New study sheds light on the progression and management of ‘silent’ adrenal tumours

CT scans are increasingly performed for a variety of medical indications, including for general health screening, which is growing in popularity. An estimated 4% of CT scans will coincidentally uncover a tumour in the adrenal gland, with no associated clinical symptoms. However, until now, evidence on how to manage these ‘silent’ tumours has been lacking, despite the fact that the growing demand for CT scans is likely to lead to increasing numbers of detections.

A new study in The Lancet Diabetes & Endocrinology is one of the first to shed light on the progression of these tumours, and should help clinicians and patients to decide how to manage them. The study rigorously assesses how ‘silent’ adrenal tumours (adrenal incidentalomas) affect patients’ risk of cardiovascular events and death. The results show that over time, some tumours became more active, and that cardiovascular risk is elevated in many patients with tumours, especially in those patients whose tumours secrete the hormone cortisol.

Currently, management of these tumours can be very expensive because insufficient information exists to enable treatment strategies to be tailored to each patient. According to lead author Professor Renato Pasquali, of the S Orsola-Malpighi Hospital, in Bologna, Italy, “Our findings are important because they add to the previously scant information about adrenal incidentalomas, which will be of use to doctors who are seeing an increasing number of patients with these masses.” 

Writing in a linked Comment, Professor Rosario Pivonello, of the Università Federico II in Naples, Italy, says that, “The study findings underline that the degree of hormonal dysfunction can worsen during follow-up…[and] support the importance of long-term hormonal follow-up for clinical management of all patients with adrenal incidentalomas. Furthermore, clinical monitoring of cardiometabolic risks seems to be important in these patients, particularly in those with [secreting tumours], for whom medical or surgical intervention could be needed.”