Exploring Hormonal Profiles in Adrenal Tumors: Insights from CT Imaging

Abstract

Introduction Adrenal tumors (AT) are commonly discovered incidentally on cross-sectional abdominal imaging performed for reasons unrelated to an adrenal mass (AM). AT affect around 4–10% of the general population, with the highest incidence occurring in the seventh decade of life1,2. In any patient with a newly discovered AM, determining whether it is malignant and whether it is hormonally active are equally important to guide optimal management3. All patients found to have an AT should undergo a detailed clinical, biochemical and radiological evaluation to select those requiring surgical management2. Modern image techniques play a central role in the diagnosis of AT. Unenhanced computed tomography (CT) attenuation is the preferred method for evaluating primary AT, as it helps differentiate between malignant and benign tumors4. CT radiographic characteristics of malignant AM include a tumor size > 4 cm, irregular margins, heterogeneous enhancement, and lesions exhibiting < 40% relative percentage washout (RPW) or < 60% absolute percentage washout (APW) of intravenous contrast5. AT can affect the synthesis of hormones produced by the adrenal glands (i.e. cortisol, aldosterone, and androgens) leading to hyperadrenalism from excess hormones or hypoadrenalism if non-functional6. In either case, the presence of an AT can significantly affect the levels of adrenal hormones, leading to various health symptoms. Aim To evaluate the distribution of different AT types, hormonal profiles, and radiological data of patients diagnosed with AT. Methods We retrospectively analyzed the medical documentation from database of the Hospital of LUHS KK of 80 patients (40 female, 40 male) who were diagnosed with AT in 2017-2018 using CT. Formal Bioethical Permit from regional legal body was obtained. Clinical and laboratory data, including hormone levels (DHEAS, testosterone, aldosterone, ACTH, cortisol, renin, metanephrine, normetanephrine), were recorded. CT features (tumor size, contrast enhancement) and hormone levels were analyzed, with statistical significance set at p<0.05 using "IBM SPSS Statistics 29.0." Results The most frequently occurring AT (42.5%) was adenoma, whereas aldosteronoma was the least common (3.8%). Analyzing the distribution of the AT types and blood hormone concentrations, it was found that the percent increase in metanephrine and noretanephrine was significantly higher in pheochromocytoma than in other tumors. There was a statistically significant difference in tumor sizes between adenomas and pheochromocytomas, with pheochromocytomas being notably larger. Additionally, pheochromocytomas showed significantly greater contrast enhancement compared to all other AT. Conclusions The most common AT type was adenoma. Pheochromocytomas showed significantly higher metanephrine and normetanephrine levels, larger tumor sizes, and greater contrast enhancement compared to other AT.