CT Preferred for Defining Adrenal Masses

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Computed tomography (CT) is highly accurate in detecting adrenal masses and should be used as the first diagnostic modality to define and localize them, investigators concluded.

Yasser Osman, MD, and colleagues at the Urology and Nephrology Center of Mansoura University in Mansoura, Egypt, reviewed data on 238 patients treated for adrenal masses at their institution. Of 175 patients who had CT scans, the scans were diagnostic in all but two cases, a sensitivity of 98.9%. Seventy-six patients had MRI scans, which successfully diagnosed all investigated masses. Ultrasound could identify masses in 199 of the 238 patients (83.6%), the researchers stated.

The authors said they recommend CT as the first diagnostic modality to define and localized adrenal masses because its accuracy is similar to or perhaps even better than MRI but more cost-effective, according to a report in Urologia Internationalis (2009;83:433-437).

Right-sided masses were more common than left-sided masses, occurring in 148 patients (62.1%). Masses ranged in size from 1.2 to 24 cm in diameter (mean 7.8 cm).

Surgeons excised masses from 206 patients, of whom 153 underwent open surgery and 53 underwent laparoscopic surgery.

In terms of pathology, pheochromocytomas were the most frequent type of tumor, occurring in 60 patients (29.1%). Neuroblastomas were the second most common tumor type (23.3%).

The researchers also observed two peaks of age incidence for adrenal tumor presentation. The first was patients younger than 10 years (52 patients, 21.8%) and the second was in patients in the fourth and fifth decade of life (94 patients, 39.5%).

In addition, the most common presenting symptom was pain (127 patients, 53.3%). Sixty-two patients (26%) presented with endocrine-related symptoms. Masses were detected incidentally in 49 patients (20.7%).

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