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Abstract
Background: The incidental discovery of an adrenal mass raises the problem of distinguishing
the frequent benign masses from the infrequent malignant ones that require surgery.
At present, univocal guidelines to approach this problem are not available. The aim
of the present study was to perform a multicentric retrospective analysis of adrenal
masses incidentally discovered (adrenal incidentalomas). Patients and Methods: Hospital
records of adrenal incidentalomas diagnosed over a 15-year period in 29 surgical and
medical centers in Italy were scrutinized. Collected cases were 1,013, and 887 were
analyzed. Results: The majority of patients were in the 5th and 6th decade and females
were predominantly affected. The frequency of adrenocortical cancer was 12% among
operated patients (316 cases). The tumor diameter was highly correlated with the risk
of malignancy, as well as the CT characteristics such as density, shape and margins.
The frequency of pheochromocytoma was 10% among operated patients. Conclusions: The
occurrence of incidentally discovered adrenocortical carcinomas and pheochromocytomas
is not rare. Evaluation of the mass size and CT characteristics are simple and effective
methods to differentiate malignant lesions. Biochemical screening for pheochromocytoma
is mandatory before surgery.