Clinical, Biochemical, and Histopathological Characteristics of Big Adrenal Masses: A Single-Center Retrospective Study

Large Adrenal Tumors ≥8 cm

Abstract

Introduction: Large adrenal tumors (≥8 cm) are associated with a high risk of malignancy, although their pathological distribution varies across institutions. Clarifying their clinical and biochemical features is essential for appropriate surgical decision-making. This study aimed to evaluate the clinical presentation, hormonal activity, surgical management, and histopathological outcomes of adrenal tumors ≥8 cm.
Methods: This retrospective study included patients who underwent adrenalectomy at a tertiary endocrine center and had a tumor size ≥8 cm on histopathology. Demographic data, hormonal evaluation, radiological findings, and follow-up outcomes were analyzed.
Results: Twenty-six patients (mean age 50.85 ± 13.04 years; 57.7% women) were included. Tumors were incidentally detected in 46.2% of cases. Hormonal hypersecretion was present in 46.2% of patients, most commonly catecholamine excess (34.6%). Pheochromocytoma was the most frequent diagnosis (38.5%), followed by adrenocortical carcinoma (15.4%). Overall, 46.2% of masses were malignant. Malignant tumors were significantly larger than benign ones (p = 0.041). Laparoscopic adrenalectomy was performed for smaller lesions than those treated by open surgery (p = 0.003). During follow-up, 58.3% of malignant cases developed metastases; two patients achieved remission.
CONCLUSION: Adrenal tumors ≥8 cm demonstrate marked clinical and pathological heterogeneity. Although tumor size is associated with malignancy, the high prevalence of pheochromocytoma in referral centers highlights the importance of comprehensive biochemical evaluation. Management should be individualized using a multidisciplinary approach rather than relying solely on tumor size.