Isolated Synchronous Adrenal Lesions in Patients with Newly Diagnosed Extra-Adrenal Malignancies

Abstract

Background: This study focused on the etiology of patients with extra-adrenal primary malignancy in addition to isolated synchronous adrenal incidentalomas. Methods: Patients who were diagnosed as extra-adrenal primary malignancy and synchronous adrenal incidentalomas were enrolled from a single tertiary medical center from 2004 to 2014. Those with a history of malignancy or any extra-adrenal metastases at the time of diagnosis were excluded. Statistical analysis was performed to determine possible predictors for adrenal metastases. Results: The primary malignancies of hepatocellular carcinoma and lung cancer had higher rates of adrenal metastases than colon cancer and renal cell carcinoma. Significant predictors for adrenal metastasis were clinical T stage and adrenal mass diameters. Patients with stage T1/2 primary malignancies were more likely to have benign adrenal tumors than those with stage T3 or T4. The average adrenal mass diameters in the benign and metastatic groups were 2.87 and 4.97 cm, respectively (P = 0.001). Conclusions: Nearly 40% of the isolated synchronous adrenal incidentalomas in patients with newly diagnosed extra-adrenal malignancies proved to be metastases. In patients with large adrenal lesions, high mass density on computed tomography scans, or a primary malignancy at a high clinical T stage, the risk of adrenal metastasis was high.