Primary Adrenal Tumors-Five Years Single Centre Experience

Rashmi D. Patel, Aruna V. Vanikar, Kamlesh S. Suthar, Kamal V. Kanodia

Department of Pathology, Laboratory Medicine and Transfusion Services and Immunohematology, G. R. Doshi and K. M. Mehta Institute Of Kidney Diseases & Research Centre (IKDRC)-Dr. H.L. Trivedi Institute of Transplantation Sciences (ITS), Civil Hospital Campus, Ahmedabad, India.

DOI: 10.4236/ojpathology.2012.24020                

Abstract

Primary adrenal tumors are less commonly encountered in clinic. They may be functional/non-functional and noted incidentally when investigating for other problems. However there is no study available in Asian countries, and especially India regarding the incidence and natural history of these tumors. We carried out a study on adrenal tumors noted in our set-up for last five years to document the prevalence of adrenal tumors, their presentation along with the most common tumor followed by incidence of other tumors and their clinical and pathological presentation. This was a retrospective study in our hospital from June 2006 to 2011. 29 adrenalectomies performed over 5 years. Their clinical presentation and investigations were recorded and analyzed. Adrenal tumors accounted for 0.6% of total surgical specimens, 18 out of 29 belonged to males. Majority (85.2%) of the patients were adults with mean age, 39.8 years. Majority (79.3%) had presented with symptoms, incidentalomas were found in 20.7% patients out of which 2 belonged to potential kidney donors. Nonfunctioning tumors were noted in 58.6% patients. Pheochromocytoma was the commonest tumor noted in 68.9% followed by adrenal cortical adenoma in 13.7%, carcinoma in 6.9% and lipoma, myelolipoma and ganglioneuroma, 3.45% each. All the patients are doing well over a mean follow-up of 2.5 years. To our knowledge this is the first study on incidence and natural history of primary adrenal tumors which are less commonly encountered and usually have good prognosis.

