# Demographics, Clinical Profiles, and Outcomes of Patients With Adrenal Disorders in a Tertiary Care Center: A Retrospective Study

## TL;DR

This study examines adrenal mass patients in India, finding pheochromocytoma is common and larger tumors are more likely to be malignant.

## Contribution

The paper provides demographic and clinical insights into adrenal disorders in a South Asian population, emphasizing management strategies and diagnostic challenges.

## Key findings

- Pheochromocytoma was the most common functional tumor (39.58% of cases).
- Laparoscopic adrenalectomy resulted in shorter hospital stays compared to open surgery.
- Tumor size greater than 4 cm was significantly associated with malignancy.

## Abstract

Background: Adrenal masses encompass a spectrum from benign incidentalomas to malignant tumors, posing diagnostic and therapeutic challenges due to their varied clinical presentations and histopathological characteristics. The increased use of imaging has led to detection rates, necessitating detailed studies to guide management strategies in diverse populations.

Objective: This study evaluates the demographic, clinical, pathological, and outcome profiles of patients with adrenal masses managed at a tertiary care center in Srinagar, India, highlighting complex cases to illustrate diagnostic and treatment intricacies.

Methods: We analyzed 48 patients with adrenal masses at Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, from January 2021 to December 2024. Data, retrospectively collected from electronic records of patients referred to Urology, included demographics, symptoms, imaging, hormonal evaluations (serum cortisol, aldosterone, 24-hour urinary metanephrines, dexamethasone suppression), surgical approaches, histopathology, and follow-up. Functional tumors and non-functional masses >6 cm underwent adrenalectomy; non-functional tumors <4 cm (45.83%) were managed as per clinical risk based on imaging, with low-risk patients kept on follow-up, and high-risk patients were surgically managed; 4-6 cm (29.17%) were managed based on CT malignancy features. Surgical approaches were laparoscopic or open adrenalectomy. Two cases highlighted clinical challenges. Statistical analyses used IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States), with p<0.05 indicating significance.

Results: The cohort comprised 30 female patients (62.5%) and 18 male patients (37.5%), with a median age of 45 years (range: 13-65 years). Presentation includes incidental findings in 23 (47.92%), local symptoms in 13 (27.08%), hormonal excess in nine (18.75%), resistant hypertension in two (4.17%), or cancer screening in one (2.08%). Functional tumors in 26 (54.17%) included pheochromocytoma in 19 (39.58%), Cushing’s adenoma in five (10.42%), and Conn’s adenoma in one patient (2.08%). The mean tumor size was 5.6 cm (range 2.1-14 cm). Surgery was performed in 42 (87.5%): laparoscopic in 22 (45.83%) or open in 20 (41.67%). Laparoscopic adrenalectomy had shorter hospital stays (p=0.014). Histopathology confirmed pheochromocytoma in 20 (45.24% of surgical cases), including one Paraganglioma; non-functional adenoma 9(18.75%), and rare cases like adrenocortical carcinoma (ACC). Complications were minimal; no deaths occurred. Tumor size >4 cm correlated significantly with malignancy (χ²=2.62, p=0.03), and functional status correlated with presentation (p=0.03). Two illustrative cases included a 31-year-old female with ACC and inferior vena cava thrombus, managed with open adrenalectomy and thrombectomy with renal preservation and a 35-year-old male with an aldosterone-secreting adenoma causing quadriparesis, resolved post-laparoscopic adrenalectomy.

Conclusion: This study highlights a high prevalence of pheochromocytoma and incidentalomas in our cohort, with effective multidisciplinary management yielding favorable outcomes. Increased size showed increased malignancy risk, supporting surgical intervention thresholds. Complex cases underscore the need for tailored approaches. Enhanced hormonal testing, genetic screening, and longer follow-up are recommended to improve care in resource-limited settings.