What is the clinical evidence from this study?

Study design: Observational. Population: Adrenal incidentaloma (n=3672). Primary outcome: Prevalence of nodule types.

What does this research mean for the field?

Among adrenal incidentalomas in Japan, 50.8% are non-functioning adenomas, while a clinically significant minority are functional or malignant tumors including cortisol-producing adenomas (10.5%), pheochromocytomas (8.5%), and adrenocortical carcinomas (1.4%). Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research investigates the characteristics and prevalence of adrenal incidentalomas in Japan over a defined period.

April 1, 20260 citationsOpen Access

Professor Special Lecture: 74th Annual Meeting of the Medical Society of Toho University Adrenal Incidentaloma in Japan

HUHajime Ueshiba

Key Result

Among 3,672 adrenal incidentalomas in Japan, 50.8% were non-functioning adenomas, 10.5% were cortisol-producing adenomas, 8.5% were pheochromocytomas, and 1.4% were adrenocortical carcinomas.

Key Points

This research investigates the characteristics and prevalence of adrenal incidentalomas in Japan over a defined period.
Nationwide multicenter study from 1999 to 2004
Examined 3,672 clinically diagnosed cases
Data included demographic and clinical information
Used computed tomography for nodule size measurement
50.8% of cases were non-functioning adenomas
10.5% were cortisol-producing adenomas, with some having subclinical Cushing's syndrome
8.5% were pheochromocytomas
Adrenocortical carcinomas accounted for 1.4% of cases
Tumor sizes were significantly larger in malignant versus benign varieties

Study Design

Type

Observational (n=3,672)

Multicenter

Yes

Structured PICO

Population

3,672 patients with clinically diagnosed adrenal incidentalomas in Japan, involving 1,874 males and 1,738 females, with a mean age of 58.0±13.0 years.

Outcome

Epidemiologic and clinical characteristics, including the prevalence of each nodule type, nodule sizes, and growth speeds.

While approximately half of adrenal incidentalomas are non-functioning adenomas, a significant proportion are hormonally active or malignant, necessitating careful evaluation and follow-up.

Limitations

The clinical incidence rate of adrenal incidentaloma might be an underestimate compared to autopsy findings

Abstract

This paper aims to evaluate the epidemiologic and clinical characteristics of incidentally discovered adrenal masses, referred to as adrenal incidentalomas, in Japan. The original study had been carried out as a project of a research proposed on behalf of the Japanese Ministry of Health, Labour and Welfare, from 1999 to 2004. This nationwide multicenter study has examined clinically diagnosed 3,672 cases of adrenal incidentalomas, involving 1,874 males and 1,738 females, with mean age 58.1±13.0 years (mean ± SD). The mean nodule size of adrenal incidentaloma based on computed tomography (CT) was 3.0±2.0 cm. Compared to non-functioning adenomas, tumor diameters were found to be significantly larger in adrenocortical carcinomas, pheochromocytomas, cortisol-producing adenomas, myelolipomas, metastatic tumors, cysts, and ganglioneuromas (p< 0.01). Endocrinological evaluations demonstrated that 50.8% of the total adrenal incidentalomas were non-functioning adenomas, while 10.5%, including 3.6% with subclinical Cushing's syndrome, were reported as cortisol-producing adenomas, 8.5% as pheochromocytomas, and 5.1% as aldosterone-producing adenomas. Adrenocortical carcinomas were accounted for 1.4% (50 cases) among our series of adrenal incidentalomas. In conclusion, while almost 50% of adrenal incidentalomas are non-functional adenomas, we must exercise great caution as adrenal incidentalomas also include pheochromocytomas or adrenocortical carcinomas, because they may be asymptomatic.

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