Keywords

Adrenal Tumors; Pheochromocytoma; Hypertension; Incidentaloma

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	S. Bovio, A. Cataldi, G. Reimondo, et al., “Prevalence of Adrenal Incidentaloma in a Contemporary Computerized Tomography Series,” Journal of Endocrinological Investigation, Vol. 29, No. 4, 2006, pp. 298-302.
[2]	P. K. Singh and H. N. Buch, “Adrenal Incidentaloma: Evaluation and Management,” Journal of Clinical Pathology, Vol. 61, No. 11, 2008, pp. 1168-1173. doi:10.1136/jcp.2006.044313
[3]	T. Gopan, E. Remer and A. H. Hamrahian, “Evaluating and Managing Adrenal Incidentalomas,” Cleveland Clinic Journal of Medicine, Vol. 73, No. 6, 2006, pp. 561-568. doi:10.3949/ccjm.73.6.561
[4]	J. H. Song, F. S. Chaudhry and W. W. Mayo-Smith, “The Incidental Adrenal Mass on CT: Prevalence of Adrenal Disease in 1049 Consecutive Adrenal Masses in Patients with No Known Malignancy,” American Journal of Roentgenology, Vol. 190, No. 5, 2008, pp. 1163-1168. doi:10.2214/AJR.07.2799
[5]	L. K. Nieman, “Approach to the Patient with and Adrenal Incidentaloma,” The Journal of Clinical Endocrinology & Metabolism, Vol. 95, No. 9, 2010, pp. 4106-4113. doi:10.1210/jc.2010-0457
[6]	M. M. Walther, H. R. Keiser and W. M. Linehan, “Pheochromocytoma: Evaluation, Diagnosis, and Treatment,” World Journal of Urology, Vol. 17, No. 1, 1999, pp. 35-39. doi:10.1007/s003450050102
[7]	J. A. Virseda Rodríguez, J. Martínez Ruiz, P. Carrión López, et al., “Pheochromocytoma: More than a Decade of Experience. Review of the Literature,” Actas Urológicas Espa?olas, Vol. 34, No. 10, 2010, pp. 888-892. doi:10.4321/S0210-48062010001000013
[8]	Y. Alderazi, M. W. Yeh, B. G. Robinson, et al., “Phaeochromocytoma: Current Concepts,” Medical Journal of Australia, Vol. 183, No. 4, 2005, pp. 201-204.
[9]	B. L. Wajchenberg, M. A. Albergaria Pereira, B. B. Medonca, et al., “Adrenocortical Carcinoma, Clinical and Laboratory Observations,” Cancer, Vol. 88, No. 4, 2000, pp. 711-736. doi:10.1002/(SICI)1097-0142(20000215)88:4<711::AID-CNCR1>3.3.CO;2-N
[10]	G. Mansmann, J. Lau, E. Balk, et al., ”The Clinically Inapparent Adrenal Mass: Update in Diagnosis and Management,” Endocrine Reviews, Vol. 25, No. 2, 2004, pp. 309-340. doi:10.1210/er.2002-0031
[11]	S. Kumar, P. Tiwari, R. K. Das, et al., “Virilizing Adrenal Carcinoma in a 3-Year Old Boy: A Rarity,” Indian Journal of Medical and Paediatric Oncology, Vol. 31, No. 1, 2010, pp. 30-32.
[12]	A. A. Ahmed, “Adrenocorical Neoplasms in Young Children: Age as a Prognostic Factor,” Annals of Clinical & Laboratory Science, Vol. 39, No. 3, 2009, pp. 277-282.
[13]	S. B. Bavdekar, R. R. Kasla, R. C. Parmar and G. S. Hathi, “Selective Testosterone Secreting Adenocrotical Carcinoma in an Infant,” Indian Journal of Pediatrics, Vol. 68, No. 1, 2001, pp. 95-97. doi:10.1007/BF02728872
[14]	R. D. Patel, A. V. Vanikar and P. R. Modi, “Giant Lipoma of the Adrenal Gland: A Case Report,” Journal of Medical Case Reports, Vol. 5, No. 1, 2011, p. 78. doi:10.1186/1752-1947-5-78
[15]	K. Y. Lam and C. Y. Lo, “Adrenal Lipomatous Tumours: A 30 Year Clinicopathological Experience at a Single Institution,” Journal of Clinical Pathology, Vol. 54, No. 9, 2001, pp. 707-712. doi:10.1136/jcp.54.9.707
[16]	K. N. Milathianakis, C. D. Farfarelos, I. M. Mpogdanos and D. K. Karamanolakis, “Giant Lipoma of the Adrenal Gland,” Journal of Urology, Vol. 167, No. 4, 2002, p. 1777. doi:10.1016/S0022-5347(05)65198-1
[17]	R. T. Kloos, et al., “Incidentally Discovered Adrenal Masses,” Endocrine Reviews, Vol. 16, No. 4, 1995, pp. 460-484.
[18]	V. G. Patel, O. A. Babalola, J. K. Fortson and W. L. Weaver, “Adrenal Myelolipoma: Report of a Case and Review of Literature,” The American Journal of Surgery, Vol. 72, No. 7, 2006, pp. 649-654.
[19]	G. C. Fernandes, R. K. Gupta and B. M. Kandalkar, “Giant Adrenal Myelolipoma,” Indian Journal of Pathology and Microbiology, Vol. 53, No. 2, 2010, pp. 325-326. doi:10.4103/0377-4929.64314
[20]	T. Yoshida, J. Saito, T. Takao, et al., “Adrenal Ganglioneuroma: A Case Report,” Hinyokika Kiyo, Vol. 51, No. 2, 2005, pp. 93-96.
[21]	Y. Qing, et al., “Adrenal Ganglioneuromas: A 10 Year Experience in a Chinese Population,” Surgery, Vol. 147, No. 6, 2010, pp. 854-860. doi:10.1016/j.surg.2009.11.010
[22]	C. Erem, et al., “Adrenal Ganglioneuroma: Report of a New Case,” Endocrinology, Vol. 35, No. 3, 2009, pp. 293-296.
[23]	B. Geoerger, et al., “Metabolic Activity and Clinical Features of Primary Ganglioneuromas,” Cancer, Vol. 91, No. 10, 2001, pp. 1905-1913. doi:10.1002/1097-0142(20010515)91:10<1905::AID-CNCR1213>3.0.CO;2-4