Hormone-inactive adrenal tumors in clinician’s practice

Objective. To study the clinical picture, malignancy potential of hormone-inactive adrenal tumors (HIAT) by the results of computed tomography (CT) to identify the most significant clinical and diagnostic signs.

Materials and methods. Case histories of 65 patients operated for HIAT (group 1) and 52 ambulatory records of HIAT patients (group 2) observed in the polyclinic were retrospectively studied. All patients underwent survey, antropometry, biochemical blood analysis, adrenal hormone level, CT of adrenal glands.

Results. The operated patients in 81.6 % of cases were under sixty, nonoperated – in 73 % of cases over sixty. The size of tumor in patients of group 1 in 84.7 % exceeded 4 cm, in group 2 – in 98.1 % was less than 4 cm. HIAT size, CT-density in NF were significantly lower (р = 0,000 and р = 0,000, respectively), but the level of morning cortisol, observation period and age were significantly higher in the group of nonoperated patients. (р = 0,013, р = 0,000 and р = 0,000, respectively). According to the results of comparative analysis of the clinical manifestations of the autonomous cortisol secretion (arterial hypertension, obesity) in the groups of nonoperated and operated patients with HIAT, statistically significant differences were established (р = 0,000, р = 0,002 respectively). In group 1, stage 2 AH was diagnosed more often and obesity – rarely. No statistically significant differences were detected in the analysis of carbohydrate metabolism disorders, osteoporosis, dyslipidemia (р = 0,531, р р = 0,322, р = 0,105). Correlation analysis of HIAT size with the period of dynamic observation and CT-density in NF showed a negative notable (р = -0,606, р = 0,000) and a positive moderate (р = 0,391, р = 0,036) (respectively) tightness of links by Chaddock scale. In case of a 1 cm increase in HIAT size, CT-density in NF is expected to rise by 1,857 HU.

Conclusions. 1. To determine the indications to adrenalectomy, it is necessary to take into account the size and native density of the adrenal tumor by the results of computed tomography as well as clinical and laboratory data. With the values of HIAT size ≥ 4.0 cm in combination with CT-density in NF ≥ 12 HU, adrenalectomy is recommended. 2. In case of a 1 cm increase in HIAT size, rise in CT-density by 1,857 HU is expected. It is worthwhile to control CT-phenotype of HIAT in nonoperated ambulatory patients to determine the malignancy potential of HIAT and up-to-date surgical treatment.