The prevalence of adrenal incidentaloma in routine clinical practice
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ORIGINAL ARTICLE
The prevalence of adrenal incidentaloma in routine clinical practice Colin Davenport • Aaron Liew • Bryan Doherty • Htet Htet N. Win • Hafiza Misran • Sarah Hanna • David Kealy • Fatima Al-Nooh • Amar Agha Christopher J. Thompson • Michael Lee • Diarmuid Smith
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Received: 1 February 2011 / Accepted: 12 February 2011 / Published online: 10 March 2011 Ó Springer Science+Business Media, LLC 2011
Abstract The prevalence of adrenal incidentaloma (AI) on computed tomography (CT) in the general population has been reported to be as high as 4.2%. However, many of the previous studies in this field utilised a prospective approach with analysis of CT scans performed by one or more radiologists with a specialist interest in adrenal tumours and a specific focus on identifying the presence of an adrenal mass. A typical radiology department, with a focus on the patient’s presenting complaint as opposed to the adrenal gland, may not be expected to diagnose as many adrenal incidentalomas as would be identified in a dedicated research protocol. We hypothesised that the number of AI reported in routine clinical practice is significantly lower than the published figures would suggest. We retrospectively reviewed the reports of all CT thorax and abdomen scans performed in our hospital over a 2 year period. 3,099 patients underwent imaging, with 3,705 scans performed. The median age was 63 years (range 18–98). Thirty-seven true AI were diagnosed during the time period studied. Twenty-two were diagnosed by CT abdomen (22/ 2,227) and 12 by CT thorax (12/1,478), a prevalence of
C. Davenport A. Liew B. Doherty H. H. N. Win H. Misran S. Hanna D. Kealy F. Al-Nooh A. Agha C. J. Thompson D. Smith Department of Diabetes and Endocrinology, Royal College of Surgeons in Ireland Medical School, Beaumont Hospital, Dublin 9, Ireland C. Davenport (&) Diabetes Day Centre, Beaumont Hospital, Dublin 9, Co Dublin, Ireland e-mail: [email protected] M. Lee Department of Radiology, Royal College of Surgeons in Ireland Medical School, Beaumont Hospital, Dublin 9, Ireland
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0.98 and 0.81% with CT abdomen and thorax, respectively, for AI in routine clinical practice. Keywords Adrenal incidentaloma Adrenal tumours Adrenal adenomas Prevalence Cushing’s
Introduction Adrenal incidentaloma (AI) is defined as an adrenal mass discovered serendipitously during a radiological examination performed for reasons other than adrenal disease. The classic definition excludes patients with clinically overt adrenal hormone hypersecretion, and those with concurrent malignancy known to metastasise to the adrenals [1, 2]. These tumours, once discovered, necessitate radiological and biochemical assessment to determine their risk of malignancy, and whether they are hypersecreting hormones. At autopsy, the prevalence of adrenal tumours in the general population has been reported to be as high as 6% [1]. Not all of these tumours can be identified on radiological imaging, and the prevalence of adrenal tumours when established by
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