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Original article
Should the Monitoring Protocols for Adrenal Incidentalomas be Changed?
¿Deberían modificarse los protocolos diagnóstico-terapéuticos de los incidentalomas suprarrenales?
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Isabel Mateo-Gavira
Corresponding author
isamateogavira@gmail.com

Corresponding author.
, Francisco Javier Vilchez-López, Laura Larrán-Escandón, María Belén Ojeda-Schuldt, Cristina López Tinoco, Manuel Aguilar-Diosdado
Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Puerta del Mar, Cádiz, Spain
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Table 1. Diagnosis of Functionality of Adrenal Incidentalomas.
Table 2. Pathology of the Incidentalomas Operated on Our Series.
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Abstract
Background

The prevalence of adrenal incidentalomas is increasing with the ageing of the population and the use of high resolution imaging techniques. Current protocols propose a comprehensive monitoring of their functional and morphological state, but with no conclusive clinical evidence that endorses it.

Method

Retrospective study of 96 patients diagnosed with adrenal incidentaloma between 2008 and 2012. We evaluated clinical, functional, and imaging at baseline and during follow-up.

Results

Initially, 9 cases were surgically removed: 4 due to hyperfunction (2 Cushing syndromes and 2 pheochromocytomas) and 5 due to size larger than 4cm. During follow-up one case of pheochromocytoma was diagnosed and another grew more than 1cm, needing surgery. In 98.86% of nonfunctional and benign lesions, there were no functional and/or morphological changes in the final evaluation.

Conclusions

The results of our study challenge the validity of current diagnostic–therapeutic protocols of incidentalomas, which should be reassessed in prospective studies taking into account efficiency characteristics.

Keywords:
Adrenal incidentaloma
Cushing syndrome
Pheochromocytoma
Adrenalectomy
Resumen
Antecedentes

La prevalencia de los incidentalomas suprarrenales está aumentando por el envejecimiento de la población y el empleo de técnicas de imagen de alta resolución. Los protocolos actuales proponen un seguimiento de su estado funcional y morfológico exhaustivos, sin una evidencia clínica concluyente que lo avale.

Método

Estudio retrospectivo de 96 pacientes diagnosticados de incidentaloma adrenal entre 2008 y 2012. Se evalúan características clínicas, funcionales y de imagen, basales y durante el seguimiento.

Resultados

Inicialmente, 4 casos fueron intervenidos por hiperfunción (2 síndromes de Cushing y 2 feocromocitomas) y 5 por tamaño superior a 4cm. Durante el seguimiento, tan solo se diagnosticó un caso de feocromocitoma y otro creció más de 1cm, indicándose cirugía. En el 98,86% de los incidentalomas diagnosticados inicialmente como benignos y no funcionantes, no se objetivaron modificaciones funcionales y/o morfológicas en la evaluación final.

Conclusiones

Los resultados de nuestra serie cuestionan la validez de los protocolos de seguimiento de los incidentalomas adrenales vigentes en la actualidad, que deberían ser revaluados atendiendo a características de eficiencia mediante estudios prospectivos.

Palabras clave:
Incidentaloma suprarrenal
Síndrome de Cushing
Feocromocitoma
Adrenalectomía

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