence of hormonal disorders
More details
Hide details
Department of Internal Medicine and Oncological Chemotherapy, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
Students’ Scientific Club, Department of Internal Medicine and Oncological Chemotherapy, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
Corresponding author
Iga Grochoła   

Oddział Chorób Wewnętrznych i Chemioterapii Onkologicznej, Samodzielny Publiczny Szpital Kliniczny im. A. Mielęckiego, Śląski Uniwersytet Medyczny w Katowicach, ul. Reymonta 8, 40-027 Katowice
Ann. Acad. Med. Siles. 2019;73:74-80
Because of technological development and easier accessibility to diagnostic imaging, incidentally detected adrenal tumors are a frequently diagnosed endocrine disorder. The aim of the paper was to present the characteristics of patients with newly incidentally detected adrenal tumors, with emphasis on the detected hormonal disorders.

Material and methods:
A retrospective, single center study included 96 patients hospitalized due to newly detected adrenal tumor between 2007 and 2014.

Adrenal tumors were detected in 92 patients. The final diagnoses were: incidentaloma – 73 (76%), nodular adrenal hyperplasia – 12 (12.5%), pheochromocytoma – 5 (5.2%), late-onset congenital adrenal hyperplasia – 5 (5.2%), Conn’s syndrome – 1 (1.1%). In 94 out of the 96 patients at least one hormonal disorder was detected. The most frequent abnormalities were: incorrect plasma renin activity (67.7% of patients), evening serum cortisol concentration (60.2%, mean level: 8.9 µg%) and morning (48.9%, mean level: 15.4 µg%). A considerable group of patients suffered from comorbidities, such as hypertension (70.8%), impaired glucose tolerance (18.7%) and type 2 diabetes (16.7%). Additionally, the diameter of the tumors was negatively (p < 0.05) associated with the serum ACTH level.

In most of the patients with incidentaloma, despite the lack of characteristic symptoms, it is possible to detect hormonal disorders in laboratory tests. The prevalence of hypertension and diabetes is high in this population of patients.

