Guidelines recommend that 1-cm or larger adrenal tumors without clinical indications of adrenal disease be assessed for possible cancer and hormone secretion. Most of these tumors are found incidentally in patients having imaging studies for other reasons. This study measured the prevalence of such tumors in patients having routine health examinations.
Abstract
Background:
With the widespread use of advanced imaging technology, adrenal tumors are increasingly being identified.
Objective:
To investigate the prevalence and characteristics of adrenal tumors in an unselected screening population in China.
Design:
Cross-sectional study. (ClinicalTrials.gov: NCT04682938)
Setting:
A health examination center in China.
Patients:
Adults having an annual checkup were invited to be screened for adrenal tumors by adrenal computed tomography.
Measurements:
The participants with adrenal tumors had further evaluation for malignancy risk and adrenal function.
Results:
A total of 25 356 participants were screened, 351 of whom were found to have adrenal tumors, for a prevalence of 1.4%. The prevalence increased with age, from 0.2% in participants aged 18 to 25 years to 3.2% in those older than 65 years. Among 351 participants with adrenal tumors, 337 were diagnosed with an adrenocortical adenoma, 14 with another benign nodule, and none with a malignant mass. In 212 participants with an adenoma who completed endocrine testing, 69.3% were diagnosed with a nonfunctioning adenoma, 18.9% with cortisol autonomy, 11.8% with primary aldosteronism, and none with pheochromocytoma. Proportions of nonfunctioning adenomas were similarly high in various age groups (72.2%, 67.8%, and 72.2% in those aged <46, 46 to 65, and ≥66 years, respectively).
Limitation:
Only 212 of 337 participants with an adrenocortical adenoma had endocrine testing.
Conclusion:
The prevalence of adrenal tumors in the general adult screening population is 1.4%, and most of these tumors are nonfunctioning regardless of patient age. Cortisol and aldosterone secretion are the main causes of functional adenomas.
Primary Funding Source:
National Key Research and Development Program of China and National Natural Science Foundation of China.
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Author, Article, and Disclosure Information
Ying Jing,
Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (Y.J., J.H., Y.Song, Z.F., Z.W., Q.C., L.M., Y.Y., Z.D., Y.W., T.L., W.H., Y.Sun, Q.L., S.Y.)
Medical Examination Centre, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (R.L., Z.L., M.Z., L.Z.)
Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (Y.M., F.L.)
Department of Medicine, Monash University, and Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia (J.Y.).
Financial Support: By the National Natural Science Foundation of China (82100833 and U21A20355); Joint Medical Research Project of Chongqing Science and Technology Commission and Chongqing Health and Family Planning Commission (major project 2022ZDXM003); and National Key Research and Development Program of China, major project of prevention and treatment of common diseases (2021YFC2501600; subproject: 2021YFC2501603).
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M22-1619.
Reproducible Research Statement: Study protocol: Available from Dr. Shumin Yang (e-mail, 443068494@qq.
Corresponding Authors: Shumin Yang, MD, PhD (e-mail, 443068494@qq.
Author Contributions: Conception and design: J. Hu, Q. Li, F. Lv.
Analysis and interpretation of the data: J. Hu, Y. Jing, J. Yang, S. Yang.
Drafting of the article: J. Hu, Y. Jing, J. Yang.
Critical revision for important intellectual content: J. Yang, S. Yang.
Final approval of the article: Q. Cheng, Z. Du, Z. Feng, W. He, J. Hu, Y. Jing, Q. Li, R. Luo, T. Luo, Z. Luo, F. Lv, L. Ma, Y. Mao, Y. Song, Y. Sun, Y. Wang, Z. Wang, J. Yang, S. Yang, Y. Yang, M. Zhang, L. Zhong.
Provision of study materials or patients: R. Luo.
Obtaining of funding: J. Hu, Q. Li, Y. Yang.
Administrative, technical, or logistic support: R. Luo, Y. Mao.
Collection and assembly of data: Q. Cheng, Z. Du, Z. Feng, W. He, J. Hu, Y. Jing, T. Luo, Z. Luo, L. Ma, Y. Mao, Y. Song, Y. Sun, Y. Wang, Z. Wang, Y. Yang, M. Zhang, L. Zhong.
This article was published at Annals.org on 13 September 2022.
* Drs. Jing, Hu, Luo, and Mao contributed equally to this article as co–first authors.
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