Management of incidentalomas of the adrenal gland in an Indian hospital set-up between 1991 and 2000

The use of imaging techniques and their increasing sensitivity have resulted in increased detection of incidentalomas of the endocrine organs. The aim of our study was to review the currently used evaluation schemes and the outcomes of surgical and conservative management of adrenal incidentalomas at an Indian center. Fifty-eight cases of adrenal incidentalomas diagnosed and treated at the Govt. General Hospital, Chennai, and private practice were reviewed. Ultrasonogram of the abdomen was the most frequently used investigation (88%). The common complaint was upper abdominal discomfort. The mean duration of treatment of symptoms before diagnosis was 3.5 months. Thirty-three cases underwent adrenalectomy. The cases not subjected to resection were followed every 6 months for 2 years and follow-up ceased if no increase in size was detected. Of these, two patients required subsequent adrenalectomy. Thirty-six of these tumors were eventually detected to be nonfunctioning adenomas, of which 15 underwent resection because of size >3 cm. Cortical carcinoma was detected in nine patients, pheochromocytoma in seven, myelolipoma in one, metastatic tumor in one, and cyst, ganglioneuroma, and tuberculoma in four. Of these, 20 developed features of hypersecretion during preparation for surgery. In tumors between 3 and 5 cm, in view of noncompliance of patients to repeated follow-up and cost factors, surgery was considered the most effective treatment option. There is a need for prospective studies to formulate diagnostic and treatment strategy.