Abstract
Purpose: The aim of this prospective study was to ascertain the nature and prevalence of incidentally discovered adrenal masses on routine chest and abdominal CT scans in patients with no known malignancy. Study was conducted in a tertiary care hospital in northern state of India. Methods and Materials: We analyzed the scans of 4469 patients in our hospital performed between December 2014 to April 2015. We found 240 incidental adrenal masses in 213 (5.12%) patients while reviewing the scans. Patients with no known malignancy and no suspicion for a hyperfunctioning adrenal mass were further isolated. A total of 337 patients were excluded. The remaining 4132 patients who fulfilled the criteria constituted the study group. The number, size and imaging features of the adrenal mass in each patient was recorded. Biochemical and demographic details were recorded. Results: A total of 240 adrenal incidentalomas were identified, including 27 bilateral lesions in 213 patients with a prevalence of 5.15%. The male patients had a slightly higher prevalence of AI than females (5.86% vs. 4.24%. These lesions were characterized with following methods: Histopathology (n=8), Imaging characterization (n = 220), Clinco-Laboratory diagnosis (n=12). In our study the most common type of adrenal mass was adenoma (n=169, 70.45%). Next common lesion was myelolipoma seen in 16(6.66%) patients. Haematoma was seen in 13 (5.41%) cases and cyst was seen in 12 (4.58%) cases. Metastaic disease was diagnosed in 10 (4.16%) cases , 4 cases were diagnosed on histology and 6 were were confirmed on imaging. There was 1 (0.41%) case of pheochromocytoma in our study. Macronodular hyperplasia was seen in 3 (1.28%) patients. A total of 16 lesions in 8 patients showed features suggestive of tuberculosis. Conclusion: Adrenal incidentalomas being common lesions need complete evaluation as there can be risk of malignancy or hormonal hyperfunction. The imaging features can predict the underlying pathology and biochemical evaluation should be done for hormonal hyperfunction. Thus there should be comprehensive reporting and selective testing strategy, so that these lesions are not missed.