Fassnacht M., Arlt W., Bancos I., Dralle H., Newell-Price J., Sahdev A., Tabarin A., Terzolo M., Tsagarakis S., Dekkers O.M. Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors. Eur. J. Endocrinol. 2016; 175(2): G1–G34, doi: 10.1530/EJE-16-0467.
Kapoor A., Morris T., Rebello R. Guidelines for the management of the incidentally discovered adrenal mass. Can. Urol. Assoc. J. 2011; 5(4): 241–247, doi: 10.5489/cuaj.11135.
Al-Thani H., El-Menyar A., Al-Sulaiti M., ElGohary H., Al-Malki A., Asim M., Tabeb A. Adrenal Mass in Patients who Underwent Abdominal Computed Tomography Examination. N. Am. J. Med. Sci. 2015; 7(5): 212–219, doi: 10.4103/1947-2714.157482.
Bednarczuk T., Bolanowski M., Sworczak K., Górnicka B., Cieszanowski A., Otto M., Ambroziak U., Pachucki J., Kubicka E., Babińska A., Koperski Ł. et al. Adrenal incidentaloma in adults — management recommendations by the Polish Society of Endocrinology. Endokrynol. Pol. 2016; 67(2): 234–258, doi: 10.5603/EP.a2016.0039.
Kim J., Bae KH., Choi YK., Jeong J.Y., Park K.G., Kim J.G., Lee I.K. Clinical characteristics for 348 patients with adrenal incidentaloma. Endocrinol. Metab. (Seoul). 2013; 28(1): 20–25, doi: 10.3803/EnM.2013.28.1.20.
Bittner J.G. 4th, Brunt L.M. Evaluation and management of adrenal incidentaloma. J. Surg. Oncol. 2012; 106(5): 557–564, doi: 10.1002/jso.23161.
Li L., Dou J., Gu W., Yang G., Du J., Yang L., Zang L., Wang X., Jin N., Ouyang J., Lü Z. et al. Clinical analysis of 4 049 hospitalized cases of adrenal lesions. Zhonghua Yi Xue Za Zhi. 2014; 94(42): 3314–3318.
Tabuchi Y., Otsuki M., Kasayama S., Kosugi K., Hashimoto K., Yamamoto T., Tsugawa M., Mineo I., Yamada Y., Kurebayashi S., Ohashi M. et al. Clinical and endocrinological characteristics of adrenal incidentaloma in Osaka region, Japan. Endocr. J. 2016; 63(1): 29–35.
Mansmann G., Lau J., Balk E., Rothberg M., Miyachi Y., Bornstein S.R. The clinically inapparent adrenal mass: update in diagnosis and management. Endocr. Rev. 2004; 25(2): 309–340.
Koopmans G.T., Lamers L.M. Gender and health care utilization: the role of mental distress and help-seeking propensity. Soc. Sci. Med. 2007; 64(6): 1216–1230.
Zdrojewski T., Wyrzykowski B., Szczech R., Wierucki L., Naruszewicz M., Narkiewicz K., Zarzeczna-Baran M. Epidemiology and prevention of arterial hypertension in Poland. Blood Press. Suppl. 2005; 2: 10–16.
Szuba A., Martynowicz H., Zatońska K., Ilow R., Regulska-Ilow B., Różańska D., Wołyniec M., Połtyn-Zaradna K., Zatoński W.A. Prevalence of hypertension in Polish population of PURE Poland study. J. Health Inequal. 2016; 2(2): 157–162, doi: 10.5114/jhi.2016.65356.
Rutkowski M., Bandosz P., Czupryniak L., Gaciong Z., Solnica B., Jasiel-Wojculewicz H., Wyrzykowski B., Pencina M.J., Zdrojewski T. Prevalence of diabetes and impaired fasting glucose in Poland—the NATPOL 2011 Study. Diabet. Med. 2014; 31(12): 1568–1571, doi: 10.1111/dme.12542.
Kastelan D., Kraljevic I., Dusek T., Knezevic N., Solak M., Gardijan B., Kralik M., Poljicanin T., Skoric-Polovina T., Kastelan Z. The clinical course. of patients with adrenal incidentaloma: is it time to reconsider the current recommendations? Eur. J. Endocrinol. 2015; 173(2): 275–282, doi: 10.1530/EJE-15-0199.
Li L., Dou J., Gu W., Yang G., Du J., Yang L., Zang L., Wang X., Jin N., Ou-Yang J., Lü Z. Etiologies of 1 173 hospitalized cases with adrenal incidentaloma. Zhonghua Yi Xue Za Zhi. 2014; 94(8): 587–590.
Comlekci A., Yener S., Ertilav S., Secil M., Akinci B., Demir T., Kebapcilar L., Bayraktar F., Yesil S., Eraslan S. Adrenal incidentaloma, clinical, metabolic, follow-up aspects: single centre experience. Endocrine 2010; 37(1): 40–46, doi: 10.1007/s12020-009-9260-5.
Cho Y.Y., Suh S., Joung J.Y., Jeong H., Je D., Yoo H., Park T.K., Min Y.K., Kim K.W., Kim J.H. Clinical characteristics and follow-up of Korean patients with adrenal incidentalomas. Korean J. Intern. Med. 2013; 28(5): 557–564, doi: 10.3904/kjim.2013.28.5.557.
Chiodini I., Morelli V. Subclinical Hypercortisolism: How to Deal with It? Front. Horm. Res. 2016; 46: 28–38, doi: 10.1159/000443862.
Terzolo M., Pia A., Reimondo G. Subclinical Cushing’s syndrome: definition and management. Clin. Endocrinol. (Oxf). 2012; 76(1): 12–18, doi: 10.1111/j.1365-2265.2011.04253.x.
Loh H.H., Yee A., Loh H.S., Sukor N., Kamaruddin N.A. The natural progression and outcomes of adrenal incidentaloma: a systematic review and meta-analysis. Minerva Endocrinol. 2017; 42(1): 77–87, doi: 10.23736/S0391-1977.16.02394-4.
Babińska A., Siekierska-Hellmann M., Błaut K., Lewczuk A., Wiśniewski P., Gnacińska M., Obołończyk L., Swiątkowska-Stodulska R., Sworczak K. Hormonal activity in clinically silent adrenal incidentalomas. Arch. Med. Sci. 2012; 8(1): 97–103, doi: 10.5114/aoms.2012.27288.
Oki K., Yamane K., Nakanishi S., Shiwa T., Kohno N. Influence of adrenal subclinical hypercortisolism on hypertension in patients with adrenal incidentaloma. Exp. Clin. Endocrinol. Diabetes 2012; 120(4): 244–247, doi: 10.1055/s-0032-1301896.
Steffensen C., Pereira A.M., Dekkers O.M., Jørgensen J.O. DIAGNOSIS OF ENDOCRINE DISEASE: Prevalence of hypercortisolism in type 2 diabetes patients: a systematic review and meta-analysis. Eur. J. Endocrinol. 2016; 175(6): R247–R253.
Kamba A., Daimon M., Murakami H., Otaka H., Matsuki K., Sato E., Tanabe J., Takayasu S., Matsuhashi Y., Yanagimachi M., Terui K. et al. Association between Higher Serum Cortisol Levels and Decreased Insulin Secretion in a General Population. PLoS One 2016; 11(11): e0166077, doi: 10.1371/journal.pone.0166077.
Lopez D., Luque-Fernandez M.A., Steele A., Adler G.K., Turchin A., Vaidya A. „Nonfunctional” Adrenal Tumors and the Risk for Incident Diabetes and Cardiovascular Outcomes: A Cohort Study. Ann. Intern. Med. 2016; 165(8): 533–542, doi: 10.7326/M16-0547.
Hackett R.A., Steptoe A., Kumari M. Association of Diurnal Patterns in Salivary Cortisol With Type 2 Diabetes in the Whitehall II Study. J. Clin. Endocrinol. Metab. 2014; 99(12): 4625–4631, doi: 10.1210/jc.2014-2459.
Pasternak J.D., Seib C.D., Seiser N., Tyrell J.B., Liu C., Cisco R.M., Gosnell J.E., Shen W.T., Suh I., Duh Q.Y. Differences Between Bilateral Adrenal Incidentalomas and Unilateral Lesions. JAMA Surg. 2015; 150(10): 974–978, doi: 10.1001/jamasurg.2015.1683.
Perogamvros I., Vassiliadi D.A., Karapanou O., Botoula E., Tzanela M., Tsagarakis S. Biochemical and clinical benefits of unilateral adrenalectomy in ptients with subclinical hypercortisolism and bilateral adrenal incidentalomas. Eur. J. Endocrinol. 2015; 173(6): 719–725, doi: 10.1530/EJE-15-0566.
Morelli V., Scillitani A., Arosio M., Chiodini I. Follow-up of patients with adrenal incidentaloma, in accordance with the European society of endocrinology guidelines: Could we be safe? J. Endocrinol. Invest. 2017; 40(3): 331–333, doi: 10.1007/s40618-016-0558-x.
Journals System - logo
Scroll to top