Predicting Functional Status in Adrenal Adenomas: The Role of Radiological Findings

Abstract

Aim: The increasing use of imaging modalities has led to a higher detection rate of adrenal incidentalomas. Surgical treatment is recommended for hormonally active (functional) lesions and for non-functional lesions larger than 4 cm due to the risk of malignancy. Determining the functional status of adrenal masses generally requires multiple hormonal tests, which may prolong hospitalization and increase healthcare costs. In this study, we aimed to evaluate whether radiological parameters could help predict the functional status of adrenal masses.Materials and Methods: This retrospective study included 60 patients who underwent adrenalectomy between January 2017 and December 2023. Demographic characteristics, clinical findings, hormonal evaluation results, and radiological parameters were analyzed. Computed tomography measurements included the lateral and medial limb lengths and the density of the contralateral adrenal gland. Patients were divided into two groups according to the functional status of their adrenal masses.Results: Among the 60 patients, 65% (n=39) were female, and the mean age was 51.5±13.2 years. Functional adrenal tumors were identified in 70% (n=43) of patients. Most surgeries were performed laparoscopically (n=47), with conversion to open surgery in three cases. When the groups were compared according to the functional status of the mass, no significant differences were found in terms of age, sex, tumor localization, contralateral adrenal gland limb lengths, or adrenal density (p>0.05). However, the adrenal gland volume on the tumor side was significantly smaller in patients with functional tumors compared to those with non-functional tumors (p=0.007).Conclusion: Radiological parameters alone do not appear to be sufficient for reliably differentiating the functional status of adrenal adenomas. Hormonal evaluation remains essential in determining the functional status of adrenal masses. Larger prospective studies are needed to clarify the potential diagnostic value of radiological findings.Keywords: Adrenal incidentaloma, Adrenalectomy, Computed tomography